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What is Tumor marker:
A substance produced by either a tumor or by the body in response to a tumor
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Name different substances that a tumor marker can be
- Cell surface antigens
- Cytoplasmic proteins
- Enzymes
- Hormones
- Onco fetal antigens-
- Receptors
- Oncogenes
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How are Tumor Markers detected
-•-Most common techniques are immunofluorescent or enzymatic assays- Most commonly used*
-Monoclonal antibodies used to bind to marker of interest with a variety of visualization techniques
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Clinical Uses for tumor markers
- 1. Screening and early detection- i.e. PSA, inexpensive test,
- 2. Diagnostic confirmation-
- 3. Prognosis and prediction of therapeutic response
- 4. Monitoring disease and recurrence-
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Factors that will affect tumor markers
- • Aging (PSA)
- • Metabolism and elimination of marker
- • Kidney or liver disease
- • Messing with metabolism and elimination of the markers
- • Hormonal imbalances (thyroid affecting metabolism or production)
- • Smoking
- • Alcoholism
- • Obesity
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Partial remission is signify by?
reduction of markers by 50%
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How are the markers seen in recurance of disease?
Incease of 25% or more of marker
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If no recent treatment, and there a rise on logarithmic scale on 3 samples, what does this signify?
is confirmatory of disease
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MARKERS TO KNOW
- 1. HCG testes, breast, ovary, GI, lung
- 2. CA 125 Ovarian
- 3. HER-2 Breast prognosis
- 4. CA 19-9 Pancreatic
- 5. PSA Prostate
- 6. CEA Colon+
- 7. AFP liver
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Carbohydrate antigen 125 (CA125)
Carbohydrate chain coded for on the MUC1 gene; production increases to detectable levels with certain cancers
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Carbohydrate antigen 125 (CA125) is associated with what cancer?
- BLOPE
- b= breast cancer
- L = lung cancer
- O= OVARIAN CANCER
p= pancreatic cancere=endomitrial cancer
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For Non-cancerous elevation, CA 125 is seen in?
Endometriosis, PID, pregnancy, acute pancreatitis
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how can Carbohydrate antigen 125 (CA125) be used?
Used to monitor response to treatment and watch for *RECURENT of disease*, and FOLLOW high risk females w/ + family hx
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Carcinoembryonic Antigen (CEA)
Endogenous glycoprotein that helps with aggregation of colorectal carcinoma cells
produced neonatal development, hold cells together in GI
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Carcinoembryonic Antigen (CEA) is associated with which cancers?
- COLORECTAL CANCER, metastatic breast cancer, lung CA, pancreatic CA, hepatocellular CA-
- (LaMb CHoP)
high levels are GI associated, and seen in smokers
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Non cancerous elevation of Carcinoembryonic Antigen (CEA) is seen in
Noncancerous elevations: Cholangitis, cholelithiasis, chronic hepatitis, COPD, IBD
(ICCCC or I 4C)
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how is Carcinoembryonic Antigen (CEA) marker used?
Usage: Establish prognosis, monitoring therapeutic effectiveness, recognizing recurrent disease in colon CA
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Alpha fetoprotein (AFP)
Germ cell tumors, HEPATOCELLULAR CARCINOMA, non-seminomatous testicular cancers
-Used to detect tumors of the *liver and testes/ovaries* (germ cell)-slight elevation seen in hepatitis or cirrhosis
-The higher the level the bigger the tumor
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Alpha fetoprotein (AFP) can be used for what else?
Antenatal diagnosis of trisomy 21( down syndrome) and neurologic congenital defects
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Non cancerous elevation of Alpha fetoprotein (AFP) is seen in?
Noncancerous elevations: viral hepatitis, liver injury, pregnancy, inflammatory bowel disease
(VLIP)
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Beta Human Chorionic Gonadotropin (beta HCG)
Glycoprotein hormone usually produced by the placenta during pregnancy
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Beta Human Chorionic Gonadotropin (beta HCG) is associated with what type of cancer
Choriocarcinoma, Germ cell tumors, testicular cancers
secondary marker for breast cancer, stomach cancer, ovarian cancer, colon cancer
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True or false? Beta Human Chorionic Gonadotropin (beta HCG) is excellent marker for screening
Only used to monitor disease following treatment, *not used in screening*
-elevated in pregnancy, not a preferred marker in colon cancer.
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Prostate-Specific Antigen (PSA)
o Glycoprotein normally produced by prostate
- o Associated malignancies: Prostate Cancer
- o Usage: Some debate about utility in screening
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Noncancerous elevation of Beta Human Chorionic Gonadotropin (beta HCG) is seen in
Testicular failure, marijuana, pregnancy
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When is Prostate-Specific Antigen (PSA) false positive?
Rise in PSA can also be due to Prostatitis, BPH, aging
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HER-2/neu
Oncogene on 17qo Associated diseases: Breast Cancer, Ovarian CA, Endometrial CA, other cancers
Usage: *Assessing for susceptibility to hormonal therapies*
• High levels of gene transcription indicates lower numbers of estrogen and progesterone receptors and therefore lower response to hormonal treatments
Specimen: Biopsy
breast cancer gene, will this help or hinder during tx, if gene is over expressed
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How is HER-2/neu normally tested
Usually tested in conjunction with ER and PR (estrogen and progesterone receptor)
• Reported as HER2( )/ER ( )/PR ( ) where the parentheses indicate positive or negative
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ER+/PR+ mean what
are more likely to respond to hormonal treatments and generally have a slower-growing tumor
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HER-2 positive indicates what?
-indicates higher risk of relapse and decreased survival time-however, there are drugs that are specific for this protein, so prognosis is good w/ treatment
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"Triple negative" means what?
= HER-2 (-), ER-/PR-is an indicator of a poorer prognosis in breast cancer
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Explain why "Triple negative" is not good
when all three markers are negative, there is reduced respond to drug therapy, thus poor prognosis
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Noncancerous elevations of CA 19-9 is seen in
Noncancerous elevations: Acute pancreatitis, cholangitis, cirrhosis
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CA 19-9
Certain product of MUC1 genes
Seen in PANCREATIC MALIGNANCIES, Hepatobiliary carcinoma, Colorectal cancer
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CA 19-9 is used for screening?
NO, Used for monitoring disease progression and recurrence rather than detection; used in conjunction with CEA
not intially elevated in all pancreatic cancer
once elevated, cancer is at advanced stage
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