April 12, 2024

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Detailed explanation of 16 major tumor markers!

Detailed explanation of 16 major tumor markers!


Detailed explanation of 16 major tumor markers!   Elevated tumor markers are not necessarily cancer; some tumors do not secrete related proteins, so normal tumor markers cannot exclude tumors.

Tumor markers were discovered in 1978. They refer to tumor-related substances that can be detected in blood, body fluids and tissues. When they reach a certain level, they can reflect the existence of certain tumors.


Classification of serum tumor markers:

Detailed explanation of 16 major tumor markers!



One of the broadest-spectrum indicators: carcinoembryonic antigen (CEA)

CEA, discovered in 1965, is the broadest-spectrum indicator. Its elevation can be seen in colorectal cancer, gastric cancer, lung cancer, pancreatic cancer, breast cancer, ovarian cancer, uterine and cervical cancer, urinary system tumors, etc., and other malignancies Tumors also have varying degrees of positive rates.

In short, CEA is most likely to increase in adenocarcinoma, followed by squamous cell carcinoma and poorly differentiated carcinoma. Patients with late tumor stage, heavy tumor burden, and tumor metastasis may also experience elevated CEA.

In addition, benign diseases such as liver cirrhosis, hepatitis, emphysema, intestinal diverticulum, rectal polyps, colitis, etc. can also cause CEA to rise, and CEA in pleural effusion, ascites, digestive juice, and secretions often rises.

33% of smokers have a higher CEA, which requires special attention.


Liver cancer: alpha-fetoprotein (AFP)

AFP is an ancient but excellent tumor marker with high specificity in primary liver cancer, with a positive rate of 70%. If the patient has a history of hepatitis B, a mass in the liver, AFP>400ng/ml and lasts for 1 month, it can be diagnosed as liver cancer.

In addition to liver cancer, patients with endodermal sinus cancer, teratoma, testicular cancer, ovarian cancer, and gastric cancer with liver metastasis will also increase AFP, and most patients with viral hepatitis and cirrhosis will also have elevated AFP, but not Will exceed 400ng/ml.

After 3 months of pregnancy, AFP starts to rise, reaching a peak at 7 to 8 months (not exceeding 400ng/ml), and returning to normal after 3 weeks of delivery.


Ovarian cancer: carbohydrate antigen 125 (CA125)

The most important clinical significance of CA125 is to reflect ovarian cancer, with a positive rate of 61.4%, and CA125 is a good indicator for judging the efficacy and recurrence of ovarian cancer. When the treatment is effective, CA125 decreases, and recurrence causes CA125 to increase before symptoms.

CA125 also has a certain positive rate in other malignant tumors. The positive rate in cervical cancer, uterine body cancer and endometrial cancer is 43%, pancreatic cancer 50%, lung cancer 41%, gastric cancer 47%, colorectal cancer 34%, and breast cancer. 40%.

Other non-malignant diseases also have elevated CA125 to varying degrees. Although the positive rate is low, it also requires vigilance, such as endometriosis, pelvic inflammatory disease, ovarian cysts, pancreatitis, hepatitis, liver cirrhosis, and tuberculosis.

Elevated CA125 can be found in benign and malignant chest and ascites, so we cannot judge benign or malignant.

In early pregnancy, CA125 is also elevated.


Breast cancer: carbohydrate antigen 15-3 (CA15-3)

CA15-3 has important clinical significance in the diagnosis of breast cancer. The sensitivity is low at the early stage of breast cancer, 30%, and the sensitivity is as high as 80% at the late stage of breast cancer. It is of great value for the observation of the efficacy, prognosis, recurrence and metastasis of breast cancer.

Other malignant tumors also have a certain positive rate, and the positive rate is less than 10% in non-malignant tumor diseases such as liver, gastrointestinal tract, lung, breast, and ovary.


Digestive system: Carbohydrate Antigen 19-9 (CA19-9)

CA19-9 is an important indicator of digestive system tumors. In pancreatic cancer, gallbladder cancer, and bile duct ampullary cancer, CA19-9 is significantly increased, especially in pancreatic cancer, the late positive rate can reach 75%.

In addition, the positive rates of CA19-9 in gastric cancer, colorectal cancer, and liver cancer were 50%, 60%, and 65%, respectively.

Similarly, do not rush to diagnose cancer as CA19-9 is elevated. In some digestive tract inflammations such as acute pancreatitis, cholecystitis, cholestatic cholecystitis, hepatitis, and cirrhosis, CA19-9 also has varying degrees of elevation.

Use CA19-9 to distinguish cancerous jaundice and obstructive jaundice: the latter CA19-9 is generally less than 200 U/mL;

Differentiating pancreatic cancer and chronic pancreatitis: the former CA19-9 is significantly elevated, the latter is normal.


Carbohydrate Antigen 242 (CA242)

CA242 is less clinically used, and is significantly elevated in adenocarcinoma, and has a higher level in non-squamous tissue than in squamous cell carcinoma. The combined detection of CEA and CA242 can improve the sensitivity of adenocarcinoma.

