CLINICALCHEMISTRY

CLINICAL CHEMISTRY LECTUREKIDNEY

LECTURE TUMOR MARKERS
FUNCTION (October
TESTS: 30, 2017) NITROGEN (NPN)
NON-PROTEIN MLS 3G JR TRIO MLS
JR FUNDAL
3G JR TRIO
BRETAA
JR FUNDAL
- CLAVEL

CANCER TUMOR SUPPRESSOR GENE

Uncontrolled growth of cells Encodes a protein involved in protecting cells
Forms a solid mass or tumor
GENETIC CHANGES ASSOCIATED WITH CANCER
CAUSES OF TUMORS
Tumorigenesis and metastasis CANCER SEVERITY
Inherited and acquired genetic mutations Tumor size
Extent of invasion
TUMORIGENESIS Lymph node involvement
Activation of growth factors and oncogenes Metastasis
In combination with: Histologic assessments
Apoptosis
Tumor suppressor GENERALIZED CANCER STAGING AND PROGRESSION
Cell cycle regulation genes

TUMOR MARKERS
Associated with the presence of cancer
Can be:
Enzymes
Hormones
Receptors
Oncofetal antigens or Oncogenes
Testing recurrence of cancer
In the presence of tumors, normal cell transforms into a malignant cell
and develops unique antigens
Produced by the tumor itself or produced by the host

COMMON CANCER TERMS STAGE I: Localized primary tumor

ANGIOGENESIS STAGE II: Invasion of primary tumor through epithelium and into blood
Development of new blood vessels vessels
APOPTOSIS
Programmed cell death STAGE III: Migration of tumor into regional lymph node
CELL CYCLE
STAGE IV: Metastasis and invasion of tumor to distant tissues
Phases of cell activity divided into Growth (G), Synthesis (S) and
Mitosis (M) IDEAL TUMOR MARKER
NEOPLASM 1. Tumor specific
Uncontrolled tissue growth 2. Absent in healthy individual
It may be malignant or benign 3. Readily detectable in body fluids
ONCOGENE Tumor markers with high specificity and sensitivity used as basis
Encodes a protein that promotes uncontrolled cell growth when Screening diagnosis
mutated Prognosis
Detection of recurrence

Page 1 of 4
CLINICALCHEMISTRY
CLINICAL CHEMISTRY LECTUREKIDNEY
LECTURE TUMOR MARKERS
FUNCTION (October
TESTS: 30, 2017) NITROGEN (NPN)
NON-PROTEIN MLS 3G JR TRIO MLS
JR FUNDAL
3G JR TRIO
BRETAA
JR FUNDAL
- CLAVEL

Monitoring the response to treatment Recurrence

SCREENING AND SUSCEPTIBILITY TESTING Lactate Hematologic Prognosis Serum using

Most of the clinically utilized tumor markers are found in normal cells Dehydrogenase malignancies indicator Immunoassay
and benign conditions in addition to cancer (LD) Elevated
non-
PROGNOSIS specifically in
Tumor marker concentration generally elevates during the progression numerous
of tumor cancer
Serum tumor marker levels at diagnosis
- Reflect the aggressiveness of a tumor Alkaline Metastatic Determination Serum using
High concentration of a serum tumor marker at diagnosis Phosphatase bone cancer of bone and Immunoassay
- Presence of malignancy and possible metastasis (ALP) Hepatocellular liver
cancer involvement;
MONITORING EFFECTIVENESS OF THERAPY AND DISEASE RECURRENCE nonspecific in
Osteosarcoma
Patients with elevated tumor markers many bone
- Effective therapy results in a dramatic decrease or Lymphoma
Leukemia related and
disappearance of the tumor marker
liver cancers
Effective initial treatment
- Appearance of circulating tumor can then be used as a highly Neuron- Neuroendocrine Prognostic Serum using
sensitive marker of recurrence specific tumors indicator and Immunohisto-
enolase monitoring of chemistry
LABORATORY CONSIDERATION FOR TUMOR MARKER MEASUREMENT
disease
Wide concentration range of tumor markers
Variability in tumor concentrations between different manufacturers progression

SERUM PROTEIN TUMOR MARKERS

TYPES OF TUMOR MARKERS
TUMOR TUMOR TYPE CLINICAL METHOD &
Enzyme
MARKER IMPORTANCE SPECIMEN
Serum protein
Endocrine Serum M- Plasma cell Diagnosis
Carbohydrate and cancer antigen protein dyscrasias Therapeutic
Receptor monitoring
ENZYME TUMOR MARKERS Serum-Free Plasma cell Diagnosis
TUMOR TUMOR TYPE CLINICAL METHOD & Light Chains dyscrasias Therapeutic
MARKER IMPORTANCE SPECIMEN monitoring
Prostate- Prostate Cancer Prostate Serum using - Hematologic Prognostic marker
specific cancer Immunoassay Microglobulin malignancies for
antigen (PSA) screening lymphoproliferative
Therapy disorders
Monitoring

