1. Tumor markers Present; by Dr. Andalib Isfahan Medical School

5. Overview
cancer is a broad term used to describe > 200 different diseases that affect 50 tissues.

6. What are Tumor Markers？
Biological substances synthesized and released by cancer cells themselves or produced by normal cells in response to tumor.
Most tumor markers are proteins

7. Tumor Specific Transplantation Antigen (TSTA)
Tumor antigens
Tumor Specific Transplantation Antigen (TSTA)
Tumor Specific Antigen (TSA)
Viral antigens
proto oncogenes
Viral Antigen :
a- Viral proteins and glycoproteins
b- New antigens produced by virally infected host cells under control of viral nucleic acid

8. Tumor antigens
Tumor Associated Antigens (TAA) of certain cancerous tissue BUT large overlap
tissue differentiation antigens
gene products with increased expression
altered glycoproteins and glycolipids
Altered expression of gene products
Oncofetal antigens
Viral Antigen :
a- Viral proteins and glycoproteins
b- New antigens produced by virally infected host cells under control of viral nucleic acid

9. p. 526

10. Tumor antigens could be used for
Screening of disease.
Diagnosis of symptomatic patients.
Staging of cancers.
Prognostic indicators.
Detect recurrence in Follow-Up of disease.
Monitoring response to therapy.
low sensitivity and lack of specificity and relation to tumor size......limited role in screening
The pre-therapeutic level of certain tumor marker can contributes a prognostic factor because of links with...
Metabolic activity,Tumor size and Invasion

11. Tumor marker First tumour marker 1938
Acid phosphatase for metastatic prostate

12. Tumor markers
Are biochemical substances which, as the name suggest, are closely associated with carcinogenesis
Are substances, such as proteins, biochemical, or enzymes, produced by tumor cells or by the body cells in response to tumor cells
Are substances that can often be detected in higher than normal in the blood, urine, or body tissues of some patients with certain types of cancer
Substances present in or produced by a tumor itself or produced by the host in response to a tumor

13. Tumor markers Measurement of tumor markers: helpful
Tumor marker levels could elevated in benign conditions
Many tumor markers are not specific to a particular type of cancer
In addition diagnosis :help physicians make a plan for appropriate therapy

14. Tumor markers Used to differentiate tumor from normal tissue
Determine presence of tumor based on quantity in blood or secretions
Higher quantity in cancer tissue, or in blood from cancer patient, then in benign tumors or normal individuals
Few tumor markers are specific for a single type of tumor

15. Tumor markers Most markers are found in many different types of tumor
Monitor a patient response to treatment
After treatment :as a part of follow up care to check for recurrence
Decrease or return to normal: favorable response to therapy

16. Tumor marker classification
Tumor antigens
Enzymes
Hormones
Oncogene products
Oncofetal
Receptors
Genetic markers

17. Tumor antigens-Oncofetal
Oncofetal:produced during normal emberyogical development and by neoplastic cells
Defined by polyclonal or monoclonal antibodies
CEA, AFP, HCG

18. Tumor associated antigens (Cancer antigen)

19. ENZYMES Neuron specific enolase(NSE) Acid phosphatase
Lactic dehydrogenase

20. Dunn et al. Nature Reviews Immunology 6, 836–848 (November 2006) | doi:10.1038/nri1961

21. Hormones * Human Chorionic Gonadotrophins (HCG)
are secreted in Choriocarcinoma, Ovarian Cancer
* Thyroxin is secreted in thyroid cancer

22. Ideal markers Present in early in disease
Before clinical evidence of disease
Increase with advancing tumor
Decrease with effective therapy
Test reproducible
Available and cost effective

23. Ideal marker
Specific: produced only by cells of a particular malignancy and not by other cancers, or benign conditions
Sensitive: produced in all patient with similar malignancy

24. Specific organ tumor systems
Gastrointestinal tumors
CEA
AFP
CA19-9

25. Prostate specific antigen
PSA
Prostate specific antigen

26. PSA In low concentration in the blood of all adult males
Is produced both normal and abnormal prostate cells
Elevated PSA levels: in blood of men with benign prostate condition
Prostatitis/benign hyperplasia/malignant