CA242 is regarded as an upgrade indicator of CA19-9. It has the same sensitivity as CA199 in pancreatic cancer and cholangiocarcinoma, and its specificity is better than CA199. It is less affected by benign diseases such as pancreatitis, hepatitis and cirrhosis. In colorectal cancer, sensitivity Up to 60%~72%.


Prostate specific antigen (PSA)

PSA is the most specific indicator of the prostate, and the positive rate can be as high as 50% to 80%. However, elevated PSA can also be seen in prostate hyperplasia, prostatitis, kidney and urogenital diseases.

When the total PSA (T-PSA) value is 4-10 ng/ml, free PSA/total PSA can be introduced, that is, the concept of F/T: F/T>0.16, which is normal; F/T<0.1, There is a 56% chance of prostate cancer; when PSA>0.25, the risk of prostate cancer is 5%.


Nerve Specific Enolase (NSE)

Small cell lung cancer is the most sensitive and specific tumor marker. It is significantly elevated in neuroendocrine tumors, such as: pheochromocytoma, medullary thyroid carcinoma, melanoma, islet cell tumor, etc.

It should be noted that the value of NSE is very unstable, and hemolysis will cause an increase.

Carbohydrate Antigen 50 (CA50)

CA50 is also a very broad-spectrum tumor marker. It is elevated in liver, lung, stomach, node/rectum, pancreas, gallbladder, kidney, uterus, ovary, breast, bladder, prostate cancer, lymphoma, and melanoma. Pneumonia, nephritis, pancreatitis, colitis and other infectious diseases will also increase.

In addition, certain ulcer diseases and autoimmune diseases also have elevated CA50.


Gastric cancer: carbohydrate antigen (CA72-4)

The positive rate of CA72-4 in gastric cancer is 65%~70%, and it is even higher in those with metastasis. There is also a certain positive rate in colorectal cancer, pancreatic cancer, liver cancer, lung cancer, breast cancer, and ovarian cancer

CA72-4 can be used as an important indicator of follow-up, recurrence and prognosis after cancer treatment.


Lung cancer: cytokeratin fragment antigen 21-1 (CYFRA21-1)

The best indicator for detecting lung cancer. If there is an unclear circular shadow in the lungs and the serum CYFRA21-1 concentration is greater than 30ng/ml, lung cancer should be highly suspected. Once CYFRA21-1 is found to be elevated at the first diagnosis of lung cancer, it can be used as an important indicator for judging the prognosis of lung cancer.

The sensitivity of CYFRA21-1 in lung cancer: squamous cell carcinoma> adenocarcinoma> large cell carcinoma> small cell carcinoma. CYFRA21-1 also increases in uterine cancer, ovarian cancer, breast cancer, bladder cancer, prostate cancer, pancreatic cancer, stomach cancer, colon cancer, liver cancer, benign liver disease, and kidney failure.


Tissue Polypeptide Antigen (TPA)

TPA is composed of cytokeratin 8, 18 and 19, which can directly reflect the degree of cell proliferation, differentiation and tumor invasion. Patients with lung cancer have increased TPA, the sensitivity is equivalent to CYFRA21-1, and the positive rate is about 61%.

Patients with bladder cancer, prostate cancer, breast cancer, ovarian cancer, and gastrointestinal malignancies have elevated TPA; acute hepatitis, pancreatitis, pneumonia, gastrointestinal diseases, and 3 months after pregnancy can also see elevated TPA.


Squamous Carcinoma Antigen (SCCA)

Squamous cell carcinoma specific markers. It is used to diagnose squamous cell carcinoma, cervical cancer, lung cancer, head and neck cancer, and its concentration increases with the severity of the disease. The increase is also seen in benign diseases such as hepatitis, cirrhosis, pneumonia, tuberculosis and so on.


Human epididymal secretory protein 4 (HE4)

HE4 is a very good tumor marker for the diagnosis of ovarian cancer, with the highest sensitivity of 72.9% (higher than CA 125) and a specificity of 95%. CA125+HE4 is the best combination for diagnosing ovarian cancer.



The most sensitive indicator of germ cell carcinoma, especially choriocarcinoma, is as high as 100%. When there is a mass on the liver, if AFP is elevated, primary liver cancer is highly suspected; if Free-β-HCG is elevated, germ cell carcinoma is suspected.

The increase of Free-β-HCG also indicates that the tumor is highly malignant and the prognosis is poor.

Ferritin (Ft)

Ft is related to a variety of tumors, but it is not a direct evidence of tumors. Blood transfusion and iron therapy; aplastic anemia, hemolytic anemia, thalassemia; primary hemosiderinosis; connective tissue disease; various liver diseases and chronic renal failure; infectious diseases, etc., will have the phenomenon of elevated Ft .

Patients with iron-deficiency anemia will experience a drop in Ft.


Tumor Marker Combination Screening

No single tumor marker can achieve 100% accuracy. One tumor marker may also be related to multiple tumors, and combined screening methods are often used in clinical practice.

Through the interpretation of these tumor markers one by one, it is not difficult to conclude that elevated tumor markers are not necessarily cancer; certain tumors do not secrete related proteins, so normal tumor markers cannot exclude tumors. Reasonable application and timely monitoring are the correct ways to apply tumor markers in clinical practice.


(source:internet, reference only)

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