week 12: diagnosis of infectious disease tumor markers thursday, october 8, 2015 biochemistry,...
TRANSCRIPT
Week 12:
Diagnosis of
infectious disease TUMOR MARKERS
Friday, April 21, 2023
Biochemistry, Microbiology and Immunology
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES
• SEROLOGY• The scientific study of blood sera and their effects• Subdivision of immunology concerned with in-vitro
Ag-Ab reaction• Concerned with the laboratory study of the
activities of the components of serum that contribute to immunity
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES
• IMMUNOLOGY• The study of the molecules, cells, organs and
systems responsible for the recognition and disposal of foreign (non-self) material
• The study of how the body components respond and interact
• The desirable and undesirable consequences of immune interactions
• The ways in which the immune system can be manipulated to protect or treat disease
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES
• Microbial antigen detection provides direct evidence of infection, and is preferred for diagnosis of infection over antibody detection (indirect evidence of infection).
• However, not all infectious agents have available antigen assays or culture techniques making the detection of specific antibodies diagnostically useful.
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES
• Infectious Disease Indicators, Non-specific
• Acute phase reactants• Limulus lysate assay
– Detects trace amounts of endotoxin from all gram (-) bacteria
– Presence in CSF = gram (-) bacterial meningitis
– Rapid clearance from blood makes serum test unreliable
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES
• Molecular Biology– Uses:
• Density of amplifiable DNA correlates with microbial density
• Monitoring of disease progression or initiation or modification of therapy
• Drug susceptibility testing• Differentiation of antigenically similar organisms• Determination of virulence of antimicrobial
resistance genes
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES
• SYPHILIS• The most commonly acquired spirochete disease
in the U.S.• A complex sexually transmitted disease that has
a highly variable clinical course• Over 50,000 cases reported in 1990 in the U.S.• Causative agent is Treponema pallidum• No natural reservoir in the environment, requires
living host
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES
• SYPHILIS• Mode of Transmission
– Organism is very fragile, destroyed rapidly by heat, cold and drying
– Sexual transmission most common, occurs when abraded skin or mucous membranes come in contact with open lesion
– Can be transmitted to fetus– Rare transmission from needle stick and blood
transfusion
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES
• SYPHILIS - - Stages of the Disease1. Primary stage
= primary lesion is chancre (is a painless ulceration (sore) most commonly formed during the primary stage of syphilis. This infectious lesion forms approximately 21 days after initiation of infection)= the lesion heals spontaneously after 1-5 weeks= swab of chancre smeared on slide, examined under dark-field microscope, spirochetes will be present= 30% become serologically positive one week after appearance of chancre, 90% positive after three weeks
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES
• SYPHILIS - - Stages of the Disease2. Secondary Stage
= occurs 6-8 weeks after initial chancre, becomes systemic, patient highly infectious= characterized by localized or diffuse mucocutaneous lesions, often with generalized lymphadenopathy= primary chancre may still be present= secondary lesions subside in about 2-6 weeks= serology tests nearly 100% positive
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES
• SYPHILIS - - Stages of the Disease3. Latent Stage
= stage of infection in which organisms persists in the body of the infected person without causing symptoms or signs= this stage may last for years= one-third of untreated latent stage individuals develop signs of tertiary syphilis= after 4 years it is rarely communicable sexually but can be passed from mother to fetus
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES
• SYPHILIS - - Stages of the Disease4. Tertiary Stage
= occurs anywhere from months to years after secondary stage, typically between 10 to 30 years
= gummatous syphilis: A gumma is a soft, non-
cancerous growth resulting from the tertiary stage of syphilis.
