tumor markers itb des2010

8/8/2019 Tumor Markers ITB DES2010

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LECTURE

Trilis Yulianty M.Kes

1 Desember 2010

Trend jumlah penderita kanker terusmeningkat, thn 2020 mencapai 16 juta,2/3nya di negara industri baru / negaraberkembang (The International Agency for

esearc on ancer

Di Indonesia : prevalensi 4,3/1000, .

(Riskesdas 2007)


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e o em..

Sebagian besar didiagnosis pada stadium

lanjut

Belum tersedia terapi yang efektif untuk

perlu sarana deteksi dini untukperlu sarana deteksi dini untuk

Anti Cancer Res, 2004


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PencitraanPencitraan

Teknik Imaging :

--osco


Nodul 2mm

Kelemahan teknik encitraan :

Mahal

Kuran sesuai untuk skrinin o ulasi skalabesar

Perlu ukuran tumor tertentu a ar terdeteksi Pemeriksaan Tumor MarkerTumor Marker

men adi ilihan lain untuk skrinin karenabersifat nonnon--invasifinvasif & mudah dilakukan& mudah dilakukan



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umor ar er a e

What areWhat are

dikeluarkan oleh sel tumor (kanker) atau oleh

bagian tubuh lainnya sebagai respon terhadap

adanya pertumbuhan tumor (kanker)

Mencerminkan ukuran & sifat kanker (agresivitas,diferensiasi, respon terapi, potensi metastasis,

mutasi genetik, dll)

Dapat dideteksi di dalam sel / cairan tubuh

(peripheral blood, in lymph nodes, in bone

, ,


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Screening for cancer

Diagnosing cancer

Evaluation Cancer Pro nosis

Predicting of Therapeutic response

Detection tumor recurrence/ remission

-

agents

SEJARAHSEJARAH

1846 - Bence-Jones Protein

1940 - Acid Phosphatase

1960 - Alpha-fetoprotein (AFP)

1965 - arcinoem ryonic ntigen

1975 - Monoclonal Antibodies

, ,

1970-1980 Oncogenes & Tumor Suppressor Genes

2001 - resentMicroarra s Mass S ectrometr

Neural Network, Multiparametric Analysis,

Bioinformatics


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1. Enzim (PSA)

2. Hormon (hCG)

3. Antigen onkofetal (AFP, CEA)

-. , ,

5. Blood Group antigen (CA 19-9)


1. rgan spec c an umor spec c

2. Positive only when malignancy is

presen

3. Positive early in the development of

ma gnancy

4. Easy to measure in blood

Robins, Basic Pathology 7th edition

Laposata, Lab Medicine


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Tumor marker yang saat ini ada tidak spesifik organ

CA 15-3

CA 27.29

ER & PRHER2/neu

c-er -

BRCA1


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- cancer antigen 15-3

Reference value

98.7% general population < 30 U/ml

Indication: breast cancer

At the time of suspected breast cancer

na e o e ec oca ze or me as a c reas cancer

Prognostic value

CA15-3 > 50 U/ml = high suspicion of metastasis with poor

prognosis

CA15-3 Follow-up: 6 weeks after surgery

Clinical follow-up

3yrs a year then every 6 months

> 50% of reference value predict reccurence or metastasis

The association of CA15-3 and CEA assays = increasesensitivity by 10%

Monthly assay during chemotherapy in metastasis stages

High correlation with the clinical response to treatment

Non-specific increases

Liver cirrhosis, acute hepatitis, severe chronic hepatitis

Other metastasis: pancreas, ovary, colorectal, lung,stomach and uterus = rarely > 50 U/ml exceptpancreas a enocarcinoma


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.

