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Tumormarkers

Tumormarkers. Tumormarkers. Tumormarkers: → optimal marker for a given disease? → optimal time of marker assessment? → diagnostic tool? Follow-up after therapy?. Tumormarkers Definition. Substances detectable in blood and body fluids of patients with malignant disease.

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Tumormarkers

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  1. Tumormarkers

  2. Tumormarkers Tumormarkers: → optimal marker for a given disease? → optimal time of marker assessment? → diagnostic tool? Follow-up after therapy?

  3. TumormarkersDefinition Substances detectable in blood and body fluids of patients with malignant disease. • Synthesis in tumor tissue • Tumor cells induce the synthesis • in other cells

  4. Criteria for a useful tumormarker • Positive predictive value/negative predictive value  qualitative/quantitative distinction between: • healthy individuals • patients with benign disease • patients with malignant disease • High specifity • High sensitivity • Method of assessment: • simple und practical • standardised

  5. TumormarkersIndications • Diagnosis • Follow up

  6. Tumormarkers Diagnosis • Early detection in asymptomatic individuals • Mass-screening • Risk-groups • Diagnostic tool in symptomatic patients • Localisation • Organ-specificity • Staging • Prognosis

  7. TumormarkersFollow-up • Postoperative follow-up • Early detection of relapse and/or metastases

  8. TumormarkersFollow-up • Early detection of relapse during adjuvant therapy • Monitoring of palliative therapy modalities

  9. TumormarkersFrequency of marker assessment • Before surgery Definition of a relevant tumor marker for follow-up • After surgery to assess the success of surgery (2-4 weeks after surgery) • Monitoring of adjuvant therapy modalities: • before initiation of therapy • every 3 months during 1st and 2nd year • every 6 months during 3rd to 5th year • Monitoring of palliative therapy modalities: • before the start/change of therapy • every 2 months

  10. Tumormarkers Types of tumormarkers Oncofetal substances CEA, AFP Oncoplacental substances -HCG Tumor associated antigens CA 19-9, CA125, CA153, CA72-4,... Proliferation antigens TPS, TPA, 2-MG, Ectopic hormones/enzymes Calcitonin, TG, NSE, VIP, Serotonin, PSA Laboratory parameters LDH, Ferritin, BSG, Acut-Phase-Proteins,...

  11. TumormarkersTumors of the Male • Germ cell tumors • Prostate carcinoma AFP, -HCG PSA, PAP

  12. TumormarkersTumors of the female • Breast carcinoma • Ovarian carcinoma • Carcinoma of cervix • Choriocarcinoma CA 153, CEA CA 125, CA 72-4 CEA, SCC -HCG

  13. TumormarkersGastrointestinal Tumors • Esophagus CEA, SCC • Stomach CA 72-4, CEA, CA 19-9 • Colon CEA, CA 19-9 • Pancreas CA 19-9, CEA • Gallbladder and biliary tract CA 19-9, CEA • Liver AFP

  14. TumormarkersOther Tumors • SCLC NSE • NSCLC CEA, CYFRA • ENT SCC • Breast cancer CEA, Ca 153 • Ovarian cancer Ca 125 • Myeloma 2-MG, Paraproteins • Lymphoma 2-MG, LDH, Ferritin

  15. Tumormarker elevations in benign conditions Smokers and COPD  CEA Ascites, peritoneal tumors  CA125 Pregnancy  CA 125, TPS Intestinal inflammation  CEA, CA19-9 Rheumatic diseases  CEA, CA19-9 Renal insufficiency CEA, PSA, β-2MCG Cirrhosis of the liver  CEA, CA19-9, etc. Mastopathy  CA 15-3 Benign ovarian tumors  CA 125

  16. Tumormarkers -HCG Diagnosis / Follow-up of non-seminatous germ cell tumor and trophoblastic tumors AFP  Diagnosis / Follow-up of hepatocellular carcinoma and non- seminomatous germ cell tumor PSA  Early diagnosis / Follow-up of prostate carcinoma CA 125  Follow-up after therapy of ovarian cancer

  17. Tumormarkers should not be applied for: • Screening of asymptomatic individuals Exception: PSA, -HCG in risk-patients • Exclusion of a malignant disease before organ transplantation, etc. • Benign diseases with known unspecific elevation of tumormarkers • Uncritically in symptomatic patients (CA 125 in males? etc.)

  18. TumormarkersConclusions • Screening within risk-groups: PSA, -HCG, CA 125 • Diagnostic within symptomatic patients (useful choice) • Follow-up after curative surgery Colon-CA, Ovarian-CA, etc. • Therapy monitoring does not substitute for radiologic examination, except if not possible  repeat value, if confirmed  initiate therapy/change therapy

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