= cardiovascular syphilis
= neurosyphilis
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES
• SYPHILIS• Congenital Syphilis
» Transmitted from mother to fetus» Fetus affected during the second or third trimester» 40% result in syphilitic stillbirth» Live-born infants show no signs during first few
weeks= 60-90% develop clear or hemorrhagic rhinitis (pus-containing discharge from the nose)= skin eruptions (rash) especially around mouth, palms of hands and soles of feet= general lymphadenopathy, hepatosplenomegaly, jaundice, anemia, painful limbs & bone abnormality
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES
• SYPHILIS - - DIAGNOSIS• Evaluation based on 3 factors
» Clinical findings» Demonstration of spirochetes bacteria in clinical
specimen» Present of antibodies in blood or CSF
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES
• SYPHILIS - - DIAGNOSIS• Laboratory Testing
C. Specific Treponemal antibody tests are used as a confirmatory test.
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES
• LYME’S DISEASE= Disease first recognized in 1977 in Lyme, Connecticut= Causative organism is Borrelia burgdorferi: (bacteria)= Organism has been isolated from blood, CSF, skin lesions and joint fluid= Can be transmitted perinatally, causing intra-uterine death= Vector of transmission is the tick= Must remain attached a minimum of 24-48 hours
for transmission to occur
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = LYME’S DISEASE
• STAGES OF THE DISEASE1. Localized rash 2. Dissemination to multiple organ system
= occurs by way of the bloodstream= may occur weeks to months after infection= migratory pain may occur in the joints, tendons and bones
= neurologic Bell’s palsy: an idiopathic unilateral facial nerve paralysis , peripheral neuropathy, aseptic meningitis: bacteria do not grow in cultures of the fluid around the brain and spinal cord (cerebrospinal fluid).
= cardiac include carditis and arrythmia3. spread widely to other organs
= characterized by chronic arthritis= affects the large joints, especially the knee
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = LYME’S DISEASE
• Diagnostic criteria• Isolation of organism from clinical specimen or• Diagnostic titers of IgG and IgM in serum or CSF
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = STREPTOCOCCAL INFECTION
• STREPTOCOCCAL SEROLOGY• Streptococci are gram (+),
• Divided into groups or serotypes based on cell wall components
• Culture and rapid screening tests detect early infection
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = STREPTOCOCCAL INFECTION
• GROUP A STREPTOCOCCAL INFECTION
• Two major sites of infection : upper respiratory tract and skin
• Upper respiratory tract = sore throat, tonsils• Skin • Suppurative complications =scarlet fever, septic
arthritis, meningitis
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = STREPTOCOCCAL INFECTION
• GROUP A STREPTOCOCCAL INFECTIONA. Rheumatic Fever
= only certain serotypes of S. pyogenes is involved= develops in 2-3% untreated upper respiratory
infections= symptoms occur about 18 days after sore throat= Group A streptococcus share antigenic determinants with host tissue, especially heart and even joints= inflammation of mitral valve most serious one= 30-60% of patients may suffer permanent disability
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = STREPTOCOCCAL INFECTION
• GROUP A STREPTOCOCCAL INFECTIONB. Post-Streptococcal Glomerulonephritis
= follows Streptococcal infection of skin or pharynx= occurs about 10 days following initial infection= characterized by damage to glomeruli of the kidneys= renal function impaired due to reduction in glomerular filtration rate, results in edema = one theory is that the damage caused by antigen-antibody complexes depositing in kidneys
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = STREPTOCOCCAL INFECTION
• LABORATORY TESTING• Most reliable test is culture and identification
of the organism from infected site
• Rapid streptococcal screening tests from the throat exudates
• Detection of Streptococcal antibodies
• Serological evidence of disease is based on elevated or rising titer of Streptococcal antibodies
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES
• SEROLOGY OF VIRAL INFECTIONSA. Hepatitis
= general term meaning inflammation of the liver, usually accompanied with fever, nausea, vomiting and jaundice
= can be caused by radiation, chemicals, disease processes such as autoimmune disease, viruses and
cancer= 5 distinct viruses – A, B, C, D and E
= initial infection may be clinically silent= chronic carrier state may develop and may result to liver
failure due to cirrhosis (malfunction of liver), hepatocellular carcinoma, or fulminant hepatitis: a rare and frequently fatal form of acute hepatitis B in which the patient's condition rapidly deteriorates, with hepatic encephalopathy, necrosis of the hepatic.
