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2021 Summary of Tumor markers corresponding to each organ
2021 Summary of Tumor markers corresponding to each organ. Tumor markers are helpful for tumor screening, diagnosis and prognosis, but their organ specificity and accuracy complicate this problem. This article will explain the common tumor markers one by one according to the anatomical order of the human body from head to toe.
Pituitary tumor is a common intracranial tumor with neuroendocrine function, so its clinical manifestations are related to the type of hormone secreted by the pituitary tumor.
The first choice markers involved are human growth hormone (HGH), adrenocorticotropic hormone (ACTH) and prolactin. Each endocrine hormone corresponds to a different clinical manifestation.
What needs to know is that most of the pituitary tumors are benign, usually endocrine or surgical treatment, only a very small number of patients will get pituitary adenocarcinoma, high degree of malignancy, easy to distant metastasis.
02. Thyroid and parathyroid glands
Thyroid cancer is the most common malignant tumor of the thyroid. There are three preferred tumor markers involved: thyroglobulin (TG), calcitonin (CT), and carcinoembryonic antigen (CEA).
Although TG is a specific protein produced by the thyroid gland, it lacks specificity for the diagnosis of the cause of the disease. Therefore, it is generally not used clinically for the preoperative diagnosis of differentiated thyroid cancer, but its changes are used to judge the residual or recurrence of the tumor. An important indicator that can be used to detect the recurrence and metastasis of differentiated thyroid cancer after surgery.
Parathyroid adenoma is relatively rare in clinical practice. It mainly involves endocrine hormones such as CT and PTH. Parathyroid adenoma also mainly affects the regulation of calcium and phosphorus, resulting in osteoporosis and elevated blood calcium.
Thyroid cancer is a malignant tumor, and surgery is the basic treatment method. TG, CT, CEA can be used for follow-up after surgery to detect the residual and recurrence of the tumor. Although parathyroid adenoma is a benign endocrine tumor, its hyperparathyroidism can cause serious damage to the skeletal system and urinary system (mainly urinary stones), so the principle of treatment is surgical resection.
03. Head and neck area
The preferred tumor markers for head and neck malignancies are squamous cell carcinoma antigen (SCC) and CEA.
SCC has very good specificity and is a very effective marker for squamous cell carcinoma, while CEA is a broad-spectrum tumor marker, and its diagnostic effect is not strong in the early stage.
The tumor markers involved in esophageal cancer are cytokeratin fragment 19 (CYFRA21-1), CEA, SCC, and tissue polypeptide specific antigen (TPS).
The above-mentioned tumor markers generally need to be used in combination to improve the diagnosis, prognosis, and monitoring and follow-up observation of advanced esophageal cancer. However, in general, the diagnosis of tumor markers for esophageal cancer, especially early diagnosis, is not mature.
For tumor markers involved in primary lung cancer, CEA, neuron-specific enolase (NSE), CYFRA21-1, gastrin releasing peptide precursor are recommended by the American Committee on Clinical Biochemistry and the European Tumor Marker Expert Group (ProGRP), SCC.
For small cell lung cancer, NSE and ProGRP are ideal indicators, while SCC, CEA, and CYFRA21-1 are conducive to the diagnosis of non-small cell lung cancer. Of course, the above indicators have follow-up value and are meaningful for judging recurrence or metastasis.
Gastric cancer is very common among gastrointestinal tumors in some countries, and it has a trend of younger onset.
The tumor markers involved are carbohydrate antigen 72-4 (CA72-4), CEA, CA19-9, CA50, and the first choice is CA72-4, which is more sensitive to gastric cancer, but other gastrointestinal tumors And ovarian cancer can also increase this index.
Breast cancer is a malignant tumor that seriously threatens women’s health. The preferred tumor markers involved are CA15-3 and CEA. Both of these have high application value in breast cancer. Their combined use can significantly improve tumor recurrence. And the detection sensitivity of metastasis.
However, the above two indicators are not suitable for the screening and diagnosis of breast cancer, because they have low sensitivity to local lesions and can also appear in some benign lesions.
Pancreatic cancer has a very high degree of malignancy. The commonly used clinical tumor markers related to pancreatic cancer are CA19-9, CEA, and CA125. Among the three, CA19-9 is the most widely used and most valuable. Therefore, it is also pancreatic cancer. The preferred tumor marker.
CA19-9 can be used for the auxiliary diagnosis of pancreatic cancer, the detection of curative effect, and the judgment of recurrence and metastasis. The untreated pancreatic cancer CA19-9 can gradually increase, and its measured value usually has a high correlation with the clinical course.
It should be noted that although CA19-9 is the preferred tumor marker for pancreatic cancer, it also has limitations, that is, false positives can occur in the case of biliary tract infection or inflammation. In addition, some (approximately 3% to 7%) pancreatic cancer patients have Lewis antigen-negative blood group structures and do not express CA19-9.
The first choice marker for primary liver cancer is of course alpha-fetoprotein (AFP), and its value is also used in the clinical diagnosis of liver cancer, and it plays an important role in early screening.
