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Cancer part 2

Unit 4. Tumour markers,


objectives:
• To know the tumour markers in use
• and how to use them clinically.
• To know the limitations of tumour markers
in clinical situations.
• To know the markers used in
chemotherapy.
Alpha fetoprotein
• Fetal albumin
• Found in germ cell tumours but also other
cancers but especially
• Liver cancers.
Disorders associated with
elevated serum AFP
• Hepatoma • 90%
• Viral hepatitis • 40%
• Chronic active • 33%
hepatitis
• Cirrhosis • 5-50%
• Tyrosinaemia • 100%
Carbohydrate/cancer antigen
CA 125
• Made by epithelial ovarian carcinoma cells
• Ovarian cancer marker in 80% but
• Found in other diseases too.
• Used for prognosis.
CA 19 9
• Gastrointestinal
• Pancreatic
• Colorectal cancers.
CA 24 25, CA 27-29
• Breast cancer markers
Placental like alkaline
phosphatase PLAP
• Breast cancer 20%
• Ovarian cancer 20%
• Seminomas 50%.
Cancer markers: hormones
• Insulin from insulinoma
• Calcitonin from medullary carcinoma of thyroid
• Catecholamines from pheochromocytoma
• ADH from bronchogenic carcinoma
• ACTH from bronchogenic ca
• hCG from choriocarcinoma
[May give rise to the paraneoplastic syndrome].
Cancer markers: monoclonal
proteins (myeloma, unit 13)
• Light chain – kappa or lambda
• Heavy chain
Also use:
• Immunoglobulin typing
• ALP for bone breakdown
• Creatinine for renal function
• Haemoglobin from bone marrow
• Calcium from bone.
Cancer markers: enzymes
• LD – lymphoma, leukaemia (tumour
necrosis syndrome) germ cell.
• CKBB – neuroendocrine. Obsolete?
• ALP – placental type, germ cell type,
intestinal type (isoenzyme). Obsolete?
• ACP – prostate – now obsolete.
• PSA (serine protease) - prostate
LD in lymphoma:
Cancer markers: cell surface
antigens

• T cell CD# (cell surface marker) in


lymphomas, leukaemias
• Oestrogen and progesterone receptor
in breast cancer.
Is Tamoxifen likely to work?
Cancer markers: acute phase
reaction proteins
• Alpha-1-acid glycoproteins (orosomucoid)
• Alpha-1-anti trypsin
• Ceruloplasmin (copper binding)
• Haptoglobin
• Fibrinogen
• C-reactive protein
Faecal occult blood
Problems with cancer markers 1
– tumour heterogeneity:
• Theory is one clone = one cancer type.
• Party line is kill the clone kills the cancer
but
• Chemotherapy works for a while then fails.
• Pathology shows different cell lines
sometimes. Cells change as cancer ages.
Problem with cancer markers 2-
immunological control:
• We can handle (by immune processes) a
cancer billion cells perhaps.
• Immune function in cancer not enhanced.
• BCG vaccine may help control cancer.
• In immune suppressed patients only some
types of cancers are seen
Karposi’s sarcoma:
Problem 3, metastasis:
• Not all cancers spread.
• No usable marker for this potential
Problem 3. secondary spread of
cancer. Laboratory tests:
• Liver – AFP, GGT – spread from colorectal,
breast, lung, pancreas, stomach, testis, uterus,
ovary.
• Bone – calcium, ALP – from prostate, breast,
lung, stomach, testis, uterus, thyroid.
• Brain – csf tests-from breast, lung, testis.
• Lung – LD - from colorectal, breast, pancreas,
stomach, thyroid, liver, uterus.
• Peritoneum AMS– from pancreas.