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = VIRAL HEPATITIS
• Hepatitis A virus (HAV)• Transmitted by fecal oral route• Occurs worldwide• Most hepatitis epidemics are due to HAV• Progress of infection:
» Incubation of 2-7 weeks, may be asymptomatic or may include jaundice
» Clinical illness develop abruptly and include fever, anorexia, vomiting, fatigue and malaise
» Increase in serum transaminases» RUQ pain (right upper quadrant) , dark urine
and pale stool» Recovery 2-4 weeks, no carrier state» Mortality 0-1%
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = VIRAL HEPATITIS
• Hepatitis A virus (HAV)• Antibody and antigen markers
» First and most clinically useful is IgM antibody to HAV
» IgM indicates acute infection, appears 4-5 weeks after exposure
» IgM disappears in 3-6 months, replaced by IgG anti-HAV
» IgG peaks during recovery and may remain detectable for life
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = VIRAL
HEPATITIS• Hepatitis B virus (HBV)
• Route of infection is usually parenteral, direct inoculation
• Incidence of infection is 140,000-320,000 cases per year resulting in 5-6,000 deaths per year
• Duration of acute infection ranges from 4-8 weeks with symptoms similar to HAV
• 10% progress to chronic• One-third of chronic at risk of developing chronic
active hepatitis, cirrhosis and/or hepatocellular carcinoma
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = VIRAL
HEPATITIS• Hepatitis D virus (HDV) = Serological
marker• IgM anti-D and total anti-HD (IgM and IgG)
detected during acute phase
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = VIRAL
HEPATITIS• Hepatitis C virus (HCV)
• Clinically and epidemiologically similar to HBV
• 60-70% of HCV patients will develop chronic hepatitis, 10-20% cirrhosis and 15% hepatocellular carcinoma
• HCV and HBV may be present as co-infections
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = VIRAL
HEPATITIS• Hepatitis E virus (HEV)
• Similar to HAV in transmission and clinical course• Found primarily in developing countries, Africa and
Asia• Results in acute hepatitis• Pregnant women with HEV may develop liver
failure and death• No distinctive markers, diagnosis based on
symptoms for exposed individuals in endemic countries
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = VIRAL
HEPATITIS• Hepatitis G virus
• Independently discovered 1995-1996 by 2 separate research groups
• RNA virus
• Transmissible by blood-borne route
• Found in patients with acute or chronic liver dse.
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = HERPES
VIRUS GROUP• Epstein-Barr Virus (EBV)
• Spread through oral transmission of infective saliva and is the cause of infectious mononucleosis: a viral infection causing fever, sore throat, and swollen lymph glands, especially in the neck
• Other diseases – malignant lymphoma , nasopharyngeal carcinoma, B-cell lymphoma
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = HERPES
VIRUS GROUP• Epstein-Barr Virus (EBV)
– Characteristics of infection• 4-7 week incubation, acute self limiting • Enlarged LN (lymph nodes) in the neck, sore
throat, fever, rash• Malaise, lethargy, extreme tiredness• Liver and spleen involvement and enlargement• Hematology: high WBC, over 20% atypical reactive
lymphocytes
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = HERPES
VIRUS GROUP• Cytomegalovirus
• Transmission occurs from person to person
• In babies may cause life-threatening illness resulting in CNS involvement, hearing loss, and mental retardation
• Seen in patients with deficient immune system, AIDS, transplantation
Rubella Virus
• Rubella, also known as German measles or three-day measles, is a disease caused by the rubella virus. The name "rubella" is derived from Latin, meaning little red. Rubella is also known as German measles because the disease was first described by German physicians in the mid-eighteenth century. This disease is often mild and attacks often pass unnoticed. The disease can last one to three days.
Rubella
• Children recover more quickly than adults. Infection of the mother by Rubella virus during pregnancy can be serious; if the mother is infected within the first 20 weeks of pregnancy, the child may be born with congenital rubella syndrome (CRS), which entails a range of serious incurable illnesses. Spontaneous abortion occurs in up to 20% of cases.
Rubella
• It is transmitted via airborne droplet emission from the upper respiratory tract of active cases (can be passed along by the breath of people sick from Rubella). The virus may also be present in the urine, feces and on the skin. The disease has an incubation period of 2 to 3 weeks.
