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Clinical Chemistry
Tumor Markers
50
Chemistry
Post-Graduate
02/11/2011

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Cards

Term

low free PSA fraction or elevated bound PSA fraction

PSAfree:PSAtotal <10%

correlates with?

Definition

Prostate cancer

PSA=protease-->minimize the viscosity of the ejaculate

Term

Prostatic manipulation and instrumentation --> effect

- PSAtotal

- PSAfree

Definition

- minimal

- markedly=> measure before/several weeks after manipulation

Term

Specimen handling

PSAfree

Definition

processed within 2hrs / freeze

-->less stable than bound PSA

Term
When % PSAfree measurement-->advantage?
Definition
prostate volume < 60cc
Term

PSAtotal = 2.5 - 4.0

?test can improve prostate Ca diagnosis

Definition

increased pro-PSA and truncated PSA isoforms1

1pPSA-->anomalous clipping

Term
Correlation between PSA and tm reccurence
Definition

weak in first 5yrs post treatment

preop--> PSA ~ tumor volume and stage

 

Term
Nonneoplastic coditions a/w elevated CEA1
Definition

Smoking, peptic ulcer dz,IBD,pancreatitis, hypothyroidism, biliary/bowel obstruction, cirrhosis

1CEA < 10ng/mL

Term
CEA elevations in malignancies other than colon
Definition
Gastric(well diff, intest. type), breast, lung,pancreas,cervical,urothelial, MTC
Term

Colorectal Ca and degree of CEA elevation

Affected by?

Definition

Tumor stage, grade, site (L>R), ploidy

obstruction,liver function (metabolism)

Term
post-treatment surveillance of colorectal Ca
Definition

serial CEA measurements

most sensitive--> liver mets

poorly sensitive--> locoregional recurrence

Term

Thyroglobulinserum - Cause of

1. Underestimation

2. Overestimation

Definition

Anti-thyroglobulin Ab's->10% (nml Indiv.),>20%Pt w thyroid Ca

2. Macro-thyroglobulin

 

Term

Pt w PTC/FTC and anti-thyroglobulin Ab's

Tumor marker?

Definition

Serial quantitative [anti-thyroglobulin Ab]serum

increase<--Ag stimulation<-- recurrence

Term
Marker for mucinous ovarian Ca, Urothelial Ca & RCC
Definition

Tumor-Associated Trypsin Inhibitor (TATI)

also in pancreatic adenoca-->limited specificity (pancreatitis)

gastric ca (60%) --> diffuse, infiltrative,signet ring

Term
TATI expression and tumor prognosis
Definition
Adverse prognostic factor
Term
Nonneoplastic cause of TATI elevation
Definition

Renal failure

Pancreatitis--> degree of elevation ~ severity

Term

CA 125

Major role in monitoring of which Pt

Definition

Non-mucinous epithelial ovarian neoplasm

elevated only ~ 50% --> stage I dz

Term

elevated CA 125

Nonneoplastic causes

Definition
Pregnancy,fibroids, benign ovarian cysts, pelvic inflammation, ascites, endometriosis
Term

elevated CA 125

In which nonovarian neoplasms?

Definition
Fallopian tube, endometrium, pancreas,breast, colon
Term

post-menopausal woman w palpable adnexal mass & CA 125> 65 U/mL

Dx?

Definition

Ovarian malignancy ( epithelial, non-mucinous)

PPV >95%

Term
Serum markers for breast Ca
Definition

CA27.29 (more sensitive &specific), CA15-3

--> different epitopes of a single Ag = protein product of breast ca assoc MUC1 gene

Term

elevated CA27.29/15-3

nonneoplastic causes?

Definition

benign ovarian cysts, liver dz, benign breast dz

CA 15-3--> sarcoidosis and lupus

Term

elevated CA27.29

non-breast malignancies

Definition
Colon, stomach, pancreas, prostate, lung
Term
Best prognostic markers in breast cancer
Definition

IHC: ER, PR, Her-21 (c-erb-2) Nc staining % of tm cells

--> correlates well with biochemical assays (ligand binding)

1IHC & / FISH -->Rx: trastuzumab

Term
Her-2 assesment in breast cancer
Definition

IHC:Only membranous staining-->only Inv. component

0-3+ --> 2+ => FISH

Term
Best marker for pancreticobiliary adenoca and assesment to treatment response
Definition

CA19-9 >10001 U/L

1not seen in benign dz ( <100 U/L)

Term

CA 19-9

What type of Ag

Definition

 = Lewis blood group Ag

not produced by Le- people

Term

AFP - physiologic effect

Site of synthesis?

