2. Clinical Division of Oncology Department of Medicine I Medical University of Vienna, Austria Tumormarkers

3. Clinical Division of Oncology Department of Medicine I Medical University of Vienna, Austria Tumormarkers: → optimal marker for a given disease? → optimal time of marker assessment? → diagnostic tool? Follow-up after therapy? Tumormarkers

4. Clinical Division of Oncology Department of Medicine I Medical University of Vienna, Austria Definition Tumormarkers Definition Substances detectable in blood and body fluids of patients with malignant disease. Synthesis in tumor tissue Tumor cells induce the synthesis in other cells

5. Clinical Division of Oncology Department of Medicine I Medical University of Vienna, Austria Criteria for a useful tumormarker Positive predictive value/negative predictive value  qualitative/quantitative distinction between:  healthy individuals  patients with benign disease  patients with malignant disease High specifity High sensitivity Method of assessment:  simple und practical  standardised

6. Clinical Division of Oncology Department of Medicine I Medical University of Vienna, Austria Indications Tumormarkers Indications Diagnosis Follow up

7. Clinical Division of Oncology Department of Medicine I Medical University of Vienna, Austria TumormarkersDiagnosis Early detection in asymptomatic individuals  Mass-screening  Risk-groups Diagnostic tool in symptomatic patients  Localisation  Organ-specificity Staging Prognosis

8. Clinical Division of Oncology Department of Medicine I Medical University of Vienna, Austria Follow-up Tumormarkers Follow-up Postoperative follow-up Early detection of relapse and/or metastases

9. Clinical Division of Oncology Department of Medicine I Medical University of Vienna, Austria Follow-up Tumormarkers Follow-up Early detection of relapse during adjuvant therapy Monitoring of palliative therapy modalities

10. Clinical Division of Oncology Department of Medicine I Medical University of Vienna, Austria Frequency of marker assessment Tumormarkers Frequency of marker assessment Before surgery Definition of a relevant tumor marker for follow-up After surgery to assess the success of surgery (2-4 weeks after surgery) Monitoring of adjuvant therapy modalities:  before initiation of therapy  every 3 months during 1st and 2nd year  every 6 months during 3rd to 5th year Monitoring of palliative therapy modalities:  before the start/change of therapy  every 2 months

11. Clinical Division of Oncology Department of Medicine I Medical University of Vienna, Austria Types of tumormarkers Tumormarkers Types of tumormarkers Oncofetal substances CEA, AFP Oncoplacental substances  -HCG Tumor associated antigens CA 19-9, CA125, CA153, CA72-4,... Proliferation antigens TPS, TPA,  2 -MG, Ectopic hormones/enzymes Calcitonin, TG, NSE, VIP, Serotonin, PSA Laboratory parameters LDH, Ferritin, BSG, Acut-Phase-Proteins,...

12. Clinical Division of Oncology Department of Medicine I Medical University of Vienna, Austria Tumors of the Male Tumormarkers Tumors of the Male Germ cell tumors Prostate carcinoma AFP,  -HCG PSA, PAP

13. Clinical Division of Oncology Department of Medicine I Medical University of Vienna, Austria Tumors of the female Tumormarkers Tumors of the female Breast carcinoma Ovarian carcinoma Carcinoma of cervix Choriocarcinoma CA 153, CEA CA 125, CA 72-4 CEA, SCC  -HCG

14. Clinical Division of Oncology Department of Medicine I Medical University of Vienna, Austria Gastrointestinal Tumors Tumormarkers Gastrointestinal Tumors EsophagusCEA, SCC StomachCA 72-4, CEA, CA 19-9 ColonCEA, CA 19-9 PancreasCA 19-9, CEA Gallbladder and biliary tract CA 19-9, CEA LiverAFP

15. Clinical Division of Oncology Department of Medicine I Medical University of Vienna, Austria Other Tumors Tumormarkers Other Tumors SCLCNSE NSCLCCEA, CYFRA ENTSCC Breast cancerCEA, Ca 153 Ovarian cancerCa 125 Myeloma  2 -MG, Paraproteins Lymphoma  2 -MG, LDH, Ferritin

16. Clinical Division of Oncology Department of Medicine I Medical University of Vienna, Austria Tumormarker elevations in benign conditions Smokers and COPD  CEA Ascites, peritoneal tumors  CA125 Pregnancy  CA 125, TPS Intestinal inflammation  CEA, CA19-9 Rheumatic diseases  CEA, CA19-9 Renal insufficiency  CEA, PSA, β-2MCG Cirrhosis of the liver  CEA, CA19-9, etc. Mastopathy  CA 15-3 Benign ovarian tumors  CA 125

17. Clinical Division of Oncology Department of Medicine I Medical University of Vienna, Austria Tumormarkers  -HCG  Diagnosis / Follow-up of non-seminatous germ cell tumor and trophoblastic tumors AFP  Diagnosis / Follow-up of hepatocellular carcinoma and non- seminomatous germ cell tumor PSA  Early diagnosis / Follow-up of prostate carcinoma CA 125  Follow-up after therapy of ovarian cancer

18. Clinical Division of Oncology Department of Medicine I Medical University of Vienna, Austria Tumormarkers should not be applied for:  Exclusion of a malignant disease before organ transplantation, etc.  Benign diseases with known unspecific elevation of tumormarkers  Uncritically in symptomatic patients (CA 125 in males? etc.)  Screening of asymptomatic individuals Exception: PSA,  -HCG in risk-patients

19. Clinical Division of Oncology Department of Medicine I Medical University of Vienna, Austria Conclusions Tumormarkers Conclusions Screening within risk-groups: PSA,  -HCG, CA 125 Diagnostic within symptomatic patients (useful choice) Follow-up after curative surgery Colon-CA, Ovarian-CA, etc. Therapy monitoring does not substitute for radiologic examination, except if not possible  repeat value, if confirmed  initiate therapy/change therapy