27.29 s g y assoc a e w reas cancer, a oug

levels are elevated in several other malignancies: Colon, astric, he atic, lun , ancreatic, ovarian, and

prostate cancers

CA 27.29 also can be found in patients with benign

isor ers o t e reast, iver, an i ney, an in patients

with ovarian cysts

CA 27.29 levels hi her than 100 units er mL are rare in

benign conditions

Ca 27.29 The CA 27.29 level is elevated in approximately

-

cancer (stage I or II) and in two thirds of women

with late-stage disease (stage III or IV)

CA 27.29 lacks predictive value in the earliest

stages of breast cancer no role in screening for ordiagnosing the malignancy

in patients at high risk for recurrence of breast

cancer (stage II or III) found that CA 27.29 was

highly specific and sensitive in detecting

prec n ca me as as s.


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Estrogen & progestin

receptor

Clinical utility

Predictive indicators of response to endocrine

therapies such as

tamoxifen, toremifene, droloxifene (anti estrogen)

Medroxyprogesterone acetate, megestrol acetate

(progestin mimics)

emp oye as prognos c ac ors w

other factors to distinguish breast cancers patient

those at low risk (good prognosis)

HER-2 neu onco ene usin monoclonalantibody)overexpression related to poorprognosis in breast cancer, related tora uzuma erapy

30% of breast cancers, correlation between c-

erbB-2 gene positivity, positive axillary nodestatus, reduced time to relapse and reducedoverall survival

BRCA1 gene on chromosome 17qfamilial- ,

cancer in early-onset breast cancer families high risk screening


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CA 125

hE4

Screening

The problem: lack of sensitivity for early stage

disease (hanya 50% stage I yg )

EGTMguidelines:CA125Notrecommended

forgeneralpopulationscreening NIH has recommended CA 125 + TVS +

rectovaginal pelvic exam screening for

ere itary ovarian cancer syn rome

Diagnosis

Prognosis & monitoring


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Annual ultrasound examination and CA 125 screening

ave een a voca e or women w ere ary

ovarian cancer syndromes Normal80% of epithelial ovarian cancer, cell types serous >

endometriod, clear cell > mucinous

PSA

Free PSA


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Tissue specific antigen, produced by

prostatic alveolar and ductal epithelial cells , a

serine protease, t 1/22~3 days

Ref value : 30 days

after the radical prostatectomy, persistent

e eva e eve n ca e res ua sease


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Free PSAPSA that is not bound to the plasma

an pro eases 1-an c ymo ryps n an 2-macrog o u n

An in ratio of free/total PSA is associated with increasedrobabilit of rostate cancer

97% specific for this disease, 96% sensitivity in detecting

disease

For population screening and diagnosisan increase

of 0.75 ng/ml per year in any given patient has high

sensitivit and s ecificit for rostate cancer vs BPH

especially when combined with DRE and TRUS

Afp


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Alpha-Fetoprotein in HCC

Glycoprotein, found in fetal liver, yolk sac,

,

in adults a - e ~ ays

Normal serum levels

12~15th gestational 30~40 ng/ml

At birth 30 ng/ml

Alpha-Fetoprotein in HCC Increased in 70% HCC, elevated in hepatoblastoma,

20~70% germ cell tumors (yolk sac tumors, embryonalce carc noma o es s an ovary, excep

dysgerminoma

or s g + c ron c epa s c rr os s screen ng

The absolute AFP level correlates with tumor bulk

Benignconditions that cause hepatic parenchymalinflammation, hepatic necrosis and hepatic regeneration,ex. epa s, pregnancy, pr mary ary c rr os s,extrahepatic biliary obstruction


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Human chorionic gonodotropin

(HCG) ycopro e n syn es ze y

syncythiotrophoblastic cells of normal placenta,

peak in the first trimester (60~90 days)

. ,

Elevated ingestational trophoblastic disease

highly suggestive), choriocarcinoma

evaluate radicality of the surgery: ex. In

testicular cancer, the presence of-HCG after

orchiectomy residual cancer and needs

further treatment

Monitor relapse (reliable indicator of Cancer

e apse


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cea

Found also in 30~50% of breast cancer, small cell

lung cancer, mucinous cystadenocarcinoma of ovary,

tumor markers itb des2010

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