Page 2 of 4
CLINICALCHEMISTRY
CLINICAL CHEMISTRY LECTUREKIDNEY
LECTURE TUMOR MARKERS
FUNCTION (October
TESTS: 30, 2017) NITROGEN (NPN)
NON-PROTEIN MLS 3G JR TRIO MLS
JR FUNDAL
3G JR TRIO
BRETAA
JR FUNDAL
- CLAVEL

ENDOCRINE TUMOR MARKERS ASSIGNMENT:

TUMOR TUMOR TYPE CLINICAL METHOD & Table 32.4 page 668
MARKER IMPORTANCE SPECIMEN Table 32.6 page 669
Table 32.7 page 670
ACTH Pituitary Ectopic ACTH-
adenoma producing tumor FREQUENTLY ORDERED TUMOR MARKERS
Ectopic ACTH- AFP
producing CA 125
tumor CEA
HCG
Antidiuretic Posterior SIADH PSA
Hormone (ADH) Pituitary
tumors AFP
C-peptide Insulin- Insulinoma Abundant carcinoembryonic serum
Increase in hepatocellular CA and germ cell tumor
secreting
Alpha feto protein
tumors

Calcitonin MTC Screening REGULATION OF AFP

Response to Participates as transport protein and maintains oncotic pressure
therapy AFP peaks at 1/10 the concentration of albumin at 30 weeks
Monitoring gestation
recurrence of MTC Infants initially have high serum AFP

Chromogranin Pheochromo- Aid in the diagnosis CLINICAL APPLICATION OF AFP

A cytoma of carcinoid tumors Diagnosis, staging, prognosis and treatment monitoring of HCC
Neuro- Pheochromo- Originates in the liver due to chronic diseases
blastoma cytomas Classification and monitoring therapy for testicular CA
Carcinoid Neuro-blastoma
SUBTYPES OF TESTICULAR CA
tumors
Small cell lung Seminomatous tumor
Directly forms from malignant germ cells
cancers
Nonseminomatous tumor
Cortisol Adrenal tumors Diagnosis of
Differentiate into embryonal CA, teratoma, choriocarcinoma,
Cushings and yolk sac tumors
syndrome
Adrenal adenoma USE OF HCG AND AFP FOR TESTICULAR CA CLASSIFICATION
Gastrin neuroendocrine prognostic marker for
tumor lymphoproliferative
Germ cell tumor AFP HCG
disorders Yolk sac tumor Increase No

Page 3 of 4
CLINICALCHEMISTRY
CLINICAL CHEMISTRY LECTUREKIDNEY
LECTURE TUMOR MARKERS
FUNCTION (October
TESTS: 30, 2017) NITROGEN (NPN)
NON-PROTEIN MLS 3G JR TRIO MLS
JR FUNDAL
3G JR TRIO
BRETAA
JR FUNDAL
- CLAVEL

Choriocarcinoma No Increased BRCA-1 Breast and ovarian CA

Embryonal CA Increased +/- CA-125 Ovarian CA

Teratoma No No CA 15-3 Breast CA

CA-19.9 Gastric, pancreatic and colorectal CA

CA 125
CA-50 Gastric and pancreatic CA
Marker for ovarian CA
Increased in individuals with endometriosis and during the 1 st CA 27.29 Breast CA
trimester of pregnancy
Expressed in the ovary Calcitonin Medullary thyroid CA

Cathepsin-D Breast CA
CEA
CEA Breast,lung, colorectal and stomach CA
Marker for colorectal CA
Utilized in combination with histology and TNM (tumor node CK-1 Small cell lung CA; prostate CA
metastasis) staging system
Lung, breast, and gastrointestinal Estrogen receptor Breast CA
(ER)
HCG
GGT Hepatoma
Normally secreted by trophoblasts to maintain the corpus luteum
through the 1st trimester of pregnancy HER-2/neu Breast CA (Herceptin therapy)
Elevated in choriocarcinoma and germ cell tumors
Prognostic indicator for ovarian CA Nuclear matrix Urinary bladder CA
Diagnostic marker for testicular CA protein
Most useful marker for detection of gestational trophoblastic
disease

FREQUENTLY REQUESTED TUMOR MARKERS

Tumor markers Associated cancer

AFP Hepatic and testicular CA

ALP Lung cancer

Amylase Pancreatic CA

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