Download contentfiles/Kate Murphy-Tumour makers (12.09.16)

Tumour Markers
Annual Practice Nurse Conference 2016
Kate Murphy (OLN) & Aoife O’Shea
(Research Nurse)
Tumour Markers
The concept of tumour markers can mean
anything that helps in the diagnosis of
cancer
In a more restricted sense it refers to the
biochemical detection of cancer.
Definition of a tumour marker
• Tumour markers are substances produced by cancer or by
other cells in the body in response to cancer or certain
benign conditions
• These substances can be found in the blood, urine, stool,
tumour tissue or other bodily fluids of some patients with
cancer
• Used to help detect, diagnose and manage some types of
cancer – usually combined with other tests (biopsies, scans
etc.)
Tumour Marker Uses
• Tumour markers are not diagnostic in themselves
• A definitive diagnosis of cancer is made by
looking at tissue biopsy specimens under a
microscope
• However, tumour markers provide information
that can be used to screen (PSA in prostate ca),
diagnose (Ca125 in ovarian cancer), stage,
determine prognosis and guide treatment
Limitations of Tumour Markers
• No “universal” tumour marker that can detect all
types of cancer, has been found
• Non-cancerous conditions can cause the levels of
certain tumour markers to increase
• Not everyone with cancer will have a high level of
a tumour marker associated with that cancer
• No tumour marker identified to date is sufficiently
sensitive or specific to be used on its own to
screen for cancer
Limitations of tumour markers
• Screening asymptomatic patients
• Screening patients with a strong family
history of cancer
• Screening patients with known cancer
causing mutation e.g. ovarian cancer
(Ca125 (BRCA))
H.S.E Guidelines
• If tumour markers were taken recently, do not
repeat
• Be specific – send tumour markers relevant to the
malignancy that is expected
• If likely unknown cancer origin, testing multiple
markers is rarely useful
• Do not take at night or over weekends
• A normal level does not exclude malignancy and
an abnormal may occur in a patient with no
malignancy
Tumour Marker Groups
•
Tumour markers can be classified in two
groups:
1. Cancer specific markers
2. Tissue specific markers
Cancer Specific Markers
• Related to the presence of certain cancerous tissue
– These markers might not be specific in making a
diagnosis
– Useful in the follow-up of treated patients
– To describe progress of the disease
– Response to treatment
Examples of these markers are CEA, Ca 15.3, Ca 125 &
Ca 19.9
Examples of Cancer Specific
Markers
•
•
•
•
•
•
•
•
Metastatic Breast Cancer – CA 15.3
Colon Cancer – CEA
Prostate Cancer – PSA
Ovarian Cancer – CA 125
Pancreatic Cancer – CA 19.9
Non-Hodgkin's Lymphoma – LDH
Testicular Cancer – AFP, Beta HCG, LDH
Multiple Myeloma – Beta 2 Microglobulin, Serum
Protein Electrophoresis (SPEP), Immunoglobulins
and Kappa and Lambda light chains
How are cancer specific markers
used?
• They are measured periodically during
cancer therapy
• A decrease in level may indicate response to
treatment
• No change or an increase may indicate that
the cancer is not responding
• May also be used after treatment has ended
to check for recurrence (return of cancer)
Carcinoembryonic Antigen (CEA)
• A blood-borne protein, first noted to be
produced by tumours of the gastrointestinal
system
• It can also be produced in lung and breast
cancer
• Rarely elevated in early disease
CEA cont….
• Elevated levels do not necessarily mean a
bowel cancer (cirrhosis, inflammatory bowel
disease, hepatitis)
• Rising CEA levels can be an early sign of
recurring bowel cancer
• Normal Range - <5.0ng/mL
CA15.3
• Breast cancer (metastatic only), lung, ovarian and
pancreatic
• Also elevated in benign breast conditions and
sometimes inflammatory bowel condition
• Stage disease, monitor treatment and determine
recurrence
• Normal Range = <31.3 IU/mL
CA 125
• Used for Ovarian cancer
• Elevated in endometriosis and some other
benign diseases
• Help diagnose, monitor treatment and
determine recurrence
• Normal Range = <35 IU/mL
CA 19.9
• Elevated in gastric, colon and pancreatic
cancer
• Also in hepatocellular and bile-duct cancer
• Non cancerous conditions that may increase
CA19-9 include gallstones, pancreatitis,
cirrhosis of liver and cholecystitis
• Normal Range = 0 - 37 IU/mL
LDH
• lactate dehydrogenase (LDH)
• when tissues are damaged by injury or
disease, they release more LDH into the
bloodstream.
• Normal Values = 125-220 IU/L
Elevated LDH
• CVA
• Drugs: anaesthetics,
aspirin, narcotics,
procainamides, alcohol
• Haemolytic anaemia
• Pernicious anaemia’s
• Infectious mononucleosis
(glandular fever)
• Intestinal and pulmonary
infarction (tissue death)
•
•
•
•
•
Kidney disease
Liver disease
Muscular dystrophy
Pancreatitis
Lymphoma and other
cancers
Tissue Specific Markers
• Related to specific tissues which have
developed cancer
- these substances are not specifically
related to the tumour, and may be present at
elevated levels when no cancer is present.
- But unlike the previous group, elevated
levels point to a specific tissue being at fault
PSA
• Often used as a screening test for prostate cancer in men
but can be elevated in prostatic hypertrophy, prostatitis,
urinary retention & post TURP
• Debate among experts and national organizations over the
usefulness of this test for screening asymptomatic men
• Not clear if PSA screening outweighs the harm of followup diagnostic tests
• Normal Range - <4.0 ng/mL
Human Chorionic Gonadotropin
(HCG)
• Elevated in testicular and trophoblastic
disease
• Elevated in pregnancy, testicular failure
• Help diagnose, monitor treatment, and
determine recurrence
Alpha-Feto Protein (AFP)
• Elevated in liver, germ cell cancer of
ovaries or testes
• Elevated during pregnancy
• Help diagnose, monitor treatment and
determine recurrence
AFP cont..
• AFP is measured in pregnant women
through the analysis of maternal blood or
amniotic fluid, as a screening test for a
subset of developmental abnormalities
• Increased in open neural tube defects and
omphalocele
• Decreased in Down syndrome.
Beta-2 Microglobulin
• Multiple myeloma and lymphomas
• Elevated in Cohn's disease and hepatitis
• Determine prognosis
Calcitonin
• Thyroid medullary carcinoma
• Can be elevated in Pernicious anaemia and
thyroiditis
• Help diagnose, monitor treatment, and
determine recurrence
Gene mutations
• Some people are at a higher risk for particular
cancers because they have inherited a genetic
mutation
• While not considered tumour makers, there are
tests that look for these mutations in order to
estimate the risk of developing a particular type of
cancer
• BRCA1 and BRCA2 are examples of gene
mutations
• Related to an inherited risk of breast cancer and
ovarian cancer
Monoclonal Immunoglobulins
• Elevated in Multiple myeloma and
Waldenstrom’s macroglobulinaemia
• Overproduction of an immunoglobulin or
antibody, usually detected by protein
electrophoresis
• Help diagnose, monitor treatment, and
determine recurrence (blood and urine)
Conclusion
• No tumour marker identified to date is
sufficiently sensitive or specific to be used
on its own to screen for cancer
• A normal level does not exclude
malignancy and an abnormal may occur in a
patient with no malignancy
Questions