Tumour Markers

Principles
Proteins produced by cancers, or in response to them
Sensitivity & specificity varies
Can help for:
- monitoring, e.g. recurrence
- diagnostic aid
- staging clues
- prognostic clues


Marker
Cancers
In what else?
When used
Sample
AFP
Liver, germ cells, ovaries, testes
Pregnancy, hepatitis
Diagnose, monitor, recurrence
Blood
CA 15-3
Breast, and others: lung, ovarian
Benign breast disease
Stage, monitor, recurrence
Blood
CA 19-9
Pancreatic, bowel, bile
Pancreatitis, IBD
Stage, monitor, recurrence
Blood
CA-125
Ovarian, pancreatic Ca (60%), other malignancies
Endometriosis, pregnancy, cysts, PID, cirrhosis
Stage, monitor, recurrence
Blood
CEA
Bowel, lung, breast, thyroid, pancreas, liver, cervix, bladder
Hepatitis, COPD, colitis, pancreatitis, smoking
Treatment and recurrence
Blood
Oestrogen R
Breast
Increased in hormone dependent Ca
Prognosis and guide Rx
Tissue
hCG
Testicular, trophoblastic
Pregnancy, testicular failure
Diagnose, monitor, treat
Tissue
Her-2/neu
Breast
Oncogene; 20-30% breast Ca
Prognosis, guide Rx
Tissue
Progesterone R
Breast
Increased in hormone dependent Ca Prognosiis, guide Rx
Tissue
PSA
Prostate
BPH, prostatitis, ageing
Diagnose, monitor, recurrence
Blood
BTA
Bladder tumour antigen; not widely used
-
Recurrence
Urine
CA 72-4
Ovarian; not better than CA-125 but can be complimentary
-
Diagnosis
Blood
Calcitonin
Thyroid medullary Ca
Pernicious anaemia, thyroiditis
Diagnose, monitor, recurrence
Blood
SA-100
Metastatic melanoma
Not widely used
Diagnosis
Blood
TA-90
Metastatic melanoma
Not widely used; under study
Diagnosis
Blood
Thyroglobulin
Thyroid

Recurrence (post removal)
Blood


Notes

Ca125
80% sensitive for ovarian >stage I
50% sensitive in stage I
Not specific (see table)
- less specific post-menopausally
Results
>35 is abnormal
>1000 is more specific