Key information: for baseline and observation --to
assess tumor burden and monitor levels of tumor and indicate
a recurrence; prognosis (what treatment to use if the tumor
should recur); most tumor markers are NOT specific, meaning
that positive result does not necessarily mean that the primary
site can be readily identified.
Acid Phosphatase Also
called: acid phos, acid f, acid p'tase. A test of blood serum
to detect a specific enzyme produced by several tissues, particularly
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the prostate. Acid phosphatase levels
are elevated in 85% of cases with skeletal metastases,
60% of untreated cases, and 20% of localized cases.
Usually ordered as a separate laboratory test. May also
be ordered as prostatic acid phosphatase (PAP), a measure
of acid phosphatase secreted by prostate gland cells
specifically. Note:test results may be affected by
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recent prostatic massage or palpation; acid phosphatase level
should be assayed before digital rectal examination. Normal
range: varies according to method of processing the serum:
1.0 - 4 |
King Armstrong microns/dl |
0.5 - 2 |
Bodansky or Gutman microns/dl |
0 - 1.1 |
Shinowara microns/ml |
0.1 - 0.73 |
Bessy Lowry microns/nk. |
0.5 - 11.0 |
units/L |
ACTH (Adrenocorticotropic
Hormone) elevated level found in paraneoplastic syndrome
caused by small cell carcinoma. Non-diagnostic of lung cancer,
but an indicator of metastases.
Alkaline Phosphatase Also
called: alk phos, alk f, ALP. May be included in blood chemistry
screening panel. Normal range: 20-90 I.U./liter. Normal range
may vary somewhat according to the brand of laboratory assay
materials used.
Alpha-fetoprotein A
serum test used as a tumor marker for hepatocellular cancer.
Elevated alpha-fetoprotein levels are also found in certain
ovarian and teratocarcinoma or embryonal carcinoma of the
testis. Elevated alpha-fetoprotein levels are not found in
other histologies of testicular cancer. Note: Observe the
date of an alpha-fetoprotein study carefully. Record a pre-operative
study only. Alpha-fetoprotein is also used as a marker postoperatively
to monitor residual tumor. Also called: FP,
AFP, alpha-fetoglobulin. Normal range: Adults: < 15 ng/ml.
bcl-2 Oncogene Analysis
diagnostic method to differentiate B-cell and follicular types
of lymphomas.
-2
Microglobulin Also called Beta 2-M. Elevated levels
are present in lymphoproliferative disorders; non-specific
to chronic lymphocytic leukemia.
CA 15-3 (Cancer Antigen 15-3)
elevated in 76% of metastatic breast cancers.
CA 19-9 (Cancer Antigen 19-9)
monitors post-therapeutic gastrointestinal cancer for recurrence;
nonspecific to stomach or colorectal cancer.
CA-125 (Cancer Antigen-125)
a tumor marker useful for monitoring for ovarian cancer by
measuring an antigen to epithelial neoplasms circulating in
blood serum. Normal range: 0 - 35 U/mL. Normal range may vary
somewhat according to institutional experience. Levels above
35 suggest the presence of ovarian tumor.
CA 195 (Cancer Antigen 195)
detects gastrointestinal cancers but cannot differentiate
among primary sites; changing level indicates progression
or regression of tumor load.
C219 Presence is associated
with multidrug resistance.
CA 549 (Cancer Antigen 549)
present in 50% of patients with advanced breast cancer.
Calcitonin elevated
levels of this thyroid hormone occasionally occur with small
cell lung cancer; increasing levels may indicate progression
of disease.
Catecholamines helps
distinguish tumor cell type; most useful in adrenal tumor.
Cathepsin D distinguishes
node-negative patients who may recur (and therefore should
receive adjuvant chemotherapy) from node-negative patients
who probably will not recur. Elevation indicates a poorer
prognosis.
CEA (Carcinoembryonic Antigen)
a blood test measuring the presence of an antigen in malignancies
arising in entodermal (embryonic) or gastrointestinal tissue.
Persistent elevated levels indicate residual or recurrent
metastatic carcinoma. CEA assay is nonspecific for identifying
a primary site, but it does indicate the presence of malignancy.
Smokers may have an elevated CEA without malignant disease;
smoking may affect accuracy of CEA results. Normal range:
< 2.5 ng/ml. Normal range may vary somewhat depending on the
brand of assay used. Levels > 10 ng/ml suggest extensive disease
and levels > 20 ng/ml suggest metastatic disease.
C-erb B-2 (also called HER-2
or neu oncoprotein) associated with larger sized tumors,
shorter relapse time and lower survival rate.
Chromogranin-A monitors
tumor bulk in neuroblastoma, APUDoma, VIPoma, pheochromocytoma;
non-diagnostic of central nervous system tumor.
