June 29, 2022

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Is it recurrence and metastasis if tumor markers postoperative increase?

Is it recurrence and metastasis if tumor markers postoperative increase?

 

Is it recurrence and metastasis if tumor markers postoperative increase? The rise of one-time tumor markers does not indicate recurrence and metastasis, and continuous and dynamic monitoring can be used as the basis for judgment.

Is it recurrence and metastasis if tumor markers postoperative increase?

 

Tumor markers refer to a class of substances synthesized and released by tumor cells or produced by the body in response to tumor cells in the process of tumor occurrence and proliferation. They mainly include proteins, carbohydrates and enzymes. Tumor markers exist in cells, tissues, blood or body fluids, and can be determined by methods such as chemistry, immunology, and genomics.

When tumors appear in the body, certain tumor markers in blood, cells, tissues or body fluids may increase accordingly. Therefore, tumor markers are an effective means for diagnosing malignant tumors. Generally speaking, because the tumor is removed after the malignant tumor, the tumor markers will gradually decrease to normal.

Patients with malignant tumors need regular follow-up after surgery to detect recurrence or metastasis early, so that treatment can be carried out as soon as possible. Such as follow-up of alpha-fetoprotein after hepatocellular carcinoma and CA-199 after pancreatic cancer. In the follow-up process of these patients, tumor markers will be found to fluctuate, sometimes decreasing, and sometimes increasing. As soon as the patient sees an increase in tumor markers, he is very worried and afraid of tumor recurrence and metastasis.

This kind of worry and fear is completely understandable, but elevated markers do not mean that the tumor must recur and metastasize. So, how should the postoperative elevation of tumor markers be treated correctly? Let us explore from the following points.

 


Factors that can affect the concentration of tumor markers

1. The total amount of tumor cells, tumor quality, tumor spread and tumor grade level.

2. The rate of synthesis and release of tumor markers.

3. Individual tumors do not carry or express tumor markers. Although non-secreting tumors can express tumor markers, they will not be released into body fluids.

4. If the blood supply of the tumor is poor, there may be fewer tumor markers reaching the peripheral blood.

5. If a large number of tumor cells disintegrate, the concentration of tumor markers can be increased, so that the concentration of tumor markers may be obviously out of proportion to the size of the tumor.

6. If the body has metabolic disorders, such as liver and kidney failure, the concentration of certain tumor markers will increase disproportionately. For example, alpha-fetoprotein can also increase in acute hepatitis, and CA-199 also increases in obstructive jaundice.

 

 

What needs attention in tumor marker detection?

1. It is best to have a comprehensive tumor marker examination after diagnosis of malignant tumor and before treatment.

First, the tumor markers known today are not 100% related to a specific tumor. For example, carcinoembryonic antigen (CEA) may be elevated in the following tumors: lung cancer, colon cancer, gastric cancer, breast cancer, Pancreatic cancer, etc.

Second, a tumor may have elevated multiple tumor markers. For example, lung cancer may have the following markers elevated: carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), squamous cell carcinoma antigen (SCC), carbohydrate antigen 125 (CA125), etc., pancreatic cancer may have CA-199, CA-254, etc.

The purpose of a comprehensive tumor marker examination before treatment is to find elevated markers and screen out tumor markers related to the tumor, as an index for future efficacy detection and recurrence monitoring.

2. Check the results before treatment as the baseline

Through the aforementioned comprehensive examination before treatment, it is possible to know which of the markers (which types) of the patient are elevated and which (which types) of markers are normal. Use this result as a baseline, and as a control standard for future efficacy testing and recurrence monitoring. If the previously elevated markers after treatment decrease, the treatment is effective. On the contrary, if the markers do not decrease or even increase, it means that it is possible. The treatment is ineffective. The efficacy can also be judged based on the degree of decline.

3. Continuous and dynamic observation of changes in tumor markers.

The change of tumor condition cannot rely solely on the result of one inspection. Only continuous and dynamic observation of the changes of tumor markers can be used as a basis for judgment. If you find that the markers continue to rise, you should be vigilant and require further inspection. One of the indicators of radical surgery for primary liver cancer is that alpha-fetoprotein drops to normal within 2 months. If alpha-fetoprotein does not return to normal, it means that there is residual cancer in the body or metastasis outside the liver.

 


What is the correlation between changes in tumor marker concentration and efficacy?

1. The concentration of tumor markers has dropped to the reference range and remains normal. This situation usually means that the effect of surgical treatment is good, and it is a radical operation rather than a palliative operation.

2. The concentration of tumor markers decreased but remained above the reference range, suggesting that there may be residual tumor and/or tumor metastasis, and the treatment effect is not good. If there is a continuous increase, it indicates that the tumor is progressing, indicating that the treatment effect is not good, and it is necessary to change chemotherapy, targeted drugs, or change the treatment.

3. The concentration of tumor markers dropped to within the reference range for a period of time, and then increased again. This situation usually means that most of the tumor was killed or significantly inhibited during treatment, and the remaining tumor or the inhibited tumor grew again after the treatment, indicating that The tumor may recur or metastasize. But pay attention to whether there is hepatitis or obstructive jaundice, because these factors can also cause the increase of alpha-fetoprotein or CA-199, which will interfere with clinical analysis and treatment.

4. Can re-examination of tumor markers be normal to completely rule out recurrence and metastasis? The answer is no, because tumors will mutate or new tumors that do not produce markers.

There was once a liver cancer patient with a significantly elevated AFP. The treatment effect was very good, and the AFP dropped to normal. After the treatment, the AFP remained stable in the normal range for more than two years. A new space occupied in the patient’s liver appeared on the post-re-examination, but the AFP did not increase, and the space occupied progressively increased. The final diagnosis was primary hepatocellular carcinoma, and it was considered that the patient had a new liver cancer that did not produce AFP.

 

Tumor markers are elevated, but imaging cannot find the lesion:

During the clinical follow-up, we can often find that the patient’s tumor markers gradually increase after they fall to normal, and the values ​​are getting larger and larger, but CT, MRI and other imaging studies can not find the lesion. The patient is very scared and worried. What should I do at this time? According to my clinical experience, there are more active tumor cells in the patient’s body.

These cells will secrete tumor markers and cause it to increase, because it is difficult to diagnose tumors below 1 cm in imaging (including PET). According to the tumor doubling time in situ, it takes 1-3 years for a single tumor cell to proliferate and develop into a 1 cm mass. It is completely possible that the tumor markers are elevated during this window period and the imaging can not find the lesion.

If you exclude other factors that cause the increase in markers and consider tumor recurrence, you can give patients some immunotherapy, such as thymosin, to help patients improve their immunity, thereby killing tumor cells and preventing their development. In my clinical patients, CA-199 has risen to hundreds. Considering recurrence and metastasis, it gradually dropped to normal after immunotherapy, indicating that the treatment effect is good.

The above are some rough interpretations of the production and changes of tumor markers, but the clinical situation is complicated, and the above situation is not absolute. The tumor markers are only for reference. The rise of one-time tumor markers does not indicate recurrence and metastasis, and continuous and dynamic monitoring can be used as the basis for judgment. To really determine the recurrence and metastasis, we still need to rely on the diagnosis of imaging, but it is easier to monitor the changes of the disease according to the changes of tumor markers.

 

(source:internet, reference only)


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