Pocket Oncology (Pocket Notebook Series), 1st Ed.

TUMOR MARKERS

Jacob L. Glass and Stephen S. Chung

Definition

Classically, a tumor marker is a substance measurable in blood or other body fluid that can be used as a surrogate marker for the presence of malignancy. Often these are followed to evaluate the efficacy of a tx or for disease recurrence. While some tumor markers are highly specific & may be used for CA dx or screening when sufficiently elevated, most are not & must be used in conjunction w/other sources of info

Current Tumor Markers by Cancer Site (Alphabetical)

• Breast

- CA 125/CA Ag 125

- CA 15-3, CA 27-29 (both tests measure the same serum antigen)

- CEA

- Calcitonin

• Gastrointestinal

- AFP (liver)

- CA 19-9 (pancreas, colorectal, bile duct, stomach)

- CA 125 (pancreas, colorectal)

- CEA (pancreas, colorectal, liver)

- DES (hepatocellular)

- hCG (stomach, pancreas)

- NSE (pancreatic endocrine)

• Genitourinary

- BTA (bladder; urine test)

- CEA (prostate)

- PAP (prostate)

- PSA (prostate)

- PSMA (prostate)

- NMP22 (bladder; urine test)

• GTC

- AFP (ovary, testis)

- hCG (trophoblastic disease, choriocarcinoma, ovary, testis)

- LDH

• Gynecologic

- CA 125 (ovary)

- CEA (cervix)

- hCG (cervix)

- HE-4 (ovary)

• Lung

- CA 15-3

- Calcitonin (small cell)

- Calretinin (mesothelioma)

- CEA

- hCG

- NSE (small cell)

- PAP

- SMRP (mesothelioma)

- TTF-1 (adenocarcinoma & small cell)

- Napsin A (adenocarcinoma)

• Lymphoma

- B2M (multiple myeloma, lymphomas)

- Monoclonal immunoglobulins (Waldenstrom, Multiple Myeloma; blood & urine tests)

- FLC (multiple myeloma)

- LDH

- PAP (multiple myeloma)

• Melanoma

- LDH

- NSE

- S100/100% soluble in ammonium sulfate at neutral pH

- TA-90/90 kDa tumor-associated antigen

• Neuroendocrine

- Calretinin (adrenocortical carcinoma)

- CgA (neuroendocrine, carcinoid)

- LDH (neuroblastoma)

- NSE (neuroblastoma, carcinoid)

• Thyroid

- Calcitonin (medullary thyroid)

- CEA

- NSE (medullary thyroid)

- Thyroglobulin

CUP (CK staining may be combined w/the above-listed markers to suggest a 1° tumor site)

- CK7+CK20- (Lung, Breast, Thyroid, Endometrial, Cervical, Salivary Gland, & Pancreas Adenocarcinomas, CC)

- CK7-CK20+ (Colorectal & Merkel Cell Carcinomas)

- CK7+CK20+ (Urothelial, Ovarian, & Pancreas Adenocarcinomas, CC)

- CK7-CK20- (HCC, RCC, Prostate, SQCLC & Small Cell Lung Carcinoma, Head & Neck Carcinoma)

Specificity of Tumor Markers

The Sn & Sp of tumor markers is limited due to their correlation w/other biologic processes

References

Merck Manual of Diagnosis and Therapy. 19th ed. 2011, online edition chapter, 123.

Delmar’s Guide to Laboratory and Diagnostic Tests. 2nd ed. 2010, online edition appendix C.

Lab Tests Online, http://labtestsonline.org/understanding/analytes/tumor-markers/, 12/15/12.

American Cancer Society, http://www.cancer.org/treatment/understandingyourdiagnosis/examsandtestdescriptions/tumormarkers/index, 12/15/12.

Pavlidis N, Fizazi K. Cancer of unknown primary (CUP). Crit Rev Oncol Hematol. 2005; 54(3):243–250.