DI test 5-tumor markers – Flashcards
Unlock all answers in this set
Unlock answersquestion
What are serum tumor markers?
answer
soluble molecules in the blood associated with specific malignancies
question
how can serum tumor markers be identified?
answer
utilizing monoclonal antibodies to the tumor marker protein
question
what is the primary clinical use of tumor markers?
answer
monitor response to therapy i patients diagnosed with particular malignancies and to monitor for relapse
question
what is the secondary clinical use of tumor markers?
answer
as a clue in the diagnosis of disease when an abnormality is detected
question
help to characterize an ovarian, testicular, or pancreatic mass
answer
secondary use for tumor markers
question
when are tumor markers used for cancer screening?
answer
not usually-possible exception of PSA
question
3 reasons TM are not useful in cancer screening
answer
-not all cancer have elevated TMs -elevated TMs can be associated with benign conditions -detecting cancer early does not necessarily translate to better prognosis
question
why are TMs not useful for cancer screening (general reason)?
answer
lack sufficient sensitivity and specificity
question
what are the 6 most widely used serum tumor markers?
answer
1. CA 19-9 2. CA 125 3. alpha fetoprotein (AFP) 4. beta subunit of human chorionic gonadotropin (B-hCG) 5. carcinoembryonic antigen (CEA) 6. prostate specific antigen (PSA)
question
Glycoprotein expressed in normal mucosal cells and overexpressed in adenocarcinoma
answer
carcinoembryonic antigen (CEA)
question
what type of cancer is CEA especially expressed in?
answer
colorectal cancer
question
normal CEA
answer
<2.5
question
other malignancies that causes elevation of CEA
answer
gastric pancreatic breast ovary lung
question
what non-neoplastic conditions caused elevated CEA?
answer
heavy smoking PUD ID pancreatitis
question
does CEA sensitivity increase with advancing tumor stage?
answer
yes-elevated in 50% with tumor in local LN, and 75% with distant metastasis
question
when is CEA ordered?
answer
after malignancy is confirmed
question
what do high tumor marker levels correspond to?
answer
more extensive cancer and worse prognosis
question
when do CEA levels return to normal after successful surgical resection?
answer
4-6 weeks after
question
what is a major role for CEA?
answer
following patients for relapse after intended curative treatment
question
what can the use of tumor marker monitoring limit?
answer
the need for post treatment imaging; there is some evidence of increased survival using CEA monitoring post treatment
question
Glycoprotein antigen seen on epithelial tissues of the pancreas, GB, biliary tract cells, stomach, liver, and colon
answer
cancer antigen 19-9
question
what do CA 19-9 elevation primary occur in?
answer
pancreatic cancer, bile duct cancers (Cholangiocarcinoma
question
can malignancies other that pancreatic and bile duct cause increased CA 19-9?
answer
yes, gastric and liver
question
what benign conditions cause elevated CA 19-9?
answer
cirrhosis cholestatic disease-gallstones, cholangitis, pancreatitis
question
are elevated CA 19-9 levels specific?
answer
no
question
how can CA 19-9 elevation be helpful diagnostically?
answer
specific clinical situations consistent with pancreatic cancer= jaundice associated with pancreatic mass on CT imagin
question
why is CA-19-9 of no value in general screening?
answer
low positive predictive value
question
if initially elevated with a malignancy, what can serum CA 19-9 levels be helpful for?
answer
estimating prognosis, following treatment effect, detecting disease recurrence
question
Large transmembrane glycoprotein normally expressed on multiple "female" and GI organs
answer
CA-125
question
what is elevated CA-125 associated with?
answer
epithelial ovarian cancer
question
what else can CA-125 be elevated in?
answer
endometrial, breast, lung, pancreatic cancers, some lymphomas
question
what are some benign disorders that also have elevated CA-125?
answer
endometriosis benign ovarian cysts PID cirrhosis pancreatitis
question
why is CA-125 not useful for screening the general population for ovarian cancer?
answer
insensitivity in early stage disease and low disease prevalence
question
what can CA-125 be helpful in some instances as a adjunct for?
answer
diagnosis of pelvic masses, particularly with post-menopausal women with ovarian masses
question
for ovarian cancer, the higher the CA-125, the more....
answer
advanced the disease
question
in post menopausal women with palpable pelvic masses, a positive predictive value of 98% for ovarian cancer has a CA-125 level of what?
answer
greater than 65
question
what do elevated CA-125 levels during follow up after treatment almost always indicate?
answer
recurrence
question
why is CA-125 much less useful as an adjunct in accurately diagnosing premenopausal women?
