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The Promise of Tumor Markers - page 3

Questions to Ask Your Doctor

If you have questions about tumor markers, be sure to ask your doctor, and keep asking until you understand. The following questions might help you plan your meeting with your doctor:

  • What tumor marker tests do you recommend for me? Which ones have you already performed?
  • How are these tests performed? How often should I have them?
  • Do I have abnormal levels of any tumor marker?
  • If I do have abnormal levels of a tumor marker, what does that mean? How will it affect my treatment?
  • How will you use tumor markers in my follow-up care? As with other laboratory tests, reliable tests for tumor markers must be both specific and sensitive.
  • If the test is not specific, there is a chance that the results could indicate a tumor marker is present when it is not (a false positive). In this case, a healthy person may go through unnecessary tests and anxiety.
  • If the test is not sensitive, the results may indicate a tumor marker is not present, when it actually is (a false negative). In this case, a person who may benefit from additional testing and treatment may not receive it.

Your doctor is the best person to talk to about testing for certain tumor markers.

 

CISN Summary

Tumor markers are recognized by most as a very promising tool that can achieve early diagnosis and more targeted treatments. Summarizing this in the broadest terms, many factors influence gene expression in the blood. See image below courtesy of Gene News

  • Heritable components derived from one's parents are one source of bloodbased gene expression.
  • External factors like air pollution or second hand cigarette smoke also generate gene expression changes in the body, which can be manifested in blood.
  • Internal factors such as a colon tumor for example also precipitate changes in gene expression in blood cells as they come in contact with the tumor and the body attempts to respond.
 


 
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Blood is obtained by standard methods and RNA extracted from the blood in order to obtain a snapshot of specific gene expression changes that are direct and specific reflections of a disease state in the body. That "snapshot" is shown on the right as a molecular signature derived from microarray analysis (the disease snapshot and normal snapshot are clearly different).

Summary of tumor markers by cancer type:

Tumor marker Primary use Other conditions that cause elevated levels Normal value
Detected in:
Bladder Cancer
   
Bladder tumor
antigen (BTA)		 Detect recurrence
  • Recent surgery
  • Genitourinary tract
    infection
  • Cancer of kidney or
    ureters

Not detectable

Urine

Nuclear matrix
protein (NMP 22)

Predict prognosis

Detect recurrence
  • Recent surgery
  • Chemotherapy
  • Genitourinary infection or disease
  • Renal or bladder stones
  • Rigorous exercise

<10 U/ml

Urine
Breast Cancer
   
CA 15-3

Monitor response to treatment

Detect metastases
  • Cervical cancer
  • Liver cancer

<31 U/ml

Blood
CA 27.29

Monitor response to treatment

Detect metastases
  • Cervical cancer

<38-40 U/ml

Blood
Carcino-embryonic
antigen (CEA)

Predict prognosis

Monitor response to
treatment

Detect recurrence

Used in combination with CA 15-3
  • Colorectal cancer
  • Lung cancer
  • Gastric cancer
  • Pancreatitis
  • Hepatitis
  • COPD
  • Cigarette smoking

<3 ng/ml

Blood
Colorectal Cancer
    
Carcino-embryonic
antigen (CEA)

Predict prognosis

Detect recurrence

Monitor response to
treatment
  • Breast cancer
  • Lung cancer
  • Gastric cancer
  • Pancreatitis
  • Hepatitis
  • COPD
  • Cigarette smoking

<3 ng/ml

Blood
CA 19-9

Monitor response to
treatment

Monitor progression
  • Pancreas cancer
  • Gastric cancer
  • Liver cancer
  • Pancreatitis
  • Ulcerative colitis
  • Inflammatory bowel
    disease

<33 U/ml

Blood
Liver Cancer
   
Alpha-fetoprotein
(AFP)

Diagnose liver cancer in patients with chronic hepatitis

Follow-up after surgery for liver cancer
  • Germ cell cancer of
    ovaries/testes
  • Cirrhosis
  • Hepatitis
  • Inflammatory bowel
    disease
  • Pregnancy

0-6.4 IU/ml

Blood
Lung Cancer (NSCLC)
   
Carcino-embryonic
antigen (CEA)		 Diagnosis, but not very
important because lung
cancer can be easily seen
on an x-ray
  • Colorectal cancer
  • Breast cancer
  • Gastric cancer
  • Pancreatitis
  • Hepatitis
  • COPD
  • Cigarette smoking

<3 ng/ml

Blood
Lung Cancer (SCLC)
    
SCLC:
Neuron-specific
enolase (NSE)

Distinguish SCLC from
NSCLC

Monitor response to
treatment

Monitor progression
  • Neuroblastoma
  • Pancreatic cancer
  • Thyroid cancer
  • Chronic bronchitis
  • COPD