27. PSA
PSA level:monitoring the effectiveness of prostate cancer treatment
Checking recurrence after treatment

28. PSA As a screen for prostate cancer or in the elevation of or to follow up a person with prostate disease

29. Cancer antigen 27-29 For Breast cancer

30. CA 27-29
Breast cancer
Check for recurrence in woman previously treated for stage 2 and stage 3 breast cancer
Colon/stomach/kidney/lung/ovary/
pancreas/uterus/liver
Nan-cancerous: first trimester pregnancy/endometritis/ovarian cysts/benign breast disease/kidney disease/liver disease

31. Title

32. Neuron-specific enolase Neuroblastoma
NSE
Neuron-specific enolase
Neuroblastoma

33. NSE
Neuroblastoma/small cell lung cancer/wilms tumor/melanoma/cancers of thyroid/kidney/testicule/pancreas
Patient prognosis
Patient response to treatment

34. Carcino-Emberyonic Antigen
CEA
Carcino-Emberyonic Antigen

35. CEA
Oncofetal protein
Normal during fetal life(low concentration in healthy adults)
Higher concentration in some epithelial malignancies
Glycoprotein(molecular weight 200,000KD)

36. CEA Found on cell membrane Easily released into fluids
Related to immunoglobolin super-family genes
Normally found in mucus secretions of the stomach, small intestine

37. CEA Small amount in the blood of healthy people
Primary use of CEA: in monitoring colorectal cancer
Melanoma/lymphoma/breast/lung/pancreas/stomach/cervix/bladder/kidney/thyroid/liver/ovary
Nan-cancerous condition: inflammatory bowel disease/pancreatitis/liver disease
Tobacco users

38. CEA
lOW SPECIFICITY and lOW SENSITIVITY

39. AFP
Alpha-fetoprotein

40. AFP First described oncofetal antigen Normally: by a developing fetus
AFP level :elevated :liver cancer/germ cell cancer/ovary/testicule
Non-cancerous condition: benign liver condition /cirrohosis or hepatitis/pregnancy

41. CA 19-9
Cancer antigen 19-9

42. CA 19-9 A carbohydrated antigen detected by monoclonal antibodies
Pancreatic cancer
Biliary tract cancer
Billary tract disease
pancreatitis

43. TUMOR MARKER
Screening
Diagnosis
Prognosis
monitoring

44. Cancer antigen 125 ovarian cancer

45. CA 125 Is produced by a variety of cells(ovarian cancer)
Is used primarily in the management and treatment of ovarian cancer
In woman with ovarian cancer: chemotherapy

46. CA125
Falling CA125 levels generally indicates that cancer is responding to treatment
Increasing CA125 levels during or after treatment: is not responding to therapy

47. CA 125 To monitor for recurrence of ovarian cancer
Uterus/cervix/pancease/liver/colon/breast/lung/digestive tract
Non-cancerous condition: elevated CA125(endometriosis/pelvic inflammatory disease/peritonitis/liver disease
Menstruation and pregnancy

48. Human chorionic gonadotropine
HCG
Human chorionic gonadotropine

49. HCG Is produced by placenta during pregnancy
For screen choriocarcinoma
Monitoring the treatment of trophoblastic disease
Elevated HCG level:testis/ovary/liver/stomach/pancreas/
lung/pregnancy/marijuana

50. Cancer antigen 15-3 breast cancer

51. CA 15-3
In following the course of treatment in women diagnosis with breast cancer(advance)
Early stage breast cancer
Ovary/lung/prostate
Non-cancerous condition: benign breast/ovarian disease /endometrisis/pelvic inflammatory disease/hepatitis
Pregnancy

52. Tumor marker Screen and diagnose cancer Predicting prognosis
Monitor treatment
observation for cancer recurrence

57. Realty
No marker to date satisfy these criteria

58. Thank you