Andrew Idoko

Group 332
Variant 14

Discuss the prognostic factors of tumour behaviour that can be applied in clinical
oncological practice.

Tumour cell markers

Tumours cell markers may be used to detect, diagnose, or treat cancer. Alone, however,
they aren't sufficient for a diagnosis. Tumour cell markers may also be associated with other
benign (non-malignant) conditions.
The Table below highlights Some of the more commonly used tumor cell markers and their
associated malignant and non-malignant conditions.

Tumour Marker Cancers Associated Non-Cancerous "Normal"

With Elevated Reasons for Elevated Results
Results Levels

Blood test (blood serum (**) indicates the Different

marker), except where most common labs may
noted. association, if one have
exists different
high/low
values

AFP Germ cell cancers of Pregnancy (clears after Low levels

Alpha-fetoprotein ovaries & testes** birth), liver disease present in
(Non-seminomatous, (hepatitis, cirrhosis, both men &
particularly toxic liver injury), non-
embryonal and yolk inflammatory bowel pregnant
sac, testicular disease women (0-
cancers). 15 IU/ml);
Some primary liver generally
cancers results >400
(hepatocellular) are caused
by cancer
(Half-life 4-
6 days)

Bence-Jones Proteins Multiple Myeloma** Amyloidosis Generally, a

(urine test) Waldenstrom's value of
or macroglobulinemia, 0.03-0.05
Monoclonal chronic lymphocytic mg/ml is
Immunoglobulins (blood leukemia significant
test) for early
disease
B2M Multiple myeloma**, Kidney disease, < 2.5 mg/L
Beta-2-Microglobulin chronic lymphocytic hepatitis
leukemia (CLL), and
some lymphomas
(including
Waldenstrom’s
macroglobulinemia)

BTA Bladder cancer**, Invasive procedure or None

Bladder Tumor Antigen cancer of kidney or infection of bladder or normally
(urine test) ureters urinary tract detected

CA 15-3 Breast** (often not Liver disease < 31 U/ml

Cancer Antigen 15-3 or elevated in early (cirrhosis, hepatitis), (30% of
Carbohydrate Antigen stages of breast lupus, sarcoid, patients
15-3 cancer), lung, tuberculosis, non- have an
ovarian, endometrial, cancerous breast elevated CA
bladder, lesions 15-3 for 30-
gastrointestinal 90 days
after
treatment,
so wait 2-3
months
after
starting
new
treatment
to check)

CA 19-9 Pancreas** and Pancreatitis, ulcerative < 37 U/ml is

Cancer Antigen 19-9 or colorectal, liver, colitis, inflammatory normal
Carbohydrate Antigen stomach and biliary bowel disease, > 120 U/ml
19-9 tree cancers inflammation or is generally
blockage of the bile caused by
duct, thyroid disease, tumor
rheumatic arthritis

CA 125 Ovarian cancer** Pregnancy, 0-35 U/ml

Cancer Antigen 125 or breast, colorectal, menstruation,
Carbohydrate Antigen uterine, cervical, endometriosis, ovarian
125 pancreas, liver, lung cysts, fibroids, pelvic
inflammatory disease,
pancreatitis, cirrhosis,
hepatitis, peritonitis,
pleural effusion,
following surgery or
paracentesis
CA 27.29 Breast** (best used Ovarian cysts, liver < 40 U/ml
Cancer Antigen 27.29 or to detect recurrence and kidney disorders, Generally,
Carbohydrate Antigen or metastasis). non-cancerous levels > 100
27.29 Colon, gastric, liver, (benign) breast U/ml signify
lung, pancreatic, problems cancer (30%
ovarian, prostate of patients
cancers have
elevated CA
27.29 for
30-90 days
after
treatment,
so wait 2-3
months
after
starting
new
treatment
to check)

Calcitonin Medullary thyroid Chronic renal <8.5 pg/mL

cancer** insufficiency, Chronic for men
use of Proton-pump < 5.0 pg/mL
inhibitors (medications for women
given to reduce
stomach acid)

