Tumor Markers

• Cancer


  uncontrolled growth of cells that often form a solid mass or tumor
• Neoplasm


  uncontrolled tissue growth may be cancerous (malignant) or non cancerous (benign)
• Tumorigenesis


  tumor formation
• Proto-oncogenes


  genes that help cells grow and divide to make new cells or help cells stay alive
• Oncogenes


  a mutated gene that has been activated and has the potential to cause cancer; encodes a protein that, when mutated, promotes uncontrolled cell growth
• Tumor-suppressor genes


  represent the opposite side of cell growth control, normally acting to inhibit cell proliferation and tumor development
• Metastasis


  spreading of cancer cells
• Apoptosis


  programmed cell death
• Angiogenesis


  formation of new blood vessels to supply oxygen and nutrients to cells
• Tumor markers


  biological markers; produced either directly (tumor) or effect on host
• Parenchyma


  consisting of transformed or neoplastic cells; active elements of the tumor
• Stroma


  consisting of connective tissue framework with lymphatic and vascular channels
• Types of cells involved to classify tumor formation

  1. Carcinomas - arise from epithelial cells
  2. Sarcomas - arise from connective tissue
  3. Adenomas - benign (precancerous)
  4. Adenocarcinomas - (cancerous) tumors that arise from internal glands of epithelial origin
• Differentiation of tumors

  • Based on its capacity to lead to death: malignant tumors or benign tumors
  • Based on histologic characteristics: Medullary (epithelial cells) or Scirrhous (connective tissue)
• Grading of tumors

  1. Differentiated cells - normal looking cells
  2. Undifferentiated cells - primitive cells
• Broader's Classification


  prognostic guide for treatment
• Grade I Differentiated Cells

  100-75%
• Grade II Differentiated Cells

  75-50%
• Grade III Differentiated Cells

  50-25%
• Grade IV Differentiated Cells

  25-0%
• Grade I Undifferentiated Cells

  0-25%
• Grade II Undifferentiated Cells

  25-50%
• Grade III Undifferentiated Cells

  50-75%
• Grade IV Undifferentiated Cells

  75-100%
• Factors used to define stage of cancer

  1. Tumor size
  2. Extent of invasion
  3. Lymph node involvement
  4. Metastasis
  5. Histologic assessment
• Staging of Tumors


  based on the size of primary lesion, determining the spread of cancer to regional lymph nodes and presence or absence of metastases
• T - Primary Tumor


  scale: 0-4

  tumor size and involvement/ invasion of nearby tissue
• N - Regional Lymph Nodes Involvement 


  N0, N2, N3 indicates progressively advancing nodal disease
• M - Metastasis


  whether there is distant metastasis; extent of tumor spreading from one tissue to another; Scale: 0-1
• Breast CA

  T3 N2 M0
• Clinical Utility

  1. Most are not specific or sensitive
  2. best used for differential diagnosis
• CA 15-3

  • Metastatic breast CA
  • Ovarian, Hepatitis, TB, SLE
  • response to therapy and detecting recurrence
  • IA
  • Serum
• CA 27-29

  • Metastatic breast CA
  • response to therapy and detecting recurrence
  • IA
  • Serum
• CA 19-9

  • Gastrointestinal CA and adenocarcinoma; stomach, colon, pancreas
  • Many association
  • Monitoring pancreatic cancer
  • IA
  • Serum
• CA 72-4

  • Stomach, colon, ovary
  • Many association
  • IA
  • Serum
• CA-125

  • Ovarian cancer, endometrium
  • Many association
  • Monitoring therapy
  • IA
  • Serum
• Metabolites

  • Homovanillic Acid (HVA)
  • Vanillylmandelic Acid (VMA)

  -Pheochromocytoma

  -Neuroblastoma

  -Paraganglioma

  -Urine (24 H)

  -Diagnosis of Neuroblastoma

  -HPLC
• Most frequently ordered tumor markers

  1. AFP - Alpha feto-protein
  2. CA-125 - ovarian CA
  3. CEA - Carcinoembryonic antigen
  4. HCG - Human Chorionic Gonadotropin
  5. PSA - Prostate Specific Antigen
• Nutrition care process (NCP)


  used by registered dietician to identify, diagnose and treat
• 4 components to the NCP

  1. Nutrition assessment
  2. Nutrition diagnosis
  3. Nutrition intervention
  4. Nutrition monitoring and evaluation