Definition

Major component of fetal serum --> ~ albumin

Yolk sac, fetal liver/GI tract

undetectable-->post partum, adults < 5.4ng/mL

benign conditions < 100 ng/mL

Term
AFP and malignancy
Definition

Yolk sac tm--> [AFP] ~ prognosis

HCC -->[AFP] ~ overlap w benign dz

Hepatoid variant of gastric Ca

Term
low level elevation of hCG in non-pregnant woman
Definition
Marijuana use
Term
Marker for monitoring transplant rejection
Definition

beta2-Micoglobulin --> surface-most nucleated cells

-->non-covalent link to MHC I

Increased cell turnover1 => elevated beta2M2

1solid tm & hematolymphoid neoplasms,2renal isufficiency

Term

Raised Alkaline Phosphatase

Causes

Definition

-->osteoblastic activity (osteogenic sarcoma, bone mets,

active Paget disease of bone)

~ Liver function--> hepatic mets (carcioids~prognosis)

Term
Pt with gonadal/urologic cancer and elevated placental-type alkaline phosphatase
Definition
Regan isoenzyme of Alk Phos
Term

modest quantity of 5-HT(serotonin), histamine, catecholamines &5-HTP

Dx: Tumor? Location?

Definition

Carcinoid

Foregut: stomach, proximal duodenum and lung

 

Term

Only serotonin production in high quantities

Dx: Tumor? Location?

Definition

Carcinoid

Midgut: distal duodenum,jejunum,ileum,appendix,right colon

Term

Carcinoid tumor

non secretory for indoles

Location?

Definition

 

Distal 1/3 of transverse, descending colon,sigmoid colon and rectum

~hCG

Term
Most accurate marker for detection of carcinoid tm
Definition

Platelet serotonin

--> take up serotonin from the serum @ constant rate

--> not affected by diet (tryptophan rich)

Term

Urine test

 elevated 5-HIAA

DDx:

Definition

Carcinoid --> 20-30% ~ normal (foregut,hindgut)

False elevation--> tryptophan rich diet

5-HT--> platelets -->some 5-HT--> renal tubules => 5-HIAA

Term

Plasma marker in neuroendocrine tm

--> Tm burden and treatment response

Definition

Chromogranin A

Small cell NE, pheo,carcinoid,islet cell tm

 

Term

Increased [Calcitonin]plasma

DDx?

Definition

MTC

Hashimoto, C-cell hyperplasia, breast ca

20 -->chronic renal failure, Zollinger-Ellison syndrome

Term

[Calcitonin]plasma < 10ng/L

more sensitive test?

Definition

provocative testing - pentagastrin/omeprazole/Ca++

--> in MEN II families

Term

MTC

Marker of worse prognosis

Definition
high CEA => greater de-differentiation
Term

Tumor with secretion of:

Epinephrine & norepinephrine

Dx?

Definition

Pheochromocytoma--> adrenal medulla --> norepinephrine --PNMT-->epinephrine

Extra-adrenal tm --> mainly norepinephrine

Term

Urinary VMA

DDx?

Definition

Paraganglioma1/Pheochromocytoma2/ Neuroblastoma3

--> fractionation of catecholamines/metanephrines

1norepinephrine--> normetanephrine --> VMA

2epinephrine--> metanephrine --> VMA

3also homovanillic acid--> metabolic product of DOPA & dopamine

Term

Most accurate test for initial screening of

tumors of chromaffin cells

Definition

1.free Metanephrineplasma

2. Metanephrine/Catecholamineurine

plasma catecholamines --> poor sensitivity --> episodic release

plasma metanephrines--> long term catecholamine secretion

Term

free Metanephrineplasma Metanephrine/Catecholamineurine

--> equivocal results --> ?test to clarify tests?

Definition
Clonidine suppression test
Term
low VMA:HVA and prognosis
Definition

<-- poorly difeerentiated Neuroblastoma

=> worse prognosis

Term

Monitoring of patients w known hx/o urothelial Ca

Marker? DDx of + results

Definition

urinary NMP22--> sensitive,nonspecific (1-6wks post Sx)

Inflammation-->rapid cell turnover --> false +

Leukocytes--> false +

Term

Bladder tumor antigen

false +

Definition
Stone disease, inflammation, BPH
Term
Urine test for Prostatic adenoCa
Definition

PCA3/DD3

RNA fro urine sediment--> quantitative real time PCR

=> # DD3 RNA transcripts (nontranslated mRNA)

Term

elevated [PSA]serum 1 in prostatic adenoca

Cause?

Definition

1Increase leakage into the extracellular matrix

KLK3 gene (encodes PSA) --> not upregulated in Prostate adenoca 

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