C-myc DNA amplification
elevated (amplified) in breast cancers in older women; juxtaposition
of this chromosome with a heavy chain immunoglobulin occurs
frequently in Burkitt's lymphoma and other B-cell lymphomas,
as well as acute lymphoblastic leukemia.
DNA Studies Also called
flow cytometery. Differentiates between tumors at high and
low risk for recurrence. DNA studies are a prognostic tool
for non-small cell lung and other solid tumors.
Ploidy Analysis--Aneuploid
tumors correlate with more aggressive behavior and a greater
risk of recurrence. Diploid tumors have a better prognosis
than aneuploid or tetraploid tumors.
S-Phase (also called Cell
Cycle Analysis)--percentage of tumor cells synthesizing
DNA; patients with high S-phase fraction have less favorable
prognosis
Proliferation Index--high
rates indicate actively growing tumors and a greater risk
of relapse
EFGR (Epidermal Growth Factor
Receptor) negative EFGR results correlate with better
prognosis regardless of ER status.
Estrogen Receptor Assay (ERA)
A laboratory test of breast cancer tissue to determine the
responsiveness of the tumor to endocrine therapy or to removal
of the ovaries. Tumors which are negative for estrogen receptors
rarely respond to hormone manipulation; about 55% of ER positive
tumors will respond to endocrine therapy. The unit of measurement
is femtomoles (fmoles) per milligram of tumor. Test results--negative:
3 fmoles or less. ERA may not be performed if tumor is less
than 1.0 cm in size or if tumor is completely in situ. Types
of ERA: Quantified (measured in femtomoles or fmoles); Immunohistochemical--a
qualitative measurement of the observed number of hormone
responsive cells, reported as positive or negative.
Ferritin measures iron
storage protein in sialic acid; low levels suggest good prognosis
in head and neck malignancies, although test is nonspecific
for head and neck cancer; elevated levels present in lymphoproliferative
disease; may indicate Hodgkin's disease or leukemia; monitors
cause of disease in neuroblastoma; nonspecific in neurogenic
tumors.
Flow Cytometry See
DNA Studies.
Gastrin differentiates
gastrin secreting non-beta islet cell tumors of pancreas;
levels above 1000 pg/ml are diagnostic of gastrinoma; also
found in some benign conditions.
Glucagon differentiates
alpha-cell tumors; levels above 900 are diagnostic of glucagonoma;
also present in diabetes and other conditions.
5-HIAA (5-Hydroxy-Indol Acetic
Acid) quantitative analysis of urine levels; levels
above 15 mg/24 hours indicate malignant carcinoid tumors (argentaffinomas),
which may also appear in stomach, appendix, or lower intestine.
Human Chorionic Gonadotropin
(hCG) ? or ? a-HCG (Alpha Subunit HCG) a nonspecific
marker for pancreatic, pituitary, and placental tumors; elevated
levels may be present in pancreatic cancer.
Beta Subunit HCG A
serum test used as a tumor marker for choriocarcinoma and
for testicular carcinoma. Beta-HCG levels are never found
in normal men. When the presence of B-HCG is detected in serum
it always indicates a malignancy. Also called: &-HCG, beta-HCG,
beta chain HCG. Note: Observe the date of the beta-HCG study
carefully. Record a preoperative study only. Beta-HCG is also
used as a marker postoperatively to monitor residual tumor
and the effectiveness of therapy. In patients with choriocarcinoma
who have had a hysterectomy and oophorectomy, the presence
of beta-HCG will confirm the patient has residual cancer that
requires further treatment. In patients with testicular cancer
who have had an orchiectomy, the presence of beta-HCG will
confirm the patient has residual cancer that requires further
treatment. However, when beta-HCG does not exist in the serum,
the presence of active cancer cannot be excluded, especially
in patients who have been previously treated. Normal range:
0 ng/ml.
HVA (Homovanillic Acid)
elevated levels suggest catecholamine-secreting tumor such
as neuroblastoma or ganglioneuroma; high levels rule out pheochromocytoma.
Int-2 DNA Amplification
elevation (amplification) associated with recurrence of tumor.
LDH (Lactic Dehydrogenase)
a blood chemistry study, usually part of a liver panel, useful
in assessing liver and pulmonary disease. All tumors produce
LDH. Normal range: total LDH levels range from 48 to 115 IU/liter.
There are five tissue-specific isoenzymes that can be identified
and measured. The distribution of isoenzymes is as follows:
LDH1: 18.1% to 29% of the total (heart, red blood cells
and kidneys)
LDH2: 29.4% to 37.5% of the total (heart, red blood cells
and kidneys)
LDH3: 18.8% to 26% of the total (lungs)
LDH4: 9.2% to 16.5% of the total (liver and skeletal muscles)
LDH5: 5.3% to 13.4% of the total (liver and skeletal muscles)
Liver Function Tests (LFT)
a series of blood chemistry tests measuring enzymes excreted
by the liver during abnormal functioning due to metastases,
obstruction or other conditions. Also called: liver panel.
