Clinical Chemistry Exam 1 Lecture 9

Cancer
Uncontrolled cellular growth in the form of tumors
What is the second cause of death in the United States of America?
Cancer
Highest Cancer Cases for Men Estimated in 2009
Prostate
Lung
Colorectal
Highest Cancer Deaths for Men Estimated in 209
Lung
Prostate
Colorectal
Highest Cancer Cases for Women Estimated in 2009
Breast
Lung
Colorectal
Highest Cancer Deaths for Women Estimated in 2009
Lung
Breast
Colorectal
Tumor Marker
A substance released by a tumor or released by a tissue affected by a tumor
Are Tumor Markers generally useful for screening?
No
Why are tumor markers generally not useful for screening?
May be = in presence of tumor
May be + in absence of tumor
6 Major Clinical Value of Tumor Markers
Monitoring therapeutic response after diagnosis
Detecting cancer recurrence
Predicting patient prognosis
Screening
Confirmation of disease
Tumor Staging
3 Basic types of tumor markers
Proteins
Tissue Receptors
DNA-based
Tissue Receptors
Cell membrane proteins that bind to hormones
When given the Protein Biomarker give the Cancer type:
AFP
Hepatocellular & germ cell
When given the Protein Biomarker give the Cancer type:
CA-125
Ovarian
When given the Protein Biomarker give the Cancer type:
HE4
Ovarian
When given the Protein Biomarker give the Cancer type:
Tg
Thyroid
When given the Protein Biomarker give the Cancer type:
PSA
Prostate
When given the Protein Biomarker give the Cancer type:
CEA
Colon
When given the Protein Biomarker give the Cancer type:
CA 19-9
Colon and Pancreatic
When given the Protein Biomarker give the Cancer type:
CA 15-3/27-29
Breast
When given the Protein Biomarker give the Cancer type:
HER2/neu
Breast
HER-2-NEU
Oncogene overexpressed in 20% invasive breast cancers
HER-2-NEU used to determine what?
Which drugs to use
CA 15-3 is used to do what?
Monitor response to treatment, to watch for recurrence, and to watch for metastases
What type of tumors are associated with Human Chorionic Gonadotrophin – Beta HCG
Hydatidiform mole
Choriocarcinoma
Testicular tumors
Ovarian tumors
Use a combination of what for monitoring response to therapy/recurrence of testicular cancer?
AFP and HCG
True or False:
Beta HCG is usually undetectable in normal adult serum
True
Beta-2 Microglobulin
Protein on the surface of WBCs, especially lymphs
Does Beta-2 Microglobulin have value in prognosis?
Yes
What diseases are associated with Beta-2 Microglobulin?
Multiple Myeloma
Lymphomas
What tests do you use to determine immunoglobulins?
Protein electrophoresis
IFE
What diseases are associated with immunoglobulins?
Multiple Myeloma
Waldenstrom’s
Bladder Tumor-Associated Antigen (BTA): Test for in what sample?
Urine
What is the Leading cause of Bladder Cancer?
Cigarette smoking
You use BTA in conjuction with what else to detect recurrence of bladder disease?
Cystoscopy
What are the following used to determine:
Estrogen and Progesterone Receptors
Response to hormone therapy
What type of receptors are Estrogen and Progesterone Receptors?
Tissue Receptors
What are the 9 FDA-Approved Protein Biomarkers?
AFP
CA 125
HE4
Tg
PSA
CEA
CA 19-9
CA 15-3
HER-2-NEU
Alpha-Fetoprotein has the highest levels in the fetus and _____ amounts in adults
negligible
What types of diseases are associated with Alpha-Fetoprotein (AFP)?
Testicular cancer
Hepatocellular carcinoma
Where is Alpha-Fetoprotein used as a screen?
Only in countries where liver cancer occurs at a high rate
CA 125 80% Positive
Ovarian Cancer
CA 125 High levels post-surgery are associated with ______ prognosis
poorer
CA 125 is also elevated with ________
endometriosis
HE4 is the newest marker that is used to determine what?
Ovarian cancer recurrence
Thyroglobulin should be ____ after resection
Low
Thyroglobulin is associated with which organ?
Thyroid
What disease is Thyroglobulin elevated in?
Grave’s Disease
PSA is what type of screen?
Prostate Cancer Screen
Only ___ amounts of PSA in healthy men
trace
Do levels of PSA increase or decrease with age?
Increase
PSA plus what is the Best Screen?
DRE
What % of PSA is bound to serum proteins
70-80%
What % of PSA is free?
A Smaller Percentage
Total PSA =
Bound + Free
Free PSA % =
Free / Total PSA
PSA is also elevated in what?
Benign Prostatic Hyperplasia (BPH)
____% PSA indicates higher risk of cancer
<25
What type of cancer is Carcinoembryonic Antigen (CEA) associated with?
Colon Cancer
Other than Colon Cancer what other types of cancer is Carcinoembryonic Antigen (CEA) associated with?
Breast Cancer
Lung Cancer
Pancreatic Cancer
Rectal Cancer
Is CEA very sensitive?
No, 35% of colorectal cancer patients have = CEAs
Is CEA supposed to be used as a screen for colorectal cancer?
No
True or False:
Cigarette smokers have higher levels of CEA than nonsmokers
True
What disease is CEA increased in?
COPD
What is CEA most frequently used for?
Cancer Management
True or False:
CEA is the most frequently used tumor marker in cancer management
True
What type of cancers is CA 19-9 associated with?
Pancreatic, Colon, and Bile Duct Cancers
CA 19-9 is Elevated in about ____% of those with bile duct cancer
65
True or False:
Non-cancerous causes of bile duct obstruction can cause very high CA 19-9 levels which fall when the blockage is cleared
True
What is the leading type of cancer in women?
Breast Cancer
What is the leading type of cancer in men?
Prostate Cancer
What is the formula for a free PSA%?
>25% is Good
What is the usefulness of calculating a fPSA%?
Differentiate Cancer from BPH
What tissue markers are frequently used to determine the expected response to hormone treatment in a woman with breast cancer?
CA 15-3
HER-2-NEU
What hormone marker is used to monitor the progression of both uterine cancer and testicular cancer?
Beta-HCG
Name the marker used with multiple myeloma patients to establish initial prognosis
Beta-2 Microglobulin
Name the marker used with multiple myeloma patients to monitor progression
Immunoglobulins
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