EKUSILENI CLINICAL LABORATORY PSA AND CEA AS SURROGATE MARKERS FOR CANCER DIAGNOSIS TALENTS MURAHWA (BIOMEDICAL SCIENTIST)

LAB & CANCER MANAGEMENT What are tumor markers Definition: - A tumour marker is a biochemical indicator selectively produced by the neoplastic tissue and released into blood and detected in blood or in other body fluids. It may be used to: - Detect the presence of a tumour Monitor the progress of disease Monitor the response to treatment 2007 EKUSILENI CLINICAL LABORATORY

Tumour Markers: - Classification Class 1: Antigens unique to a neoplasm not shared by other tumours of same histological type . Class 2: Antigens expressed by many or most tumours of a specific histological type and of other histological type, But not expressed by normal adult tissue. Class 3: Antigens expressed by both cancer and normal adult tissue. 2007 EKUSILENI CLINICAL LABORATORY

NATURE OF TUMOUR MARKERS 1.Oncofetal antigens Alpha Feto Protein CEA Pancreatic Oncofoetal Antigen 2.Proteins Casein – By breast carcinoma Ferritin- Leukaemia 3.Enzymes Creatinekinase – Prostate tumour Alkaline Phosphatase – Lungs tumour Acid Phosphatase – Prostate tumour 2007 EKUSILENI CLINICAL LABORATORY

EKUSILENI CLINICAL LABORATORY Receptors Oestrogen, Progesterone, Androgen Polyamines Spermine, Spermidine, Putridine – leukemia, lymphoma, colorectal CA Cell Markers T cell marker, B cell marker-lymphoma Ectopic Hormones HCG, GH, Erythropoetin, Renin 2007 EKUSILENI CLINICAL LABORATORY

EKUSILENI CLINICAL LABORATORY LOCAL LABORATORY TESTS ON OFFER 1.Alfa Feto Protein 2.CEA 3.PSA ALPHA AMYLASE LDH 2007 EKUSILENI CLINICAL LABORATORY

EKUSILENI CLINICAL LABORATORY Alfa Feto Protein:- Measurement of maternal serum and amniotic fluid levels play an important role in the screening for Foetal neural tube defects Chromosomal abnormalities including Down’s Syndrome. Most measurements are done at 16 weeks of gestation. Raised maternal serum AFP levels are not specific for neural tube defects. Must be used in combination with other modalities such as USG, amniotic fluid AFP and acetylcholine esterase. 2007 EKUSILENI CLINICAL LABORATORY

EKUSILENI CLINICAL LABORATORY Alfa Feto Protein:- Many fetal conditions are associated with abnormal maternal serum AFP levels. Elevated: NTD, GI obstruction, Liver necrosis, Abdominal wall defects (Omphalocele, Gastroschisis), Sacrococcygeal tumour, Cystic hygroma, IUGR, multiple pregnancies, renal anmalies. Low: Chromosomal trisomies (Down’s syndrome), Gestational trophoblastic diseae, IUD, placental defects, GA underestimated, Foetal distress, Hydrops Foetalis, TOF, Cyclopia. 2007 EKUSILENI CLINICAL LABORATORY

EKUSILENI CLINICAL LABORATORY Alfa Feto Protein:- After birth AFP usually falls, within 8 to 12 months of delivery to a very low conc.of 10mcg/ml and persists at this low level throughout life. Unexplained and persistent elevation of AFP in nonpregnant state should be screened, as it may be due to- Hepatocellular Ca, germ cell tumour, hereditary persistence of AFP, viral hepatitis and cirrhosis . In addition to its role in prenatal diagnosis, it is also widely used in the diagnosis, therapeutic monitoring and follow up of patients in germ cell tumours. 2007 EKUSILENI CLINICAL LABORATORY

Germ Cell Tumours Producing AFP Dysgerminoma -- Endodermal Sinus tumour / + yolk sac tumour Immature tetratoma +/- 4. Mixed germ cell tumour +/- 5. Choreocarcinoma -- 6. Embryonal CA -- 2007 EKUSILENI CLINICAL LABORATORY

EKUSILENI CLINICAL LABORATORY CEA:- It is a glycoprotein of mol.wt 200kda. Though it is a tumour marker for GI cancers, it is also expressed by malignant mucinous tumor (100%), 100% cases of atypical hyperplasia of endometrium, 60% cases of endometrial Ca, 50-80% cases of squamous cell of Cx, 75-100% cases of adenocarcinoma of Cx. It is also produced in pneumonia, hypothyroidism and pancreatic tumours. 2007 EKUSILENI CLINICAL LABORATORY

EKUSILENI CLINICAL LABORATORY PSA Prostate-Specific Antigen (PSA) A prostate-specific antigen (PSA) test measures the amount of prostate-specific antigen in the blood. PSA is released into a man's blood by his prostate gland. 2007 EKUSILENI CLINICAL LABORATORY

EKUSILENI CLINICAL LABORATORY Healthy men have low amounts of PSA in the blood. The amount of PSA in the blood normally increases as a man's prostate enlarges with age. PSA may increase as a result of an injury, a digital rectal exam, sexual activity (ejaculation), inflammation of the prostate gland ( prostatitis), or prostate cancer 2007 EKUSILENI CLINICAL LABORATORY

EKUSILENI CLINICAL LABORATORY PSA Why is it done? Why It Is Done The prostate-specific antigen (PSA) test is done to: Monitor prostate cancer and how it responds to treatment. If PSA levels increase, the cancer may be growing or spreading. PSA is usually not present in a man who has had his prostate gland removed. A PSA level that rises after prostate removal may mean the cancer has returned or has spread. 2007 EKUSILENI CLINICAL LABORATORY

EKUSILENI CLINICAL LABORATORY PSA Prostate cancer often grows very slowly, without causing major problems. Detecting prostate cancer early and treating it may prevent some health problems and reduce the risk of dying from the cancer. However, some treatments for prostate cancer can cause other problems, such as 2007 EKUSILENI CLINICAL LABORATORY

EKUSILENI CLINICAL LABORATORY PSA Determine if cancer may be present when other tests, such as a digital rectal exam, are not normal. A PSA test does not diagnose cancer, but it can be used along with other tests to determine if cancer is present. 2007 EKUSILENI CLINICAL LABORATORY

EKUSILENI CLINICAL LABORATORY PSA Check men for prostate cancer. Experts disagree on the usefulness of PSA testing as a screening tool for prostate cancer. If a PSA test is used for screening, it is usually done for men older than age 50 or for those at high risk for prostate cancer, such as men with a family history of prostate cancer, or for African-American men who have a higher chance of developing cancer than other men. Since other common medical conditions, such as prostatitis, can cause high PSA levels, a prostate biopsy is needed to confirm a diagnosis of cancer. 2007 EKUSILENI CLINICAL LABORATORY

EKUSILENI CLINICAL LABORATORY CONCLUSION TM cannot be NECESSARILY constructed as primary modalities for diagnosis of tumours THANK YOU 2007 EKUSILENI CLINICAL LABORATORY