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = GERMAN
MEASLES• Rubella Virus
– Laboratory testing• Performed primarily for diagnosis of
acquired infections and to determine immune status of pregnant patients
• Some tests detect IgG antibodies, other IgM
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = HIV
• Human Immunodeficiency Virus (HIV)• Etiologic agent of AIDS• Discovered independently by Luc Montagnier of
France and Robert Gallo of the US in 1983-1984• One million people infected in US, 30 Million
worldwide are infected• Leading cause of death of men aged 25-44 and 4th
leading cause of death of women in this age group in the US.
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = HIV
• Laboratory diagnosis of HIV infection1. Methods utilized to detect
• Antibody• Antigen• Viral nucleic acid• Virus in culture
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = HIV
• Laboratory diagnosis of HIV infectionViral Load Tests
= viral load or viral burden is the quantity of HIV-RNA that is in the blood= measures the amount of HIV-RNA in one milliliter of blood
take 2 measurements 2-3 weeks apart to determine baseline repeat every 3-6 months in conjunction with
CD4 counts to monitor viral load and T-cell count
repeat 4-6 weeks after starting or changing antiretroviral therapy to determine effect on viral load
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = DENGUE
• Dengue fever• Transmitted by mosquitoes• There are 4 known distinct serotypes
( dengue virus 1, 2, 3 and 4)• In children , infection is often sub-clinical or
causes a self-limited febrile disease• Secondarily infected with a different
serotype, dengue hemorrhagic fever or dengue shock syndrome
SEROLOGICAL DIAGNOSIS OF INFECTIOUS DISEASES = Typhoid Fever
• Caused by Salmonella typhi• Rapid detection is now available in the market
» Typhidot = a qualitative detection test against a specific antigen of Salmonella typhi. It can detect both IgG and IgM separately and simultaneously. Thus, indicating the status of acute infection, convalescence or previous exposure
» Salmonella typhi IgG/IgM Rapid test = an immunochromatographic assay for rapid, qualitative and differential detection of IgG and IgM antibodies to Salmonella typhi in human serum, plasma or whole blood.
Typhidot
Typhoid Fever Rapid test
Typhoid Fever Rapid Test
H. Pylori Rapid test
Malaria Ab Rapid test
Rapid test for TB
Rapid test for Chlamydia
Rotavirus/Adenovirus Rapid test
Rapid test for Rubella
Rapid test for RSV
Rapid test for Tetanus
TUMOR MARKERS
• What are they?• Are substances usually proteins, that are produced by the
body in response to cancer growth or by the cancer tissue itself and certain benign (noncancerous) conditions
• Detected in higher than normal amounts in the blood, urine, or body tissues
• Some tumor markers are specific for one type of cancer, while others are seen in several cancer types
• Measurements can be useful – when used along with x-rays, or other tests in the detection and diagnosis of some types of cancer
TUMOR MARKERS
• Measurements of tumor marker levels alone are not sufficient to diagnose cancer for the following reasons:– Tumor marker levels can be elevated in people with
benign conditions– Tumor marker levels are not elevated in every person
with cancer – especially in early stages of the disease– Many tumor markers are not specific to a particular
type of cancer
TUMOR MARKERS• Characteristics required of the “ideal” tumor marker
