TUMOR MARKERS IN

SURGERY
BY
DR JOSEPH ASUQUO
OUTLINE
 INTRODUCTION/DEFINITION
 XTERISTICS OF AN IDEAL TM
 CLINICAL USES OF TM
 FACTORS THAT AFFECT TM LEVEL
 CLINICAL USES
 LOCOREGIONAL LIMITATION
 CLASSIFICATION
 TUMOR MARKERS OF SURGICAL IMPT
 FUTURE TRENDS
 CONCLUSION
INTRODUCTION
 TM are biochemical substances or products of
the metabolic activity of tumors & are either
tumor-derived or tumor-associated, although not
tumor specific.
 Cld be isolated in blood, urine or as increase
tissue-receptors > in normal tissue. Using
immunoassay & immunohistochemistry.
 Has a role in cancer mgt which is the 3rd leading
cause of dead in the world
HISTORICAL PERSPECTIVE
 First TM is Bence Jones protein
 Gutman etal in 1938, identified Acid
Phosphatase, which is 1st clinically useful
TM
 Gold & Freedman in 1965, identified CEA
in extracts of gut tumor / fetal gut tissue
 RB gene, 1st oncogene identified
 John & Brown dev the technique of
Radioimmunoassay
XTERISTICS OF IDEAL TM
 It must be tumor sensitive
 It must be tumor specific
 It must have positive predictive value
 It must have a low false negative result
 Present at concentration that responds
rapidly to changing tumor mass.
 Present at levels that correlates with
malignant tissue mass.
 Estimation must be cheap & reproducible
FACTORS THAT AFFECT TM LEVELS

 Tumor vascularity
 Tumor production rate
 TM half-life
 Rate of disposal
CLINICAL USES OF TM
 SCREENING / PREVENTION
 DIAGNOSTIC
 STAGING & GRADING
 PROGNOSTIC
 MONITORING
 THERAPEUTIC
 RESEARCH
 MEDICOLEGAL
LOCO-REGIONAL LIMITATIONS IN THE
USE OF TM
 COST
 SHORTAGE OF REAGENTS
 POWER SUPPLY
 PERSONNEL
 POOR SCREENING ATTITUDE
XSSIFICATION
 ENZYMES
 PROTEINS
 HORMONES
 ONCOGENES
 TISSUE RECEPTORS
 OTHERS
ENZYMES
 Prostatic Acid Phosphatase – Prostate
cancer
 Alkaline Phosphatase – Metastatic bone
Ca, liver & osteogenic sarcoma.
 Neuron-specific enolase – Neuroblastoma
& Broncogenic Ca
 Lactate Dehydrogenase – Germ cell tumor
PROTEINS
 AFP – Teratoma, seminoma & hepatoma
 CEA – Colorectal, breast, lungs,
pancreatic & gastric
 PSA – Prostate Ca
 CA - 15.3 ; Breast
-19.9 (50 & 242) ; Colorectal,
pancrease & gastric.
-125 ; Ovarian & other gynaecologic
tumor
- 27.29 ; Breast cancer assoc. antigen
HORMONES
 HCG – Trophoblastic, testicular &
gestational tumor
 CALCITONIN – Medullary thyroid Ca,
bronchogenic & breast
 CATHECOLAMINES – MEN II, adrenal Ca
& Pheochromocytoma
 ACTH – Bronchogenic Ca
 ONCOGENES
 BRAC-1 & 2
 APC ; Colorectal Ca, FAP
 RB ; Osteosarcoma, colon, retinoblastoma
 Ph-1 ; HML
 P53 ; Most human Ca, Li- Fraumeni
TISSUE RECEPTORS
 Estrogen receptor
 Progesterone receptor
 Interleukin-2 receptor
 EGF receptor
 Her 2 or c-erb B-2 receptor
 OTHERS
 Acute phase proteins
- C - reactive proteins
- Ferritins
 Inflammatory markers
- ESR
CLINICALLY USEFUL TM
 PSA
 CEA
 ΑLPHA-FETOPROTEIN
 HCG
ALPHA FETOPROTEIN
 Synthesized by fetal yolk sac, liver & GIT
 Normal level is 1-16ug/l in adults
 >40ug/l seen in abt 60% of teratomas
 Can be elevated in liver dsr, pregnancy
with fetal distress
 Can be used for dx(spinal bifida),staging,
prognosis & monitoring
PROSTATE SPECIFIC ANTIGEN
 Its organ specific
 Secreted by ductal epithelial cells
 >4ng/ml occur in 65% of males with stage
A prostate Ca
 Elevated in BPH, prostatitis(returns to
normal after 8wks),after DRE or trauma to
prostate & after ejaculation
 Pts with low levels of free PSA are more
likely to have Ca
CARCINOEMBRYONIC ANTIGEN

 Produced in embryonic gut, liver &

pancreas.
 Elevated in colorectal Ca, also in breast,
ovarian, stomach, liver & pancreas etc
 Also elevated in pancreatis, IBD, heavy
smokers, PUDs, hypothyroidism, collagen
dsx & liver dsx.
 Lacks specificity & sensitivity but useful in
staging, monitoring & prognosis.
HUMAN CHORIONIC GONADOTROPIN

 Produced by developing placenta &

trophoblast
 Max conc by 8th wk in utero
 Elevated in chorioCa, trophoblastic
tumors, seminomas & testicular teratomas.
 Can be seen in pancreas, stomach &
bronchial Ca. Also after orchidectomy &
hypogonadism due to ↑ LH
 Used for dx, monitoring & prognosis.
FUTURE TRENDS
 PSP-94
 PSMA
 CA 74-2
CONCLUSION
 It is hoped that with the continue
expansion in research into discovery of an
ideal TM which will serve as a useful tool
in the prevention & early detection of all
types of tumors.
THANKS FOR LISTEN