Tumour markers

Breast cancer Ca 15-3 can be ↑ in people with breast cancer & also in other conditions as liver cirrhosis , benign ovarian and breast disease Metastatic breast cancer – testing for CA 15-3 , CA 27.29 and or CEA + symptoms / imaging may be employed to monitor growth of recurrent or metastatic disease

Colorectal cancer Does not help as a screening tool ( CEA ) but can help monitor effectiveness of therapy CEA low diagnostic ability but high pre-treatment levels are correlated with stage of the disease. CEA can also be raised in non cancer conditions as gastritis , peptic ulcer disease , diverticulitis , liver disease , COPD , diabetes and other inflammatory states CEA , CA 50 , CA 19-5 , CA 19-9, CA 72-4 , Chromogranin A

Gastro-intestinal tumours CA 72-4 elevated in a number of human adenocarcinomas , studies have shown that it may play a role in disease monitoring of pancreatic , ovarian and colorectal carcinomas Chromogranin A – has been used for assessment of neuro-endocrine tumours and used traditionally in the management of patients with tumors of gastro-enteropancreatic origin CA 19-9 – predictive role in case of metastatic or recurrent cases and in those undergoing curative surgery CEA CA 15-3 CA 19-9 CA 50

Liver cancer – Alfa fetoprotein Lens cullinaris agglutinin reactive fraction of AFP CA 19-9 Des-gamma-carboxy prothrombin ( DCP ) AFP can be helpful in evaluation of suspected hepatocellular carcinoma but low sensitivity and specificty doesn’t allow it to be used as a primary surveillance test Several other biomarkers in combination with AFP are being evaluated

Lung tumours – Lung
 tumours Calcitonin , ACTH , ADH , CEA , neurophysin , oxytocin , β endorphin , neuron specific enolase and CKBB are elevated in serum specimens in 25 % t0 75 % of cases of small cell carcinoma use of tumor markers in clinical practice is not established yet

Pancreatic tumours CA 19-9 has some role in prognosis , indicator of disease activity CA 19-9 is used in the diagnostic workup of patients diagnosed with pancreatic cancer -but it lacks sensitivity and specificity associated with a gold standard marker ( ↑ in cancers of the digestive tract )

Prostate cancer –  PSA is widely used for prostate cancer screening Molecular prognostic tests are promising and can help in stratification of both untreated and treated men with localised prostate cancer PSA Prostate cancer antigen 3 microRNA’s

Testicular 
cancer all 3 tumor markers have well established role in management helpful in diagnostic process and useful in prognosis , risk stratification , monitoring response to treatment and detecting recurrence LDH is ↑ when cellular destruction is present  beta -hCG AFP LDH

Ovarian tumours – CA 125 Human epididymis protein 4 ( HE4 ) CEA , CA 19-9 Inhibin a & B ALfa fetoprotein ( AFP ) CA 125 is recommended for use by NICE in primary care in the diagnostic workup of ovarian cancer CA 125 may also be raised in various other gynaecological conditions as menstruation , pregnancy , benign ovarian cysts , endometriosis AFP can be ↑ in cancers as liver , germ cell testicular cancers , bowel , stomach , lung , breast , lymphoma , ovarian germ cell tumours

REFERENCES

1. Tumor Markers for Ovarian Cancer https://www.oncolink.org/cancers/gynecologic/ovarian-cancer/tumor-markers-for-ovarian-cancer
2. Appropriate use of tumour markers http://www.bpac.org.nz/
3. Toyoda H, Kumada T, Tada T, Sone Y, Kaneoka Y, Maeda A: Tumor Markers for Hepatocellular Carcinoma: Simple and Significant Predictors of Outcome in Patients with HCC. Liver Cancer 2015;4:126-136. doi: 10.1159/000367735 ( Abstract )

4. Tumor Markers in Patients with Lung Cancer DOI:https://doi.org/10.1378/chest.89.4_Supplement.219S Mogens Hansen, M.D.Anders Gersel Pedersen, M.D

5. O’Neill, Robert S, and Alina Stoita. “Biomarkers in the diagnosis of pancreatic cancer: Are we closer to finding the golden ticket?.” World journal of gastroenterology vol. 27,26 (2021): 4045-4087. doi:10.3748/wjg.v27.i26.4045

6. Cooper EH. Tumour markers in prostatic cancer. Scand J Clin Lab Invest Suppl. 1991;206:42-51. doi: 10.3109/00365519109107724. PMID: 1719610.