When AFP ≥ 400 ug/L, the diagnostic criteria can be reached by excluding active or chronic hepatitis, liver cirrhosis, embryonic tumors of the testis or ovary, and pregnancy.
In addition, α-L-fucosidase and abnormal prothrombin are also commonly used molecular markers for the diagnosis of liver cancer.
10. Gallbladder, biliary tract
The vast majority of gallbladder cancer and cholangiocarcinoma are adenocarcinomas, with strong invasiveness and poor prognosis. The preferred tumor markers involved are CA19-9 and CEA.
Especially in the diagnosis, follow-up and evaluation of treatment effects of cholangiocarcinoma, CA19-9 has certain significance. According to literature reports, its specificity is 92.7% and its sensitivity is 50%. In addition, CA19-9 and CEA can also be used for disease monitoring.
Tumor markers related to colorectal cancer include CEA, CA19-9, AFP for liver metastasis, and CA125 for ovarian metastasis.
For a long time, no tumor markers specific to renal cell carcinoma have been found. Later, people realized that M2 renal pyruvate kinase (M2-PK) is mainly expressed in the distal renal tubules in normal renal tissues, which has a significant effect on renal cell carcinoma. The high sensitivity is considered as a promising kidney cancer marker.
Pyruvate kinase is a key enzyme in the glycolysis pathway and has several isoenzymes of L, R, M1, and M2. M2-PK refers to M2 type pyruvate kinase. When the cells become malignant, the increase in the expression of M2 isoenzymes will lead to an increase in the content of M2-PK in tumor cells, which in turn leads to the growth and metastasis of tumor cells.
Therefore, the preferred tumor markers are M2-PK, Tissue Polypeptide Antigen (TPA), and CEA is the next choice.
13. Adrenal glands
The preferred tumor markers for pheochromocytoma/paraganglioma (PPGL) are adrenaline (plasma), catecholamines (urine), chromaffin A (CgA), followed by homovanillic acid (urine), vanilla Mandelic acid (urine), NSE, etc.
The plasma concentration of CgA can be used as a surrogate marker for the functional activity of patients with normal levels of PPGL and preoperative MN (methoxy adrenaline) and 3MT (3-methoxytyramine). The specific clinical significance is that in patients with tumors that develop MN or 3MT, a significant increase in MN or 3MT levels 2 to 6 weeks after recovery from surgery may indicate incomplete tumor resection or recurrence.
This is a type of low-grade malignant tumor originating from the endocrine cells of the gastrointestinal tract. It is characterized by its tissue structure resembling cancer, with a tendency to become malignant, but rarely metastases, so it is named carcinoid and belongs to the category of rare diseases.
It can secrete a large amount of serotonin and other biologically active substances, which can cause vascular dyskinesia, gastrointestinal symptoms, etc., collectively referred to as carcinoid syndrome.
Therefore, the preferred markers are serotonin and 5-hydroxyindole acetic acid (urine).
The preferred tumor markers for ovarian cancer are CA125 and human epididymal protein 4 (HE4), both of which have very high application value in ovarian epithelial cancer.
CA125 is the most commonly used ovarian tumor marker, especially for serous ovarian cancer. Literature studies have found that CA125 has a higher application value in menopausal people.
The diagnostic specificity of HE4 is significantly higher than that of CA125, and it has a big advantage-its level is not affected by the menstrual cycle and menopausal status.
What needs to know is that the commonly used clinical ROMA index is a model that combines CA125 and HE4. Its specific value depends on the levels of CA125 and HE4, hormones, and menopausal status.
Of course, tumor markers related to ovarian malignant reproductive tumors include AFP, β-human chorionic gonadotropin (β-hCG), NSE, lactate dehydrogenase (LDH), CA19-9 and so on.
Bladder cancer is one of the common malignant tumors of the urinary system. The FDA-approved urine markers for bladder cancer include nuclear matrix protein 22 (NMP22), bladder tumor antigen (BTA), and fibrinogen degradation products (FB/FDP). Wait.
Although the above-mentioned markers have high sensitivity, their specificity is low.
There are currently no specific and sensitive markers for endometrial cancer. CA125, CA19-9, CA153, etc. can be selected as tumor markers. The above indicators have certain reference value for diagnosis and postoperative detection of the disease.
The preferred tumor markers for prostate cancer are prostate specific antigen (PSA), free PSA, and prostate cancer gene 3 (PCA3) (urine).
PSA is highly specific to prostate cancer, and its normal value is generally less than 4 ng/mL, but when PSA is greater than 10 ng/mL, it is of clinical significance for prostate cancer.
It should be noted that benign prostatic hyperplasia and prostatitis will also have increased PSA, at this time free PSA testing is required.
Testicular cancer is a rare cancer. Its main manifestation is the appearance of hard lumps in the testicles, which can enlarge, metastasize and spread. The preferred markers involved are AFP, β-hCG, LDH, and placental alkaline phosphatase.
Testicular cancer is considered a curable malignant tumor, and most patients can survive long-term after treatment.
(source:internet, reference only)