1. Gazira Hospital of
Renal Diseases
&Surgery
Urology Department
Unit of
Mr: Mostafa Omran,Prof:Mohamed
Elemam& Mr: Sami

2. Tumor Markers
Presented by:
Dr:
Adam Mohammed Ibrahim

3. Definition
• Tumor markers are substances, usually
proteins, that are produced by the body in
response to cancer growth or by the cancer
tissue itself and that may be detected in
blood, urine, or tissue samples.
• Some tumor markers are specific for a
particular type of cancer, while others are
seen in several cancer types.

4. Definition
• Most of the well-known markers may also be
elevated in non-cancerous conditions.
Consequently, tumor markers alone are not
diagnostic for cancer.
• There are well-established tumor markers that
are routinely used .
Many other potential markers are still being
researched.

5. Definition
• Some markers cause great excitement when
they are first discovered but, upon further
investigation, prove to be no more useful than
markers already in use.

6. Classification
• Tumor markers can be classified in two
groups:
1-Cancer-specific markers
2-tissue-specific markers.

7. Cancer-specific markers
- Related to the presence of certain cancerous
tissue
- these markers might not be specific in
making a diagnosis
- useful in the follow-up of treated patients
-to describe progress of the disease
-response to treatment.
Examples of these markers are CEA,
CA19-9, CA125

8. CEA
• carcinoembryonic antigen, is a blood-borne
protein, first noted to be produced by tumors
of the gastrointestinal system.
- it was produced by the lung and breast
cancer case,an elevated level does not
necessarily mean a bowel cancer.
- a rising CEA level can be an early sign of
recurring bowel cancer.

9. Tissue-specific markers
• Related to specific tissues which have
developed cancer
- these substances are not specifically
related to the tumor, and may be present at
elevated levels when no cancer is present.
- But unlike the previous group, elevated
levels point to a specific tissue being at fault.
- Examples include PSA, beta-HCG, ), AFP-
L3, and Thyroglobulin.

10. AFP
AFP is a major plasma protein( glycoprotein )
produced by the yolk sac and the liver during
fetal development that is thought to be the fetal
form of serum albumin.
- AFP is measured in pregnant women through
the analysis of maternal blood or amniotic fluid,
as a screening test for a subset of developmental
abnormalities
-Increased in open neural tube defects and
omphalocoele .
-Decreased in Down syndrome.

11. AFP
• - It used as a biomarker to detect a subset of
tumors in non-pregnant women, men, and
children.
A level above 500 nanograms/milliliter of AFP
in adults can be indicative of :
-Hepatocellular carcinoma
-Germ cell tumors
-Metastatic cancers of the liver.
-

12. Gene Mutations
• Some people are at a higher risk for particular
cancers because they have inherited a genetic
mutation.
• While not considered tumor makers, there are
tests that look for these mutations in order to
estimate the risk of developing a particular
type of cancer.
• BRCA1 and BRCA2 are examples of gene
mutations.
• related to an inherited risk of breast cancer
and ovarian cancer.

13. USES
• Tumor markers are not diagnostic in
themselves.
• A definitive diagnosis of cancer is made by
looking at tissue biopsy specimens under a
microscope.
• . However, tumor markers provide information
that can be used to:

14. USES
• 1-Screen
• PSA testing may be used to screen for prostate
cancer.
• 2-Diagnose
• CA-125 for ovarian cancer.
• 3-Stage
• 4-Determine Prognosis
• 5-Guide Treatment
• Breast cancer patients who are Her2/neu
positive are more likely to respond to Herceptin
treatment).

15. USES
• 6-Monitor Treatment
AFP in a child previously treated for
teratoma suggests relapse with endodermal
sinus tumor.
• 7-Determine Recurrence

16. SCREENING TESTS

17. Prostate Specific Antigen (PSA)
• the only tumor marker to gain wide
acceptance as a screening test is Prostate
Specific Antigen (PSA) for prostate cancer in
men.
• Even with PSA there is continued debate
among experts and national organizations
over the usefulness of this test for screening
asymptomatic men.

18. Other markers
• Other markers are either not specific enough
(too many false positives, leading to expensive
and unnecessary follow-up testing) or they are
not elevated early enough in the disease
process to be useful for screening

19. Common Tumor Markers Currently
in Use

20. AFP (Alpha-feto protein)
• CANCERS • Liver, germ cell cancer
of ovaries or testes
• WHAT ELSE? • Also elevated during
pregnancy
• WHEN/HOW USED • Help diagnose, monitor
treatment, and
determine recurrence
• USUAL SAMPLE • Blood

21. B2M (Beta-2 microglobulin)
• CANCERS • Multiple myeloma
and lymphomas
• WHAT ELSE? • Crohn's disease and
hepatitis
• WHEN/HOW USED • Determine prognosis
• USUAL SAMPLE • Blood

22. CA 15-3 (Cancer antigen 15-3)
• CANCERS • Breast cancer and lung,
ovarian
• WHAT ELSE? • Also elevated in benign
breast conditions
• WHEN/HOW USED • Stage disease, monitor
treatment, and
determine recurrence
• USUAL SAMPLE • Blood

