3 Tumor markersTumor markers are usually proteins which are produced from cancer cells or as response to cancerCancer specificTissue specific
4 Tumor markersCancer 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 PSAMonitoring i.e AFPDiagnosis (when biopsy is not feasible)Determine prognosis
6 Tumor markers: CEAComplex glycoprotein that is associated with the plasma membrane of tumor cells, from which may be released in the bloodElevated specially in Colon cancer, But Also in Pancreatic, Gastric, Lung, breast and Ovarian cancerALSO in cirrhosis, inflammatory bowel disease, chronic lung disease, pancreatits, 19% of smokers, 3% of healthy population
7 Tumor markers: CEANOT satisfactory for screening for a healthy populationMonitor of recurrenceMonitor of treatment
8 Tumor markers: Ca-12580% of nonmucinus ovarian cancer detected by monoclonal antibodyElevated in Ovarian, Endometrial, Pancreatic, Lung, Breast, Colon, Menstruation, Pregnancy, Endometriosis and other gynecological and non conditions.
9 Tumor markers: Ca-125Useful in monitoring ovarian cancer recurrence & treatmentNot useful foe screeningScreening of high risk population(BRCA1-2 Carriers)
10 Tumor markers: CA 19-9 21-42% elevated in gastric ca 20-40% elevated in colonic ca71-93% elevated in pancreaticUseful for differentiated benign from malignant disease
11 Tumor markers: PSA Prostate Specific Antigen: Glycoprotein Ideal for tumor marker, high tissue specificityHigh sensitivity for prostate cancer, also elevated in benign prostate hypertrophy & prostatitisUseful in diagnosis
12 Tumor markers: PSA Useful for: Diagnosis of prostate cancer Prognostic factorMonitor recurrence & response to treatment?Screening of prostate cancer (+rectal examination)
13 Screening for Prostate Cancer: Recommendations and Rationale U.S. PREVENTIVE SERVICES TASK FORCEThe USPSTF found good evidence that PSA screening can detect early-stage prostate cancer but mixed and inconclusive evidencethat early detection improves health outcomes.The USPSTF concludes that the evidence is insufficient to recommendfor or against routine screening for prostate cancer PSA testingor digital rectal examination (DRE).
14 Tumor markers: AFPNormal serum fetal protein synthesized by the liver, yolk sac, gastrointestinal tractHeptocellular cancer:diagnosis (>500)screening of high risk population
15 Tumor markers: AFPTesticular germ cell tumor (embrional or endodermal):diagnosismonitor of recurrence & responseprognostic marker (> –high risk)Less frequent elevated: pancreatic caGastric caColonic caBronchogenic ca
16 ASCO SPECIAL ARTICLE2000 Update of Recommendations for the Use of Tumor Markersin Breast and Colorectal Cancer:Clinical Practice Guidelines of the American Society of Clinical OncologyAmerican 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 metastaticdisease to treatment is not recommended. However, in the absence of readilymeasurable disease, a rising CEA may be used to suggest treatment failure.2000 Update: Routine use of CEA for monitoring response of metastatic diseaseto treatment is not recommended. However, in the absence of readily measurabledisease, 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 recommendCA 15–3 for screening, diagnosis, staging, or surveillanceafter primary treatment.Although a rising CA 15–3 level can detect recurrence afterprimary treatment, the clinical benefit is not established; therefore, it cannotbe 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 ofc-erbB-2 (HER-2/neu)gene amplification or overexpression for management of patients with breast cancer.2000 Recommendation: c-erbB-2 overexpression should be evaluatedon every primary breast cancer either at the time of diagnosisor 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 testfor colorectal cancer.2000 Recommendation : No change.1997 Recommendation : CEA may be ordered preoperatively in patients with colorectalcarcinoma if it would assist in staging and surgical treatment planning.Although elevated preoperative CEA (> 5 ng/mL) may correlatewith poorer prognosis, data are insufficient to support the use of CEAto 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 every2 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 institutionof 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 routineuse of the serum CEA alone for monitoring response to treatment.If no other simple test is available to indicate a response,CEA should be measuredat the start of treatment for metastatic diseaseand every 2 to 3 months duringactive treatment.Two values above baseline are adequate to document progressive diseaseeven 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 recommendedfor use in determining operabilityor 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 themselvescannot provide definitive evidence of disease recurrence without seekingconfirmation 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 19-9rules alone for monitoring response to treatment.However, CA 19-9 can be measured at the start of treatment for locally advancedmetastatic 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 indicationof progressive disease, and confirmation with other studies should be sought.