– The following are desirable• 100% accuracy in differentiating between healthy
individuals and tumor patients• Ability to detect all tumor patients, if possible at
a very early stage• Organ specificity, so that information is provided
on the localization of the tumor• Correlation between the concentration of the
marker freely circulating in serum and the individual tumor stages
• Ability to indicate all changes in tumor patients receiving treatment
TUMOR MARKERS
• Clinical Uses of Tumor Markers
• Early detection of the tumor
• Differentiating benign from malignant conditions
• Evaluating the extent of the disease
• Monitoring the response of the tumor to therapy
• Predicting the recurrence of the tumor
TUMOR MARKERS
• CARCINO-EMBRYONIC ANTIGEN (CEA)• A complex glycoprotein with a MW of
approximately 180,000 daltons• First discovered in patients with
adenocarcinoma of the colon in 1965• Metabolized primarily by the liver with a
circulating half-life ranging from 1 to 8 days• Hepatic diseases, including extrahepatic biliary
obstruction, intrahepatic cholestasis and hepatocellular disease, may impede clearance rates and increase serum concentrations
TUMOR MARKERS
• CARCINO-EMBRYONIC ANTIGEN (CEA)– Benign conditions that cause elevated CEA
• Cigarette smoking Bronchitis• Emphysema Gastritis• Gastric ulcer Hepatic disease• Pancreatitis Polyps of colon &
rectum• Diverticulitis Crohn’s disease
Renal disease
TUMOR MARKERS
• Alpha-FETOPROTEIN (AFP)• An oncofetal protein that was first discovered in
1963 in the serum of mice with hepatoma• Normal fetal protein synthesized by the liver, yolk
sac, and GIT (gastrointestinal tract) that shares sequence homology with albumin
• A major component of fetal plasma, reaching a peak concentration of 3mg/ml at 12 weeks of gestation -- following birth, it clears rapidly from the circulation, having a half-life of 3.5 days
• Concentration in adult serum <20ng/ml
TUMOR MARKERS
• Alpha-FETOPROTEIN (AFP)– Benign conditions causing elevation of AFP
• 2nd and 3rd trimesters of pregnancy
• Cirrhosis
• Acute and chronic hepatitis
• Hepatic necrosis
TUMOR MARKERS
• Alpha-FETOPROTEIN (AFP)– Malignant conditions causing elevation of AFP
aside from hepatoma• Teratocarcinoma : cancer made of cysts that
contain one or more of the three layers of cells found in a developing (70%)
• Carcinoma of the pancreas (23%)• Carcinoma of the stomach (18%)• Carcinoma of the lung (7%)• Carcinoma of the colon (5%)
TUMOR MARKERS
• HUMAN CHORIONIC GONADOTROPIN (HCG)
• Normally secreted by placental tissue with highest circulating levels occurring at 60 days of gestation
• Significant elevation occurs during pregnancy and in patients with trophoblastic neoplasms tumors
• It maybe secreted in small amounts by the testis, pituitary gland and GIT
• Maybe elevated in some benign conditions – peptic ulcer disease, inflammatory intestinal disease and cirrhosis
• In patients with trophoblastic disease, levels of HCG correlate with tumor burden, prognosis of patient and response to therapy
TUMOR MARKERS
• CALCITONIN• A peptide hormone
• A hypocalcemic factor secreted by C cells of the thyroid gland
• Serum half-life is 12 minutes and normal levels are <0.1 nanogram/ml using radioimmunoassay
• Marked elevations are observed in carcinoma of the thyroid
TUMOR MARKERS• CATECHOLAMINE METABOLITES
• Most useful in diagnosing and monitoring patients with NEUROBLASTOMA (malignant (cancerous) tumor that develops from nerve tissue. It usually occurs in infants and children).
