CANCER MARKER

Tumour marker is substance present in or produced by a tumour itself or produced by the host in response from normal tissue or to determine the presence of a tumour based on measurement in blood or secretion . it is measured qualitative or quantitatively by chemical ,immunological or molecular method to identify cancer presence . ideally tumour marker should occur only in patient white malignancy , should correlate with stage and response to treatment and should be easily and reproducibly measured . no tumour marker has met this ideal yet . tumour marker are either polypeptide , protein ,hormones ,surface antigen ,cytokines ,oncogenes or gene product .Baseline level measured prior to therapeutic intervention and followed later by serial periodic measurement help to periodic outcome therapy .toumor marker also help in early detection of recurrence , replace and metastasis . however ,it is the rate of change the tumor marker level which is more important then its absolute value .these test should not be used as screening test but should be correlated with other clinical criteria .

Clinical Application:-

mass screening ,differential diagnosis in symptomatic

patients ,clinical staging ,estimating tumor volume , prognostic indicator of disease progression , detecting recurrence ,evaluating the success of treatment and monitoring response to therapy .

Alpha Fetoprotein ( AFT ):AFT (A glycoprotein) is one of best known oncofetal antigen .it is elevated in 80% of patient with hepatocellular carcinoma and 60-80% of patient with testicular germ cell tumour .about 55100% cases of yolk sac tumours are AFP positive .this fact is helpful in distinguishing solid patterns of yolk sac tumours from seminomas as the seminomas are AFP negative .False positive resulthave been noticed in many non-neoplastic condition like cirrhosis ,massive liver necrosis ,chronic hepatitis etc. plasma AFP is elevated to a laser extent in carcinomas of colon , lung and pancreas .in early stage ,its level correlates with tumour size .Except pregnancy ,levels 1000micro g/l indicate cancer .the AFP levels decline rapidly after surgical resection of liver cancer or treatment of germ cell tumor .serial post therapy measurement of AFP provide a sensitive index of response to therapy and recurrence , good prognostic indicator of survival . AFP can be used for screening in high risk cases .

MARKERS Hormones

ASSOCIATED CANCERS

HCG Trophoblastic tumour,non seminomatous testicular tumor Calcitonin medullary thyroid carcinoma Catecholamines and metabolites Pheochromocytoma Ectopic Hormones:ACTH small cell carcinoma lung, pancreatic carcinoma and neural . tumour ADH/ANH small cell carcinoma lung intracranial neo plasma PTH-rP Squamous cell carcinoma lung ,breast, ovarian renal .. carcinoma and adult T-cell lymphoma Insulin Fibrosarcoma ,mesenchymal sarcomas hepatocellular . .. carcimoma Serotonin Bronchial adenoma ,pancreatic and gastric carcinoma Erythropoietin Renal carcinoma , cerebellar hemangioma ,heptocelloular . .. carcinoma Ferritin Acute leukemia ,Hodgkin disease ,multipale myeloma .. ,malignant lymphoma ,liver and prostate carcinoma ONCOFETAL ANTIGEN :AFP Hepatocellular carcinoma ,nonseminomatous germ cell testicular tumour CEA Isoenozmey prostate cancer phosphate (PAP) small cell carcinoma lung ,neuroblastoma Carcinoma of colon ,pancreas ,lung ,stomach and breast

Prostatic acid Neuron specific enolase Specific proteins Immunoglobulins Beta 2 Prostate specific Thyroglobulin IGFBP-2

Multiple myeloma Multiple Myeloma microgloubulin Prostate cancer antigen (PSA) ,total ,free and ratio Differentiated thyroid carcinoma Prostate cancer

Mucins and Glycoprotins:CA125 CA19.9 CA72.4 CA15.3 Cyfra 21.1 Viruses Human papilloma virus (HPV) .. Cervical carcinoma Epstein Barr virus (EVB) .. Burkitt,s lymphoma ,nasopharyngeal carcinoma and some lymhoproliferative disorders Ovarian cancer Pancreas and colon cancer Gastric and colon cancer Breast cancer Non small cell lung cancer

Tumor markers According to Tissue of Tissue of Origin:Breast Cancer . Prostate Cancer Colorectal cancer Gastric cancer Pancreatic cancer ., .. Liver cancer Lung cancer Ovarian cancer Cervical cancer Trophoblastic cancer Testicular cancer Urinary Blader cancer CA15.3,CA27.29,CEA,ERandPR, pS2,HER-2/neu ,catheepsin .. D,p53,DNA ploidy,S phase,EGFr PAP ,PSA,DNA polidy,IGFBP-2 CEA,p53 CA72.4,CEA CA19.9,CEA (carcinoma); glucagon (glucagonama); insulin .. proinsulin ,cpeptide and IGFBP-1(insulinoma);pancreatic . polypeptide (endocrine tumor) AFP,CEA ,ferritin Cyfra-21.1(NSCLC);neuron specific enolase (SCLC) CA125,CEA(epithelial);urinary gonadotropin peptide . .. .(endometroid); inhibin (granulosa cell) HPV,squamous cell carcinoma antigen (SCC-Ag) Beta hCG AFP(yolk sac tumour) ,beta hCG (Trophoblast) DNA polidy,s-phase

Thyroid cancer

Calcitonin (medullary carcinoma thyroglobulin (differentiated) Squamous cell carcinoma antigen N-myc oncogene, .neuron specific enolase ,HPV Chromogranin a VMA, catecholamines , metanephrines

Head and Neck cancer neuroblastoma . Pheochromocytoma