<13 ng/ml

Blood
Lymphoma
    
Lactic dehydrogenase
(LDH)		  
  • Hepatitis
  • Myocardial infarction
  • Melanoma metastasis
  • Liver metastases

100-210 u/l

Blood
Beta-2-microglobulin
(B2M)

Predict prognosis

Monitor progression
  • Multiple myeloma
  
Gamma globulin  
  • Multiple myeloma

3.0-13.0 g/L

Blood
Melanoma Skin Cancer
    
TA 90

Detect metastasis

Predict prognosis

  

Not detected

Blood
Multiple Myeloma
    
Bence Jones protein

Diagnosis

Predict prognosis

Monitor progression

Monitor response to
treatment
  • Non-Hodgkin’s
    lymphoma

0.02 to 0.5 mg/mL

Urine
Myeloma protein
(M-protein or Mspike)

Diagnosis

Predict prognosis

  

<30 g/L

Blood
Beta-2-microglobulin
(B2M)

Predict prognosis

Monitor progression
  • Lymphoma
  • Acute lymphocytic
    leukemia
  
Gamma globulin  
  • Non-Hodgkin’s
    lymphoma

3.0-13.0 g/L

Blood
Ovarian Cancer (epithelial)
    
CA 125

Indicates most common
form of ovarian cancer,
epithelial

Monitor response to
treatment

Detect recurrence
  • Breast cancer
  • Colorectal cancer
  • Ovarian cysts or fibroids
  • Endometriosis
  • Inflammatory bowel
    disease
  • Cirrhosis
  • Peritonitis
  • Pancreatitis

0-35 U/ml

Blood
Ovarian Cancer (germ cell)
    
Alpha-fetoprotein
(AFP)

Diagnosis

Follow-up after treatment
  • Germ cell cancer of the testes
  • Cirrhosis
  • Hepatitis
  • Inflammatory bowel
    disease
  • Pregnancy

0-6.4 IU/ml

Blood
Pancreatic Cancer
    
CA 19-9

Predict prognosis

Monitor response to treatment

Monitor progression
  • Colorectal cancer
  • Gastric cancer
  • Liver cancer
  • Pancreatitis
  • Ulcerative colitis
  • Inflammatory bowel
    disease

<37 U/ml

Blood
Prostate Cancer
    
Prostate specific
antigen (PSA)

Screening

Detect early stage disease

Monitor progression

  

<4 ng/ml

Blood
Prostatic acid
phosphatase (PAP)		 *Rarely used because PSA is more sensitive
  • Present in many body
    tissues
  • Enlarged prostate

Varies from lab to lab

Blood
Prostate-specific *Still under investigation
  • Age
  
membrane antigen (PSMA)      
Testicular Cancer
    
Human chorionic
gonadotropin (hCG)

Diagnose at-risk
individuals

Monitor response to
treatment

Detect metastases
  • Pregnancy
  • Cirrhosis
  • Duodenal ulcers
  • Benign breast, lung,
    pancreas, ovary, GI
    cancers
  • Choriocarcinoma
  • Mediastinal germ cell
    neoplasms

>31 ng/mL

Blood
Alpha-fetoprotein
(AFP)

Diagnose

Follow-up after treatment
  • Germ cell cancer of the ovaries
  • Cirrhosis
  • Hepatitis
  • Inflammatory bowel
    disease
  • Pregnancy

<40 ng/mL

Blood
Thyroid Cancer
    
Calcitonin

Diagnose early disease

Screening for at-risk
individuals
  • Lung cancer
    (rarely measured)

<13 pg/ml

Blood
Thyroglobulin

Monitor response to
treatment

Monitor progression

  

>1 μg/L

Blood

For More Information

Does the NCI have guidelines for the use of tumor markers?

No, the NCI does not have such guidelines. However, some organizations do have guidelines for some types of cancer.

The American Society of Clinical Oncology (ASCO), a nonprofit organization that represents more than 21,500 cancer professionals worldwide, has published clinical practice guidelines on a variety of topics, including tumor markers for breast and colorectal cancer. These guidelines, called Patient Guides, are available on the ASCO Web site at: http://www.plwc.org/.

The National Comprehensive Cancer Network® (NCCN), which is also a nonprofit organization, is an alliance of cancer centers. The NCCN provides Patient Guidelines, which include tumor marker information for several types of cancer. Most of the guidelines are available in English and Spanish versions. The Patient Guidelines are on the NCCN's Web site at: http://www.nccn.org/.

The National Academy of Clinical Biochemistry (NACB) is a professional organization dedicated to advancing the science and practice of clinical laboratory medicine through research, education, and professional development. The Academy publishes Practice Guidelines and Recommendations for Use of Tumor Markers in the Clinic, which focuses on the appropriate use of tumor markers for specific cancers. More information can be found on the NACB Web site at: http://www.aacc.org/.

 

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