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 phos, acid f, acid p'tase. A test of blood serum to detect a specific enzyme produced by several tissues, particularly 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 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:
ACTH (Adrenocorticotropic Hormone)
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.
CA 15-3 (Cancer Antigen 15-3)
CA 19-9 (Cancer Antigen 19-9)
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)
Presence is associated with multidrug resistance.
CA 549 (Cancer Antigen 549)
Present in 50% of patients with advanced breast cancer.
Helps distinguish tumor cell type; most useful in adrenal tumor.
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)
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.
- 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.
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.
See DNA Studies.
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)
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)
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.
|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|
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.
Philadelphia Chromosome (Ph1)
PLAP (Placental Alkaline Phosphatase or PL-AP)
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.
Differentiates cell type for endocrine-secreting tumors; elevated in insulinoma and islet cell tumors.
Prostate Specific Antigen
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.
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; nonspecific — also found in pituitary and placental tumors.