23. CA 19-9 (Cancer antigen 19-9)
• CANCERS • Pancreatic, sometimes
colorectal and bileducts
• WHAT ELSE? • Pancreatitis and
inflammatory bowel
disease
WHEN/HOW USED • Stage disease, monitor
treatment, and
determine recurrence
USUAL SAMPLE
• Blood

24. CA-125 (Cancer antigen 125)
• CANCERS • Ovarian
• WHAT ELSE? • endometriosis, some
other benign diseases
• WHEN/HOW USED • Help diagnose, monitor
treatment, and
determine recurrence
• USUAL SAMPLE
• Blood

25. Calcitonin
• CANCERS • Thyroid medullary
carcinoma
• WHAT ELSE? • pernicious anemia and
thyroiditis
• WHEN/HOW USED • Help diagnose, monitor
treatment, and
determine recurrence
• USUAL SAMPLE • Blood

26. CEA (Carcino-embryonic antigen
• CANCERS • Colorectal, lung,
breast, thyroid,
pancreatic, liver, cervix,
WHAT ELSE? and bladder
• hepatitis, COPD, colitis,
pancreatitis, and in
cigarette smokers
WHEN/HOW USED
• Monitor treatment and
determine recurrence
• USUAL SAMPLE • Blood

27. Chromogranin A (CgA)
• CANCERS • Neuroendocrine tumors
(carcinoid tumors,
neuroblastoma)
WHAT ELSE? • May be most sensitive
tumor marker for
carcinoid tumors
• WHEN/HOW USED
• To help diagnose and
monitor
• USUAL SAMPLE • Blood

28. Estrogen receptors
• CANCERS • Breast
• WHAT ELSE? • Increased in hormone-
dependent cancer
• WHEN/HOW USED • Determine prognosis
and guide treatment
• USUAL SAMPLE • tissue

29. hCG (Human chorionic gonadotropin)
• CANCERS • Testicular and
trophoblastic disease
• WHAT ELSE? • Elevated in pregnancy,
testicular failure
• WHEN/HOW USED • Help diagnose, monitor
treatment, and
determine recurrence
• USUAL SAMPLE • Blood, urine

30. Her-2/neu
• CANCERS • Breast
• Oncogene that is
• WHAT ELSE? present in multiple
copies in 20-30% of
invasive breast cancer
• WHEN/HOW USED
• Determine prognosis
and guide treatment
• USUAL SAMPLE • Tissue

31. Monoclonal immunoglobulins
• CANCERS • Multiple myeloma and
Waldenstrom’s
macroglobulinemia
• WHAT ELSE? • Overproduction of an
immunoglobulin or
antibody, usually detected
by protein electrophoresis
• Help diagnose,
• WHEN/HOW USED monitor treatment, and
determine recurrence
• USUAL SAMPLE • Blood, urine

32. Progesterone receptors
• CANCERS • Breast
• WHAT ELSE? • Increased in hormone-
dependent cancer
• WHEN/HOW USED • Determine prognosis
and guide treatment
• USUAL SAMPLE • Tissue

33. PSA (Prostate specific antigen), total
and free
• CANCERS • Prostate
• WHAT ELSE? • benign prostatic
hyperplasia, prostatitis
• WHEN/HOW USED and with age
• Screen for and help
diagnose, monitor
treatment, and
determine recurrence
• USUAL SAMPLE • Blood

34. Thyroglobulin
• CANCERS • Thyroid
• WHAT ELSE? • Used after thyroid is
removed to evaluate
• WHEN/HOW USED treatment
• Determine recurrence
• USUAL SAMPLE
• Blood

35. Other Tumor Markers Less Widely
Used

36. BTA (Bladder tumor antigen)
• CANCERS • Bladder
• WHAT ELSE? • Not widely available,
but gaining acceptance
• WHEN/HOW USED • Help diagnose and
determine recurrence
• USUAL SAMPLE • Urine

37. CA 72-4 (Cancer antigen 72-4)
• CANCERS • Ovarian
• WHAT ELSE? • No evidence that it is
better than CA-125 but
may be useful when
combined with it; still
being studied
• WHEN/HOW USED • Help diagnose
• Blood
• USUAL SAMPLE

38. Des-gamma-carboxy prothrombin
• CANCERS • Hepatocellular carcinoma
(HCC)
• WHAT ELSE? • New test; often used
along with an imaging
study plus AFP and/or
AFP-L3% to evaluate if
someone with
• WHEN/HOW USED • To evaluate risk of
developing HCC; to
evaluate treatment; to
• USUAL SAMPLE • Blood

39. NMP22
• CANCERS • Bladder
• WHAT ELSE? • Not widely used
• WHEN/HOW USED • Help diagnose and
determine recurrence
• USUAL SAMPLE • Urine

40. Prostate-specific membrane antigen
(PSMA)
• CANCERS • Prostate
• WHAT ELSE? • Not widely used; levels
increase normally with
• WHEN/HOW USED age
• Help diagnose
• USUAL SAMPLE • Blood

41. Prostatic acid phosphatase (PAP)
• CANCERS • Metastatic prostate
cancer, myeloma, lung
cancer
• WHAT ELSE? • Not widely used
anymore; elevated in
prostatitis and other
conditions
• WHEN/HOW USED • Help diagnose
• USUAL SAMPLE • Blood

42. THANKS