PENGERTIAN LAMA :
Berbagai substansi yang diekskresikan oleh
sel kanker kedalam cairan tubuh /
diproduksi oleh sel jinak sebagai respons
terhadap keganasan
Tumor marker
BIOMARKER KEGANASAN
Dapat diukur kualitatif & kuantitatif
P
E
N
A
N
D
A
T
U
M
O
R
SEROLOGIK :
produk sel ganas
produk sel sebagai respons
terhadap keganasan
SELULER :
perubahan yang tampak/
diidentifikasi di tingkat
seluler
MOLEKULER
(Biomarker)
perubahan yang diidentifikasi
di tingkat molekuler
Protein Onkofetal .
- Carcino Embrionik Antigen ( CEA ) .
- Alfa feto Protein ( AFP ) .
Hormon .
- HCG ,HPL , ACTH , ADH , Parathormon .
Enzim .
- PAP , LDH , NSE .
Immunoglobulin .
Antigen terassosiasi tumor
- CA 19-9 , CA 125 , PSA .
Statistical Considerations
Sensitivitycancer (+), abnormal test
Specificitycancer (-), normal test
Positive predictive valueabnormal test,
cancer (+)
Negative predictive valuenormal test,
cancer (-)
Prevalenceaffect PPV, every marker has
failed as a screening test in ASYMPTOMA TIC persons, because the PREVALENCE of
cancer is low among ASYMPTOMATIC
persons
Colorectal Cancer
CEA
Alpha-Fetoprotein in HCC
Glycoprotein, found in fetal liver, yolk sac,
GI tract, biochemically related to albumin
in adults
half-life4~6 days
Normal serum levels
30 ng/ml
<20 ng
synthesized by syncythiotrophoblastic
cells of normal placenta, never in males!
Serum and urine HCG in early gestation and peak
in the first trimester (60~90 days)
T : 1.25 days, ~30 hours
Elevated ingestational trophoblastic disease ( a
progressive rise in after 90 days of gestation
highly suggestive), choriocarcinoma
Monitor
Breast Cancer
31 U/ml
in 20% with localized breast cancer, ~80%
with metastatic disease, esp. if with bone
involvment
Specificity of 86%, sensitivity of 30%
Also increased in gastric, pancreatic, cervical
lung cancer
Breast Cancer
Estrogen receptor (ER)
2 isoformsERa + ERb
ERa better prognosis, predictor of relapse
useful when deciding on adjuvant hormone treatment
Not guarantee response, fails in 30~40% of patients to
endocrine treatment
As diagnostic marker when it is a primary unknown tumor
ERb distinct biological roles and ligand binding specificity,
good prognostic factor, correlate with low grade and (-)
axillary LN status
BRCA1 gene on chromosome 17qfamilial breastovarian cancer syndrome, and breast cancer in early-onset
breast cancer families high risk screening
1. Howley PM, Lowy DR. In: Knipe DM, Howley PM, eds. Philadelphia, Pa: Lippincott-Raven; 2001:21972229.
2. Schiffman M, Castle PE. Arch Pathol Lab Med. 2003;127:930934. 3. Wiley DJ, Douglas J, Beutner K, et al. Clin Infect Dis. 2002;35(suppl 2):S210S224. 4. Muoz
N, Bosch FX, Castellsagu X, et al. Int J Cancer. 2004;111:278285.
14.6
18
69.7
45
25.7
North America/
Europe
17
52.5
31
33
52
67.6
12.6
South Asia
58
Others
Northern Africa
57
Central/South
America
A pooled analysis and multicenter case control study (N = 3607)
1. Muoz N, Bosch FX, Castellsagu X, et al. Int J Cancer. 2004;111:278285.
Ovarian Cancer
CA-125
Low
CA 19-9
A
Pancreatic Cancer
CA 19-9
mucin,
normal<37
infrequently elevated in patients with other
mucin-secreting cancer (colorectal, gastric cancer)
Diagnosis, monitor, detect relapse, 70% specificity
and 90% sensitivity
Mild in pancreatitis and early stage of pancreatic
cancer, not for diagnosing early-stage pancreatic
caner
Prostate Cancer
PSA
Tissue
Age
40~50
0~2.5
50~60
0~3.5
60~70
0~4.5
70~80
0~6.5
Relapse
Melanoma
Tyrosinase
Use RT-PCR to detect hematogenous spread of
melanoma cells from a solid tumor in peripheral
blood
S100B protein
For confirmation of amelanotic malignant
melanoma in immunohistology
in 70% with stage IV metastasized melanoma
MIA (melanoma inhibitory activity)
Preoperation: 59% at stage III, 89% at stage IV
Thyroid Cancer
Thyroglobulin
Thyrocalcitonin
Produced by thyroid C cells and medullary thyroid cancer
normal: <100 ng/L or <29 p mole/L
Effective in screen patients with 1st degree relatives
affected by medullary thyroid cancer and multiple
endocrine neoplasia type 2
Multiple Myeloma
2-microglobulin
Normal:
Lymphoma
Neuroendocrine Tumors
TRANSLOKASI
KROMOSOM PHILADELPHIA
bcr
22q
abl
9q
bcr
abl
22q
22
9q
Translokasi
bcr
abl
Conclusion