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Tumor markers in gynaecology
1.
BY: DR. MONICAPREET KAUR
MODERATOR : DR. SHALINI K. MAKKAR
2. Tumor markers are soluble glycoproteins that are
produced by cancer or by other cells of the body in
response to cancer or certain benign
(noncancerous) conditions.
The various tumor markers differ in their
usefulness for screening, diagnosis, prognosis,
assessing therapeutic response, and detecting
recurrence.
3. • It should be produced only by the tumor
cells
• High sensitivity and specificity for
cancerous growth
• Correlation of marker level with tumor
size.
• Its measurement either in blood or urine
should be sensitive enough to detect
microscopic or subclinical disease.
• Inexpensive and acceptable
4. 1. Enzymes or isoenzymes ( ALP , LDH )
2. Hormones ( inhibin , AMH , hCG, GAT )
3. Oncofetal proteins (AFP , CEA )
4. Carbohydrate epitopes ( CA 125 , CA 15-3 ,
CA19-9 )
5. Receptors (estrogen , progestrone and
testosterone )
6. Serum and tissue proteins ( TAG 72 , HE 4
7. Others ( SCC A , OV X1 , OV X2 , CELL FREE
DNA , CYFRA 21-1 )
5. High molecular weight glycoprotein.
Developed through immunization of mice with cells from
ovarian carcinoma line to produce OC 125 monoclonal
antibody .
Half life of 20 days
value higher than 35 U/mL is suggestive of epithelial ovarian
cancer.
CA 125 is elevated in 90 % of malignant non mucinous
tumors .
It is used for screening , monitoring of patient during
chemotherapy and for follow up of epithelial cancers of
ovary.
6. Benign condition with raised CA 125:
• Fibroid
• Adenomyosis
• Endometriosis
• Genital TB
• PID
• Cirrhosis
• Hepatitis
• Early pregnancy ( 25 %)
• Pleural effusion
• Pericarditis
Maligniant conditions with raised CA
125 :
• Epithelial ovarian carcinoma
• Ca endometerium
• Adenocarcinoma of cervix , and
fallopian tube(85 %)
• Uterine sarcomas
• Immature teratoma
• cancers of breast, lung , colon
7. Newer maker of ovarian cancers
Minimally produced by normal ovarian tissue
Elevated in epithelial ovarian cancer .
More sensitive and specific than CA 125 .
Normal range < 150 pM.
8. Risk of ovarian malignancy algorithm
Classifies patient with low or high risk of malignancies
Uses CA 125 , HE 4 and menopausal status
Interpretation is made by algorithm on website , calculator or
by using mobile application.
9. OVA 1 : Increased CA125, beta 2 microglobulin
decreased transferrin, transthyretin and apolipoprotein
A
Overa : combines CA 125 , HE 4 , transferrin ,
apolipoprotein A
and FSH
RMI( risk of malignancy index ) includes CA125 , pelvic
USG and menopausal status.
10. • normal fetal serum Glycoprotein synthesized by the liver,
yolk sac, and gastrointestinal tract.
• Performs some of function of albumin in fetal circulation.
• Started decreasing after birth , achieved adult level after 6
months to 1 year of age
• Half life : 5 days
• AFP concentration in adult serum is less than 20 ng/mL.
Physiological conditions with elevated AFP :
• PREGNANCY
• AGE <1 YEAR
15. Highly glycosylated cell surface protein involved in
intracellular adhesions
Normally produced by gastrointestinal tissue during fetal
life but stops before birth .
Most commonly associated with colorectal cancers
16. Benign conditions with
elevated CEA :
• Smokers
• Hepatitis
• Cirrhosis
• Pulmonary emphysema
• Bronchitis
• Ulcerative colitis
• Renal disease
Malignant conditions with
raised CEA :
• Ovarian ( serous ,
endometeroid)
• Cervical ( squamous cell
type )
• ADENOCARCINOMA of
colon , rectum breast , lung
17. Normal serum concentration < 37u/ml
Half life 24 hours
Non specific , helps in early detection of recurrance
Malignacies associated with high
CA19 9
• ENDOMETERIAL CANCER
(35%)
• Immature teratoma
• Pancreatic adenocarcinoma
• Gastric adenocarcinoma
• Colorectal cancers
• Bile duct cancers
• Hepatoma
Benign conditions with raised CA 19
9:
• Chronic pancreatitis
• Cirrhosis
• Acute cholangitis
• Bile duct stenosis
• Cystic fibrosis
• Diabetes mellitus
18. Elevated levels of both are strongly suggestive of
SCSTS with signs and symptoms of virilization.
Serum testosterone level > 150g/dl and
Serum DHEAS levels > 8000g/l strongly suggestive of
androgen secreting tumor.
19. Peptide hormone normally produced by ovarian
granulosa cells .
Level reaches peak level follicular phase of menstural
cycle and undetectable in menopausal women
Elevated in granulosa cell tumors and mucinous
epithelial ovarian carcinoma .
Both inhibin A and B are raised but inhibin B levels are
usually elevated in higher propotion .
Normal levels INHIBIN A < 5ng/l
INHIBIN B < 15 ng/l
20. Peptide produced by granulosa cells of primordial follicle
and by sertoli cells of testis .
Caused mullerian duct regression during male sex
defferentiation.
Helps in oocyte maturation and follicular development
and recruitment of dominant follicle.
Elevated in Granulosa cell tumor ( 75%)
21. Elevated in CARCINOMA CERVIX , VULVAR AND VAGINAL
SQUAMOUS CELL CARCINOMA
Elevated levels correlate with tumor size, stage , stromal
invasion , and lymph node status in carcinoma cervix .
Not specific
Monitor tumor response and predict tumor reoccurrence.
22. MARKER
TISSUE OF ORIGIN
HCG TROPHOBLASTIC and GERM CELL TUMOR (
DYSGERMINOMA AND EMBRYONAL CARCINOMA
AFP GERM CELL ( YOLK SAC AND IMMATURE TERATOMA
TUMOR
CA 125 OVARIAN EPITHELIAL TUMOR , ENDOMERTERIAL
ADENOCARCINOMA , CA CERVIX
HE 4 SEROUS EPITHELIAL OVARIAN TUMOR
CEA OVARIAN ( SEROUS , ENDOMETEROID),CERVICAL
(SQUAMOUS CELL )
TUMOR
ASSOCIATED
GLYCOPROTEIN 72
OVARIAN EPITHELIAL TUMOR
MACROPHAGE
COLONY
STIMULATING
FACTOR
OVARIAN EPITHELIAL TUMOR
SQUAMOUS CELL
CARCINOMA
ANTIGEN
CA CERVIX , VULVAR AND VAGINAL SQUAMOUS CELL
CARCINOMA
23. MARKERS TISSUE OF ORIGIN
GLACTOSYL
TRANSFERASE
ASSOCIATED WITH
TUMOR
TO DIFFERENTIATE OVARIAN CANCER FROM
ENDOMETEROSIS
ESTROGEN ,
PROGESTRONE ,
TESTOSTERONE
SEX CORD STROMAL TUMOR ( SCSTS)
INHIBIN, ANTIMULLARIAN
HORMONE
GRANULOSA CELL TUMOR ( SCSTS)
CELL FREE DNA OVARIAN CARCINOMA
HE 2 ENDOMETERIAL CANCER
CYFRA 21-1 ENDOMETERIAL CANCER , OVARIAN CANCER