A liver panel may contain any of the following tests. If any
one of these tests is outside the normal range of values,
the test should be reported as abnormal.
TEST
|
NORMAL
VALUES |
Alkaline Phosphatase (Alk.Phos.)
|
20-90 IU/liter |
Lactic Dehydrogenase (LDH) |
100-190 u/L at 37 degrees |
Transaminase |
|
SGOT |
8-46 u/L (M) |
|
4-35 u/L (F) |
SGPT |
7-46 u/L (M) |
|
4-35 u/L (F) |
Leucine aminopeptidase (LAP) |
80-200 Goldbarg-Rutenburg u/ml
(M) |
|
75-185 u/ml (F) |
Bilirubin (total) |
< 1.5 mg/dl |
NSE (Neuron Specific Enolase)
elevated level indicates presence of small cell carcinoma
of lung and neuroblastoma; of secondary use in testicular
neoplasms; nonspecific to central nervous system tumors.
Pancreatic Polypeptide
diagnoses pancreatic gamma cell tumors; elevated in APUD-omas,
VIP-omas, and MEN (Multiple Endocrine Neoplasia).
Philadelphia Chromosome (Ph1)
presence of abnormal chromosome in bone marrow confirms diagnosis
of chronic myelogenous leukemia; absence of Ph1 chromosome
does not rule out CML.
PLAP (Placental Alkaline Phosphatase
or PL-AP) differentiates the source of tumor among
liver, bone, and germ cell origin; non-diagnostic by itself,
it helps confirm malignancy in a small number of patients.
PLP (Parathyroid hormone-like
Protein) elevated levels of this circulating hormone
are found in squamous cell cancer and in breast cancer.
Progesterone Receptor Assay
(PRA) a laboratory test of breast cancer tissue to
determine the responsiveness of the tumor to endocrine therapy
or to removal of the ovaries. Progesterone receptor assay
increases the reliability of estrogen receptor assay results:
a positive progesterone receptor assay indicates greater likelihood
that the patient will respond to hormone therapy. The unit
of measurement is femtomoles (fmoles) per milligram of tumor.
Test results--negative: 5 fmoles or less. Test may not be
performed if tumor is less than 1.0 cm in size or if tumor
is completely in situ. Types of PRA: Quantified (measured
in femtomoles or fmoles); Immunohistochemical--a qualitative
measurement of the observed number of hormone responsive cells,
reported as positive or negative.
Proinsulin C-peptide
differentiates cell type for endocrine-secreting tumors; elevated
in insulinoma and islet cell tumors.
Prostate Specific Antigen
Also called: PSA. Excludes: prostatic acid phosphatase. Tumor
marker assay (test) of blood serum for antigen released from
cells in prostate tissue. Value may be elevated in benign
prostatic hypertrophy; greatest elevation occurs in stage
C and D prostate cancer. After radical prostatectomy or radiation
therapy, rising levels of PSA indicate residual disease or
recurrence. Note: test results may be affected by recent prostatic
massage or palpation; PSA level should be assayed before digital
rectal examination.
Normal range: 0 - 4.0 ng/ml. Normal range also varies depending
on the patient's age.
SMA (Vanillylmandelic Acid)
elevated levels suggest catecholamine-secreting tumor such
as neuroblastoma or ganglioneuroma; nonspecific to SMA.
Squamous Cell Carcinoma (SCC)
Antigen monitors tumor burden after treatment for squamous
cell carcinoma; usually used for advanced disease; primary
application is head and neck cancer, secondarily for lung
cancer; nonspecific to cervical carcinoma but specific to
squamous cell carcinoma.
Thyroglobulin elevated
levels of this serum hormone are found in follicular carcinoma
and return to normal following treatment if all tumor is removed;
useful for monitoring residual disease and recurrence of follicular
carcinoma.
TDT (Terminal Deoxynucleotidal
Transferase) differentiates acute lymphocytic leukemia
from acute non-lymphocytic leukemia; differentiates lymphoblastic
lymphomas from other non-Hodgkin's lymphomas; TDT levels are
absent in patients in remission.
TPA (Tissue Polypeptide Antigen)
an antigen marker for cancers of gynecologic sites,
bladder, and lung; nonspecific to ovarian and cancer; elevated
levels indicate presence of malignancy; also used to monitor
bladder and lung cancer in males.
a-TSH (Alpha Subunit Thyroid
Stimulating Hormone) a marker that can differentiate
pancreatic from other hormonal tumors; non-specific--also
found in pituitary and placental tumors.
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