answer
they have more benign causes of elevated CA-125
question
who benefits from ovarian cancer screening?
answer
women with familial ovarian cancer syndrome-lynch syndrome, BRCA 1 and BRCA 2
question
in women with familial ovarian cancer syndrome, what is the recommended screening?
answer
combo of CA 125 and transvaginal ultrasound every 6 - 12 months
question
what are suggestions for initiating screening of ovarian cancer in women with familial ovarian cancer syndrome?
answer
age 30 years or 5-10 years earlier than the earliest age of first diagnosis of ovarian cancer in the family
question
A major protein of fetal serum, but falls to very low levels after birth
answer
alpha-fetoprotein (AFP)
question
what cancers is AFP elevated in primarily?
answer
hepatocellular cancer (HCC) testicular germ cell tumors
question
what other cancers is AFP elevated in?
answer
gastric and ovarian
question
what other diseases/states is AFP increased in?
answer
chronic liver disease of any cause pregnancy
question
major risk factors for HCC development
answer
chronic liver disease-HBV, cirrhosis of any cause
question
why should AFP not be used as a screening test for HCC, even for those at high risk?
answer
low positive predictive values
question
what should be used for screening of Hepatocellular cancer in high risk patients?
answer
ultrasonography of liver at 6 month intervals ("HCC surveillance")
question
In a high risk pt for HCC with a suspicious finding on ultrasound, it is generally accepted that serum levels of AFP greater than what are diagnostic of HCC?
answer
500
question
is serial AFP recommended as a screening strategy in patients with high risk of HCC?
answer
no
question
In a man with a suspicious testicular mass, ↑AFP consistent with dx of what?
answer
some types of testicular germ cell tumors
question
does the frequency of AFP increase with advancing clinical stage of testicular cancer?
answer
yes, 10-20% with stage 1, 40-60% with distant metastasis
question
what is the most commonly elevated tumor marker in testicular germ cell cancer (both seminomas and non-seminomas?
answer
beta-hCG
question
what is beta-hCG elevated in primarily?
answer
testicular germ cell cancer-both seminomas and non-seminomas
question
Serum concentrations of AFP and/or beta-hCG are elevated in what percentage of men with testicular germ cell tumor?
answer
80 to 85%
question
what does the level of beta-hCG elevation correlate with?
answer
prognosis, higher levels reduce 5 year survival
question
Although AFP and beta-hCG provide supportive evidence for the initial diagnosis of a testicular cancer and are useful for prognosis and risk stratification, what is their main use?
answer
monitoring response to treatment and detecting recurrence
question
what is AFP or beta-hCG elevation is frequently the first evidence of? (when monitoring post treatment)
answer
germ cell tumor recurrence; need prompt reinstitution of therapy
question
when is AFP especially elevated in pregnancy?
answer
when the pregnancy is complicated by a spinal cord defect-neural tube defect
question
when in pregnancy is AFP screening routinely done?
answer
second trimester of pregnancy
question
Glycoprotein produced by prostatic epithelium
answer
Prostate specific antigen (PSA)
question
what do PSA elevation occur with?
answer
prostate cancer
question
what benign conditions is elevated PSA seen in?
answer
benign prostatic hypertrophy, prostatitis, prostate trauma
question
what was PSA originally introduced as a tumor marker for?
answer
to follow disease progression and monitor for cancer recurrence post treatment
question
do PSA levels help predict the presence of metastatic disease?
answer
yes levels 100 generally have widespread mets
question
when is surveillance for prostate cancer done in men who have have undergone definitive therapy for localized disease?
answer
PE and serum PSA q 6 months for 5 yrs is usually recommended, annually thereafter
question
does the USPSTF recommend PSA based screen for prostate cancer?
answer
no-recommends against it
question
what percentage of invasive cancers does cancer of unknown primary (CUP)
answer
4-5%
question
what do patients with CUPs typically present with symptoms referable to?
answer
the metastases
question
what is the initial work-up, including physical examination, laboratory studies, biopsy studies, and imaging procedures of CUPs used for?
answer
to try and identify the primary site
question
when is checking tumor markers helpful for CUP?
answer
-in older men with significant PSA elevation-diagnosis for prostate cancer -poorly differentiated tumors, marked elevations of AFP and beta-hCG levels can signify testicular germ cell tumor
question
what tumor markers are useful in checking for CUP?
answer
PSA AFP beta-hCG
question
what serum tumor markers are not useful for checking CUP?
answer
CEA CA-15 CA-19-9