CEA Colorectal cancers ** Cigarette smoking, <2.5 ng/ml

Carcinoembryonic Breast, lung, gastric, pancreatitis, hepatitis, in non-
Antigen pancreatic, bladder, inflammatory bowel smokers <5
kidney, thyroid, head disease, peptic ulcer ng/ml in
& neck, cervical, disease, smokers
ovarian, liver, hypothyroidism, Generally, >
lymphoma, cirrhosis, COPD, biliary 100 signifies
melanoma obstruction metastatic
cancer

Chromogranin A Neuroendocrine Proton-pump Normal

Tumors**, carcinoid inhibitors (medications varies on
tumors, given to reduce how tested,
neuroblastoma, and stomach acid) but typically
small cell lung cancer < 39 ng/l is
normal

Cytokeratin Fragment Lung, urologic, Lung disease 0.05-2.90

21-1 gastrointestinal, and ng/ml
(Blood Test) gynecologic cancers
HCG Germ cell, testicular Pregnancy, marijuana In men: <
Human Chorionic cancers**, use, hypogonadism 2.5 U/ml
Gonadotrophin gestational (testicular failure), In non-
Or Beta-HCG, B-HCG trophoblastic cirrhosis, pregnant
neoplasia inflammatory bowel women: <
disease, duodenal 5.0 U/ml
ulcers

5-HIAA Carcinoid tumors Celiac & tropical Normal 6-

5-Hydroxy-Indol Acetic sprue, Whipple's 10 mg over
Acid disease, dietary: 24 hours
(24 hour urine walnuts, pecans,
collection) bananas, avocados,
eggplants, pineapples,
plums & tomatoes;
medications:
acetaminophen,
aspirin and
guaifenesin

LDH Lymphoma, Hepatitis, MI (heart Normal

Lactic Dehydrogenase melanoma, acute attack), stroke, anemia values are
leukemia, seminoma (pernicious & 100-333 u/l
(germ cell tumors) thalassemia), muscular
dystrophy, certain
medications
(narcotics, aspirin,
anesthetics, alcohol),
muscle injury

NSE Small cell lung Proton pump inhibitor Normal < 9

Neuron-specific Enolase cancer**, treatment, hemolytic ug/L
neuroblastoma anemia, hepatic
failure, end stage renal
failure, brain injury,
seizure, stroke

NMP 22 Bladder cancer** BPH (benign prostatic Normal < 10

(urine test) hypertrophy), U/ml
prostatitis

PAP Metastatic prostate Prostatitis, Gaucher's Normal :

Prostatic Acid cancer** disease, osteoporosis, 0.5 to 1.9
Phosphatase Myeloma, lung cirrhosis, u/l
cancer, osteogenic hyperparathyroidism,
sarcoma prostatic hypertrophy
 PSA Prostate** BPH (benign prostatic Normal < 4
Prostate Specific Antigen hypertrophy), nodular ng/ml (half
prostatic hyperplasia, life 2-3
prostatitis, prostate days)
trauma/ inflammation,
ejaculation

Tg Thyroid Cancer Anti-thyroglobulin < 33 ng/mL;

Thyroglobulin antibodies if entire
thyroid
removed
< 2 ng/mL

Urine Catecholamines: Neuroblastoma** Dietary intake 8 – 35

VMA Pheochromocytoma, (bananas, vanilla, tea, mmols over
Vanillylmandelic Acid ganglioneuroma, coffee, ice cream, 24 hours
(24 hour collection of rhabdomyosarcoma, chocolate),
urine; it is a PNET medications
catecholamine (tetracyclines,
metabolite) methyldopa, MAOIs)

HVA Neuroblastoma** Same as VMA, in Up to 40

Homovanillic Acid addition: psychosis, mmols over
(24 hour collection of major depression, 24 hours
urine; it is a dopamine (a
catecholamine medication)
metabolite)
Clinical manifestations of tumours

In most patients, the earlier the cancer is found, the more effective the treatment is likely to
be and the better the Prognosis. Some cancers may be diagnosed on a routine physical
examination, even before the person develops any signs or symptoms.
Cancer's seven warning signs
The American Cancer Society has developed an easy way to remember the seven warming
signs of cancer. Each letter in the word CAUTION represents a possible warning sign that
should spur an individual to see a doctor.
C hange in bowel or bladder habits
A sore that doesn't heal
U nusual bleeding or discharge
T hickening or lump in the breast or elsewhere |
I ndigestion or difficulty swallowing |
O bvious change in a wart or mole
N agging cough or hoarseness