Tumor Markers

• Tumor markers are defined as a biochemical substance (e.g. hormone,

enzymes, or proteins) synthesized and released by cancer cells or
produced by the host in response to cancerous substance and are used
to monitor or identify the presence of a cancerous growth.
• Sites : Tumor markers may be present in
Blood circulation
Body cavity fluids
Cell membrane
Cell cytoplasm
• Methods of detection :
a) Immunohistological and immunocytological tests are used to
detect those tumor markers which are present only on cell membrane
and cytoplasm of cells and not in blood circulation.
• Examples
• Immunofluorescence
• Immunoperoxidase
• Monoclonal antibody technology
b)Biochemical methods are used for measuring tumor markers found
in blood circulation.
• Examples :
• Radioimmunoassay
• Enzyme-immune assay
• Immunochemical reactions
• Clinical uses of tumor markers
I. For screening specially in asymptomatic population.
II. For diagnosis in symptomatic patients.
III. As a prognostic predictor.
IV. For monitoring during treatment of the patients.
V. For early detection for relapse/recurrence of the cancerous process.
• Characteristics of an ideal tumor marker
1. Ideal tumor marker must satisfy the following criteria:
2. Should have high sensitivity.
3. Should have high specificity.
4. Should have high accuracy.
5. Should have high precision.
6. Method should be simple and easy to measure.
7. Should not be very costly.
a) Clinical criteria
• Should be disease sensitive.
• It must be positive in all patients with particular cancer.
• No false- negative results.
• Should have high disease- specificity
• Should not be detectable in normal healthy people.
• Should be associated only with a particular cancer.
• No false-positives.
• Classification of tumor markers
• Tumor markers which have been found clinically useful in cancer
patients may be grouped as follows:
1)Tumor associated antigens
• Carcinoembryonic antigen (CEA)
• Alpha fetoprotein (AFP)
2)Carbohydrate antigens
• Detected by monoclonal antibody
• CA-125 (ovarian cancer)
• CA-19-9 (pancreatic cancer)
• CA-15-3 (breast carcinoma)
3)Pregnancy associated antigen
• Human chorionic gonadotropin (BHCG)
4)Enzymes and isoenzymes – used as tumor markers
• Prostate specific antigen (PSA)
• LDH isoenzymes
• CK isoenzymes
• Commonly used tumor marker
1)Carcinoembryonic antigen (CEA)
• It is one of the oncofetal antigens used most frequently and widely as a
tumor marker in clinical oncology.
• It is present in the circulation of patients with gastrointestinal malignancy
and in the normal epithelial cell of foetal GI tract, hence it was named as
CEA because of its presence in both carcinoma and embryonic tissue.
• It is glycoprotein
• Molecular weight varies from 150,000 to 300,000
• CEA has been reported to be most useful as tumor marker in colorectal
cancer.
2)Human chorionic gonadotropin (BHCG)
• HCG is a placental hormone. It is synthesized by the
syncytiotrophoblastic cells of placental villi.
• Normally, it is present in the serum of non pregnant women in vey
trace amounts or not at all but it is markedly elevated in pregnancy.
• It is a glycoprotein.
• Molecular weight average 45000.
• BHCG is an ideal tumor marker for diagnosing and monitoring
gestational trophoblastic tumor and germ cell tumor of testes and ovary.
• Alpha fetoprotein (AFP)
• Like CEA, alpha fetoprotein is another oncofoetal antigen. AFP is
synthesized in the liver, yolk sac and GI tract in foetal life and is released
into the serum of foetus.
• It is a normal component of serum protein in human foetus.
• It is a glycoprotein.
• Molecular weight 61,000 to 70,000
• AFP is the most specific and ideal tumor marker for primary
carcinoma of the liver (hepatocellular carcinoma)
• AFP as tumor marker has been found to be also most useful in germ
cell tumor of the testes and ovary.