1. Eleni Galani Medical Oncologist
Tumor markers
Eleni Galani
Medical Oncologist

3. Tumor markers
Tumor markers are usually proteins which are produced from cancer cells or as response to cancer
Cancer specific
Tissue specific

4. Tumor markers
Cancer specific of certain cancerous tissue BUT large overlap (low specificity)
Tissue specific i.e PSA, AFP, B-HCG, thyroglobulin

5. In oncology tumor markers are used:
Screening i.e PSA
Monitoring i.e AFP
Diagnosis (when biopsy is not feasible)
Determine prognosis

6. Tumor markers: CEA
Complex glycoprotein that is associated with the plasma membrane of tumor cells, from which may be released in the blood
Elevated specially in Colon cancer, But Also in Pancreatic, Gastric, Lung, breast and Ovarian cancer
ALSO in cirrhosis, inflammatory bowel disease, chronic lung disease, pancreatits, 19% of smokers, 3% of healthy population

7. Tumor markers: CEA
NOT satisfactory for screening for a healthy population
Monitor of recurrence
Monitor of treatment

8. Tumor markers: Ca-125
80% of nonmucinus ovarian cancer detected by monoclonal antibody
Elevated in Ovarian, Endometrial, Pancreatic, Lung, Breast, Colon, Menstruation, Pregnancy, Endometriosis and other gynecological and non conditions.

9. Tumor markers: Ca-125
Useful in monitoring ovarian cancer recurrence & treatment
Not useful foe screening
Screening of high risk population
(BRCA1-2 Carriers)

10. Tumor markers: CA 19-9 21-42% elevated in gastric ca
20-40% elevated in colonic ca
71-93% elevated in pancreatic
Useful for differentiated benign from malignant disease

11. Tumor markers: PSA Prostate Specific Antigen: Glycoprotein
Ideal for tumor marker, high tissue specificity
High sensitivity for prostate cancer, also elevated in benign prostate hypertrophy & prostatitis
Useful in diagnosis

12. Tumor markers: PSA Useful for: Diagnosis of prostate cancer
Prognostic factor
Monitor recurrence & response to treatment
?Screening of prostate cancer (+rectal examination)

13. Screening for Prostate Cancer: Recommendations and Rationale
U.S. PREVENTIVE SERVICES TASK FORCE
The USPSTF found good evidence that PSA screening can detect early-stage prostate cancer but mixed and inconclusive evidence
that early detection improves health outcomes.
The USPSTF concludes that the evidence is insufficient to recommend
for or against routine screening for prostate cancer PSA testing
or digital rectal examination (DRE).

14. Tumor markers: AFP
Normal serum fetal protein synthesized by the liver, yolk sac, gastrointestinal tract
Heptocellular cancer:
diagnosis (>500)
screening of high risk population

15. Tumor markers: AFP
Testicular germ cell tumor (embrional or endodermal):
diagnosis
monitor of recurrence & response
prognostic marker (> –high risk)
Less frequent elevated: pancreatic ca
Gastric ca
Colonic ca
Bronchogenic ca

16. ASCO SPECIAL ARTICLE
2000 Update of Recommendations for the Use of Tumor Markers
in Breast and Colorectal Cancer:
Clinical Practice Guidelines of the American Society of Clinical Oncology
American Society of Clinical Oncology Tumor Markers Expert Panel

17. CEA as a Marker for Breast Cancer
1997 Recommendation: CEA is not recommended for screening, diagnosis, staging,
or routine surveillance of breast cancer patients after primary therapy.
2000 Update: None.
2000 Recommendation: No change.
1997 Recommendation: Routine use of CEA for monitoring response of metastatic
disease to treatment is not recommended. However, in the absence of readily
measurable disease, a rising CEA may be used to suggest treatment failure.
2000 Update: Routine use of CEA for monitoring response of metastatic disease
to treatment is not recommended. However, in the absence of readily measurable
disease, or an elevated MUC-1 marker (CA 15-3 and/or CA 27.29),
a rising CEA may be used to suggest treatment failure.

18. CA 15-3 as a Marker for Breast Cancer
1997 Recommendation : Present data are insufficient to recommend
CA 15–3 for screening, diagnosis, staging, or surveillance
after primary treatment.
Although a rising CA 15–3 level can detect recurrence after
primary treatment, the clinical benefit is not established; therefore, it cannot
be recommended.
2000 Recommendation: No change. CEA as a Marker for Breast Cancer

19. c - erb B -2 (HER-2/neu) as a Marker for Breast Cancer
1997 Recommendation: Present data are insufficient to recommend the use of
c-erbB-2 (HER-2/neu)
gene amplification or overexpression for management of patients with breast cancer.
2000 Recommendation: c-erbB-2 overexpression should be evaluated
on every primary breast cancer either at the time of diagnosis
or at the time of recurrence. Measures of c-erbB-2 amplification may also be of value.

20. CEA as a Marker for Colorectal Cancer
1997 Recommendation : CEA is not recommended to be used as a screening test
for colorectal cancer.
2000 Recommendation : No change.
1997 Recommendation : CEA may be ordered preoperatively in patients with colorectal
carcinoma if it would assist in staging and surgical treatment planning.
Although elevated preoperative CEA (> 5 ng/mL) may correlate
with poorer prognosis, data are insufficient to support the use of CEA
to determine whether to treat a patient with adjuvant therapy.

21. CEA as a Marker for Colorectal Cancer
1997 Recommendation : If resection of liver metastases would be clinically indicated,
it is recommended that postoperative serum CEA testing may be performed every
2 to 3 months in patients with stage II or III disease for 2 or more years after diagnosis.
An elevated CEA, if confirmed by retesting,
warrants further evaluation for metastatic disease but does not justify the institution
of adjuvant therapy or systemic therapy for presumed metastatic disease.
2000 Recommendation : No change.

22. CEA as a Marker for Colorectal Cancer
1997 Recommendation : Present data are insufficient to recommend routine
use of the serum CEA alone for monitoring response to treatment.
If no other simple test is available to indicate a response,CEA should be measured
at the start of treatment for metastatic diseaseand every 2 to 3 months during
active treatment.
Two values above baseline are adequate to document progressive disease
even in the absence of corroborating radiographs.
CEA is regarded as the marker of choice for monitoring colorectal cancer.
2000 Recommendation : No change.

23. CA 19-9 As a Marker for Pancreatic Cancer
2006 recommendation for use of CA 19-9 as a screening test.
CA 19-9 is not recommended for use as a screening test for pancreatic cancer.
2006 recommendation for use of CA 19-9 to determine operability.
The use of CA 19-9 testing aloneis not recommended
for use in determining operability
or the results of operability in pancreatic cancer.
2006 recommendation for use of CA 19-9 to provide evidence of recurrence.
CA 19-9 determinations by themselves
cannot provide definitive evidence of disease recurrence without seeking
confirmation with imaging studies for clinical findings and/or biopsy.

24. CA 19-9 As a Marker for Pancreatic Cancer
2006 recommendation for use of CA 19-9 for monitoring response to therapy.
Present data are insufficient to recommend the routine use of serum CA 19-9
rules alone for monitoring response to treatment.
However, CA 19-9 can be measured at the start of treatment for locally advanced
metastatic disease and every 1 to 3 months during active treatment.
If there is an elevation in serial CA 19-9 determinations, this may be an indication
of progressive disease, and confirmation with other studies should be sought.