TUMOR MARKER

Ng HN Tuan, MD, PhD

Globocan 2012
HEPATOCELLULAR CARCINOMA
NCCN guidelines
NCCN guidelines
NCCN guidelines
NCCN guidelines
NCCN guidelines
AFP
A glycoprotein that is
normally produced
during gestation by the
fetal liver and yolk sac.

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AFP
• Elevated serum AFP occurs with tumors of gonadal origin & in a
variety of other malignancies.
• Elevated serum AFP may also be seen in patients with chronic liver
disease without HCC such as acute or chronic viral hepatitis.

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AFP – clinical values
• A rise in serum AFP in a patient with cirrhosis or hepatitis B should
raise concern that HCC has developed.
• Patients with cirrhosis and persistently elevated AFP values have an
increased risk of developing HCC compared with those who have
fluctuating or normal levels.
• It is generally accepted that serum levels greater than 500 ug/L
(normal in most laboratories is between 10 and 20 ug/L) in a high-risk
patient is diagnostic of HCC.

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AFP – clinical values
• HCC is often diagnosed at a lower AFP level
in patients undergoing screening.
• Serum concentrations are normal in up to
40% of small HCCs.
• An elevated AFP may be more likely in
patients with HCC due to viral hepatitis
compared with alcoholic liver disease.
• AFP levels are normal in the majority of
patients with fibrolamellar carcinoma (a
variant of HCC) Fibrolamellar carcinoma

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AFP – clinical values
The sensitivity, specificity, and predictive value for the serum AFP in the
diagnosis of HCC depends upon:
1. the characteristics of the population
2. the cutoff value chosen for establishing the diagnosis
3. the gold-standard used to confirm the diagnosis.

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AFP – clinical values
The diagnostic characteristics of the serum AFP in screening for HCC in
patients with different types of chronic liver disease:
• AFP cutoff 16 ug/L (sensitivity 62, specificity 89 percent)
• AFP cutoff 20 ug/L (sensitivity 60, specificity 91 percent)
• AFP cutoff 100 ug/L (sensitivity 31, specificity 99 percent)
• AFP cutoff 200 ug/L (sensitivity 22, specificity 99 percent)

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AFP – clinical values
The following estimates were based upon a cutoff value of >20 mcg/L
in a systematic review that included five studies:
• Sensitivity 41 – 65%
• Specificity 80 – 94%
• Positive likelihood ratio 3.1 - 6.8
• Negative likelihood ratio 0.4 - 0.6

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NON SMALL CELL LUNG CANCER
NCCN guidelines
NCCN guidelines
NCCN guidelines
Harris & McCormick, 2010
 EGFR signaling pathways

Janku, F. et al. (2010) Targeted therapy in non-small-cell lung cancer—is it becoming a reality?
Nat. Rev. Clin. Oncol. doi:10.1038/nrclinonc.2010.64
Sharma et al. Nature Reviews Cancer 7, 169–181 (March 2007) | doi:10.1038/nrc2088
OPTIMAL trial