TUMOR MARKERS
• PROSTATIC ACID PHOSPHATASE: PAP• First proposed as a marker of advanced carcinoma
of the prostate in 1938• Acid phosphatases are group of enzymes that are
also present in lower concentrations in the bone, kidney, liver, spleen, and intestine
• PAP is a glycoprotein• Levels can be elevated in some benign conditions
— osteoporosis, hypoparathyroidism, hyperthyroidism, prostatic surgical treatment, and benign prostatic hypertrophy
TUMOR MARKERS
• ADRENOCORTICOTROPHIC HORMONE (ACTH)
• Most frequently observed ectopic hormone produced by neoplasms
• Associated with other malignant diseases – adenocarcinoma and squamous cell carcinoma of the lung, pancreatic islet cell tumor, carcinoma of the breast, carcinoma of the colon, medullary thyroid carcinoma and carcinoma of the ovaries
TUMOR MARKERS• ANTIDIURETIC HORMONE (ADH)
• Malignant diseases with ectopic secretion of ADH – carcinoma of pancreas, bronchial tumors, carcinoma of the adrenal cortex, carcinoma of the bladder and prostate
• Benign conditions – pulmonary disease, disorders of the CNS, anesthetics, and ingestion of drugs
TUMOR MARKERS
• CA 125• An antigen present on 80% of nonmucinous
ovarian carcinomas• Defined by a monoclonal antibody (OC125)
that was generated by immunizing laboratory mice with a cell line established from human ovarian carcinoma
• Elevated in other cancers – endometrial, pancreatic, lung, breast, and colon
• Elevated in benign conditions – menstruation, pregnancy, endometriosis
TUMOR MARKERS
• CA 19-9
• A monoclonal antibody generated against a colon carcinoma cell line to detect a monosialoganglioside found in patients with gastrointestinal adenocarcinoma
• Elevated in gastric cancer (21-42%), colon cancer (20-40%), pancreatic cancer (71-93%)
TUMOR MARKERS
• PROSTATE-SPECIFIC ANTIGEN (PSA)• Found in normal prostatic epithelium and
secretions but not in other tissues• It is a glycoprotein• Highly sensitive for the presence of prostatic
cancer• Elevation correlated with stage and tumor
volume• Predictive of recurrence and response to
treatment
COMMON TUMOR MARKERS CURRENTLY IN USE
Tumor Markers Cancers What else? Sample
AFP (Alpha-fetoprotein)
Liver, germ cell cancers of ovaries or testes
Also elevated during pregnancy
blood
CA 15-3 Breast and others including lung and ovaries
Also elevated in benign breast conditions;
blood
CA 19-9 Pancreatic, sometimes colorectal and bile ducts
Also elevated in pancreatitis and inflammatory bowel disease
blood
CA 125 ovarian Also elevated with endometriosis, some other diseases and benign conditions; not recommended as a general screen
blood
COMMON TUMOR MARKERS CURRENTLY IN USE
Tumor markers Cancers What else? Sample
CEA (Carcino-embryonic antigen
Colorectal, lung, breast, thyroid, pancreatic, liver, cervix, and bladder
Elevated in other conditions such as hepatitis, COPD, colitis, pancreatitis and in cigarette smokers
blood
Estrogen Receptors
breast Increased in hormone dependent cancer
tissue
hCG (human chorionic gonadotropin)
Testicular and trophoblastic
Elevated in pregnancy, testicular failure
Blood, urine
Her-2/neu breast Oncogene that is present in multiple copies in 20-30% of invasive breast cancer
tissue
COMMON TUMOR MARKERS CURRENTLY IN USE
Tumor markers Cancer What else? Sample
Monoclonal Immunoglobulins
Multiple Myeloma and Waldenstrom’s macroglobulinemia
Overproduction of an Ig or Ab, usually detected by protein electrophoresis
Blood, tissue
Progesterone Receptors
breast Increased in hormone dependent cancer
tissue
PSA, total and free
prostate Elevated in BPH, prostatitis and with age
blood
LESS COMMON TUMOR MARKERS
Tumor Markers
Cancers What else? Sample
B2M (Beta-2 microglobulin
Multiple myeloma, lymphomas
Crohn’s disease, hepatitis
Blood
BTA (Bladder tumor antigen
Bladder Gaining acceptance
Urine
CA 72-4 (Cancer antigen 72-4
Ovarian No evidence that is better than CA 125
Blood
LESS COMMON TUMOR MARKERS
Tumor Markers Cancers What else? Sample
Calcitonin Thyroid Medullary carcinoma
Also elevated in pernicious anemia and thyroidits
Blood
NSE (Neuron-specific enolase
Neuroblastoma, lung cancer
Blood
NMP22 Bladder Not widely used Urine
Prostate-specific membrane antigen (PSMA)
Prostate Not widely used, levels increase normally with age
Blood
LESS COMMON TUMOR MARKERS
Tumor Markers Cancers What else? Sample
Prostatic acid phosphatase (PAP
Metastatic prostate cancer, myeloma, lung cancer
Not widely used anymore, elevated in prostatitis and other conditions
Blood
S-100 Metastatic melanoma
Not widely used Blood
TA-90 Metastatic melanoma
Not widely used, being studied
Blood
Thyroglobulin Thyroid Used after thyroid is removed to evaluate treatment
Blood