What is BRCA1 and how can it be used?

BRCA1 is a tumor marker for breast cancer

It can be used to screen for the disease as well as determining who may be susceptible to it

What is the most common marker for colon cancer?

What is it used for?

CEA (Carcinoembryonic antigen)

It is used to check for metastasis

What is a good tumor marker for screening?

Why is it so useful?

PSA

It has high sensitivity AND specificity

Why is an ER+ breast tumor considered a good prognosis?

Because it can be treated with an estrogen receptor blocker that will prevent the tumor from growing....

Tamoxifen

Name a depressant, a stimulant and a narcotic

Depressant: Alcohol, Heroin, Diazepan, Barbituates

Stimulant: Sympatomimetics (Cocaine)

Narcotic: Opiates

What are the two enzymes involved in alcohol metabolism?

1. Alcohol Dehydrogenase

2. Acetaldehyde Dehydrogenase

What two qualities make a tumor marker test useful?

Sensitivity and Specificity 

What does a tumor marker test with good sensitivity do well?

It detects all patients in a screening pool who have a particular cancer

What does a tumor marker test with good specificity do well?

It IDs patients who have a specific tumor and not those with non-malignant diseases

What does CEA stand for?

Carcinoembyonic Antigen (CEA)

What is the normal serum and tissue fluid value of CEA?

<3.0 ng/ml

CEA can act as an early relapse detector of ___(1)___ and is a good ____(2)_____

1. Colorectal

2. Prognostic indicator

A normal pretherapy CEA value indicates...

Lower metastasis incidence

A high pretherapy? CEA value indicates...

Higher metastasis incidence

CEA is a fetal _______

Glycoprotein

AFP is a major __(1)__ that is synthesized __(2-5)__

1. Fetal protein

2. Yolk sac

3. Fetal liver

4. GI tract

5. Kidney

Moderate elevations of AFP are found in...

Liver disease (hepatitis/cirrhosis)

Concentrations of greater than >1000 ug/L are associated with ____________

Hepatocellular carcinoma

A combined AFP/hCG of

AFP: High

hCG: Not increased

indicates?

Yolk sac tumors

A combined AFP/hCG of

AFP: Not increased

hCG: High

indicates?

Choriocarcinoma or Seminoma

A combined AFP/hCG of

AFP: High

hCG: High

indicates?

Embryonal carcinoma

-or-

Nonseminomatous testicular tumor

A combined AFP/hCG of

AFP: Not increased

hCG: Not increased

indicates?

Teratoma

In breast cancer what is the marker found on the surface of cancer cells?

What is it used for?

CA15-3

It is used to monitor treatment and to detect recurrance

^{What is the specificity and sensitivity of the CA15-3 breast cancer marker?} 

Specificity: 86%

Sensitivity: 30%

This tumor supressor repairs damaged DNA or destroys cells if the DNA cannot be repaired

BRCA1

A screening that picks up a mutation of BRCA1 indicates ________________

A high risk screening

What are the two isoforms of the estrogen receptor?

ERa and ERb

ERa is an idicator of....

Good prognosis???

ERb is an indicator of...

Predictor of relapse????

What is the treatment for a tumor that relies on estrogen receptors?

Tamoxifen

How does tamoxifen work to reduce tumor growth?

It binds to an estrogen receptor (blocking estrogen from binding ) in a way that does not change the shape of the receptor and does not allow it to bind to coactivators

Free PSA is PSA that is not bound to the plasma antiproteases __(1)__ and __(2)__

1. a1-antichymotrysin

2. a2-macroglobulin

In increase in the ratio of free/total PSA is associated with...

An increased probability of prostate cancer

A PSA (free? total? both?) screening test has a specificity of __(1)__ and a sensitivity of __(2)__

1. 97 %

2. 96 % (prostate C)

Why do most tumor markers fail the sensitivity component of screening?

1. There is a low prevalence of malignancy in asymptomatic persons

2. In patients with a small volume (early) cancer, values aren't elevated

In Asia, primary hepatoma is screened for with ___

AFP

Men over 50 years old should be screened for ___

PSA

For several family cancers susceptibility genes include:

1. For breast or ovarian cancer

2. For colon cancer

1. BRCA 1 and 2

2. APC (Adenomatous polyposis coli)

What is the most useful applications of tumor markers?

 To monitor treatment response

What is the second most important use for tumor markers?

Early detection of recurrance

(The cancer has already been id'd so sensitivity is more important than specificity)

A diagnosis can be difficult to make with tumor markers because...

Most markers have a low specificity

A prognosis using tumor markers can assess these four characteristics

1. Assessment of tumor aggressiveness

2. Indication of risk

3. Prediction of length of being relapse-free

4. Predict the survival period