Tumour marker

D. Faraggi and A. Kramar, Some methodological issues associated with tumour marker development biostatistical aspects. Urol. Oncol. 5, 211-213 (2000). 

AFP is a 70 kDa glycoprotein found in the circulatory system of the developing foetus. It is synthesized primarily by the yolk sac and (foetal) liver. AFP is present only in vanishing low quantities in the serum of adults (where it is replaced by serum albumin). Elevated adult serum levels of this marker are often associated with various cancers of the liver, as well as germ cell tumours. It is also sometimes expressed by gastric and pancreatic cancer cells. Although a useful tumour marker, increased serum AFP levels also often accompany cirrhosis and some other non-cancerous liver diseases. 

McShane LM, Altman DG, Sauerbrei W et al. REporting recommendations for tumour MARKer prognostic studies (REMARK). Br J Cancer 2005 93 387-391. 

Navis I, Sriganth P, Premalatha B. 1999. Dietary curcumin with cisplatin administration modulates tumour marker indices in experimental fibrosarcoma. Pharmacol Res 39 175-179. 

Ohta K, Ohigashi M, Naganawa A, Ikeda H, Sakai M, Nishikawa J, Imagawa M, Osada S, Nishihara T. 2007. Histone acetyltransferase MOZ acts as a co-activator of Nrf2-MafK and induces tumour marker gene expression during hepatocarcinogen-esis. Biochem J 402 559-566. 

Yousef GM, Diamandis EP. An overview of the kallikrein gene families in humans and other species Emerging candidate tumour markers small star, filled. Clin Biochem 2003 36 443-452. 

Tumour markers. Specific types of cancer may produce so-called tumour markers. These markers can be monitored by serum samples that will show the amount of the marker in the blood. Again it is essential to have a baseline measurement of the specific tumour marker in order to monitor any change during treatment. In the case of Mrs KT, a baseline measurement of the CEA (carcinoembryonic antigen) marker should be taken and then monitored at each cycle of treatment. Response to treatment should be demonstrated by a progressive reduction in tumour marker levels. 

The elevations of the germ cell tumour markers P-human chorionic gonadotrophin (P-HCG), a-fetoprotein (AFP) and lactate dehydrogenase (LDH) further support the working diagnosis of testicular cancer. The levels of P-HCG and AFP in particular are negligible in males in normal circumstances, but they are raised in patients with testicular cancers as the tumours secrete these substances in large quantities. 

The pharmacist should therefore look to reinforce the information already provided to Mrs RP by outlining those parameters being monitored (i.e. tumour marker, symptoms and a CT scan after the third or fourth cycle). It will also be necessary to inform Mrs RP of the need to monitor carefully for side-effects. Often it is useful for patients to be asked to record the side-effects that they suffer from during treatment in a patient diary booklet or similar. 

Engwegen, J. Y., Gast, M. C., Schellens, J. H., and Beijnen, J. H. Clinical proteomics searching for better tumour markers with SELDI-TOF mass spectrometry. Trends Pharmacol. Sci. 27, 251-259, 2006. 

Nakata, B., Takashima, T., Ogawa, Y, ISHIKAWA, T, Hirakawa, K. (2004). Serum CYFRA 21-1 (cytokeratin-19 fragments) is a useful tumour marker for detecting disease relapse and assessing treatment efficacy in breast cancer. Br. J. Cancer. 91, 873-878. 

Biochemistry Non-specific signs of inflammation, cholestasis parameters and increasing jaundice are found. The tumour markers AEP and CEA are normal, while the tumour markers CA 19-9 and CA 50 are usually elevated. There may also be mutations of the cyclin-dependent kinase inhibitor pl6/MTSl. (s. tab. 37.11)... 

Tab. 37.12 Laboratory findings and tumour markers arousing suspicion in liver metastasis...

The following factors are decisive for the success rate (7.) age of the patient, (2.) distribution pattern and number of metastases, (3.) size of the largest metastasis, (4.) stage of primary tumour, (5.) extrahepatic metastases, (6.) lymph node involvement, (7.) respective value of the tumour marker, and (5.) intraoperative blood loss. (323)... 

The availability of secondary standards (i.e., sample matrix-based standards) has the advantage that the calibration and analysis can be performed in a similar matrix, however, without complete elimination of the matrix effects [133]. For many analytes that are structurally heterogeneous (e.g., some hormones and tumour markers), even the development of reference methods constitutes a serious problem [133]. 

Takami, H. et al. (1992) Calcitonin gene-related peptide as a tumour marker for medullary thyroid carcinoma. Int. Surg.. 77.181-185. 

Hodgall EV, Hodgall CK, Tingulstad S, et al. Predic- tive values of serum tumour markers tetranectin, OVXl, CASA and CA125 in patients with a pelvic mass. Int J Cancer 2000 89 519-23. 

Eriksson B, Oberg K, Stridsberg M. Tumour markers in neuroendocrine tumours. Digestion 2000 62(suppl l) 33-8. 

AZIZ, K., Tumour markers Current status and future applications, Scand. J. Clin. Lab. Invest. 55 (1995) 153-155. 

Leader M, Gollins M, Patel J, Henry K. Vimentin an evaluation of its role as a tumour marker. Histopathology. 1987 11 63-72. 

Haglund C, Lindgren J, Roberts PJ, Nordling S. Difference in tissue expression of tumour markers CA 19-9 and CA 50 in hepatocellular carcinoma and cholangiocarcinoma. Br J Cancer. 1991 63 386-389. 

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