Tumor Markers: Understanding 10 Common Markers and Their Clinical Significance
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Tumor Markers: Understanding 10 Common Markers and Their Clinical Significance
Tumor markers (TMs), produced by tumor cells or the body’s abnormal response to these cells during the malignant tumor formation and proliferation process, are substances reflecting the presence and growth of tumors.
These markers include proteins, hormones, enzymes (isoenzymes), polyamines, and cancer gene products, found in patients’ blood, body fluids, cells, or tissues.
They can be determined through biochemical, immunological, and molecular biology methods, offering value in auxiliary diagnosis, differential diagnosis, treatment efficacy observation, recurrence monitoring, and prognosis assessment for tumors.
This article will provide a detailed overview of 10 major tumor markers, including Alpha-Fetoprotein (AFP), Carcinoembryonic Antigen (CEA), Neuron-Specific Enolase (NSE), Squamous Cell Carcinoma Antigen (SCC or SCCA), Cytokeratin 19 Fragment (CYFRA 21-1), Progastrin-Releasing Peptide (ProGRP), Cancer Antigen 125 (CA 125), Cancer Antigen 15-3 (CA 15-3), Cancer Antigen 19-9 (CA 19-9), and Prostate-Specific Antigen (PSA).
Alpha-Fetoprotein (AFP)
Screening: Serum AFP combined with liver ultrasound can screen high-risk individuals for primary liver cancer. The high-risk population includes those with hepatitis B (HBV) and/or hepatitis C (HCV) infections, chronic alcohol abusers, and those with a family history of primary liver cancer. Screening should start at age 40 for men and age 50 for women, with checks every 6 months.
Auxiliary Diagnosis: Serum AFP is commonly used as a tumor marker for the auxiliary diagnosis of primary liver cancer. AFP levels exceeding 400μg/L for over a month or ≥200μg/L for two months, after excluding pregnancy, active liver disease, and reproductive embryonic tumors, should raise suspicion of liver cancer. B-ultrasound and, if necessary, CT/MRI and biopsy are recommended for diagnosis.
Prognosis Assessment: Elevated serum AFP indicates a poor prognosis for primary liver cancer.
Treatment Efficacy and Recurrence Monitoring: Serum AFP measurement aids in monitoring liver cancer patients’ response to treatment. After liver cancer surgery, a decrease in AFP concentration to the reference range indicates effective surgery.
Carcinoembryonic Antigen (CEA)
Screening: Serum CEA is generally not used for tumor screening in asymptomatic individuals.
Auxiliary Diagnosis: Serum CEA is a broad-spectrum tumor marker used in the auxiliary diagnosis of common tumors such as colorectal, lung, breast, esophageal, pancreatic, and gastric cancers.
Prognosis Assessment: Elevated serum CEA levels suggest a poor prognosis for tumors.
Treatment Efficacy and Recurrence Monitoring: Changes in serum CEA concentrations can indicate the effectiveness of treatments like surgery, chemotherapy, targeted therapy, or immunotherapy. Monitoring is recommended every 3 months for 2 years after treatment.
Neuron-Specific Enolase (NSE)
Screening: Serum NSE is generally not used for lung cancer screening.
Auxiliary Diagnosis: Serum NSE is a preferred marker for small cell lung cancer (SCLC) and neuroblastoma. Elevated NSE levels also occur in other neuroendocrine tumors and some benign diseases.
Prognosis Assessment: Elevated serum NSE levels indicate a poor prognosis for small cell lung cancer and neuroblastoma.
Treatment Efficacy and Recurrence Monitoring: Serum NSE levels reflect the response to SCLC chemotherapy. Continuous elevation suggests poor treatment outcomes.
Squamous Cell Carcinoma Antigen (SCC or SCCA)
Screening: Serum SCC is generally not used for cervical and lung squamous cell carcinoma screening.
Auxiliary Diagnosis: Serum SCC is mainly used for the auxiliary diagnosis of squamous cell carcinoma in the cervix and lungs, with increased levels indicating disease progression.
Prognosis Assessment: Elevated serum SCC levels are considered a risk factor for poor prognosis in cervical and lung squamous cell carcinoma.
Treatment Efficacy and Recurrence Monitoring: Serum SCC is used to develop personalized treatment plans for cervical squamous cell carcinoma. It is also employed for assessing efficacy, follow-up, and monitoring for recurrence.
Cytokeratin 19 Fragment (CYFRA 21-1)
Screening: Serum CYFRA 21-1 is generally not used for lung cancer screening.
Auxiliary Diagnosis: Serum CYFRA 21-1 is a preferred marker for non-small cell lung cancer (NSCLC), particularly squamous cell carcinoma, with diagnostic value.
Prognosis Assessment: Elevated serum CYFRA 21-1 levels suggest a poor prognosis for NSCLC.
Treatment Efficacy and Recurrence Monitoring: Serum CYFRA 21-1 is used to monitor NSCLC treatment efficacy and recurrence. Testing is recommended every 3 months for the first 2 years after treatment.
Progastrin-Releasing Peptide (ProGRP)
Screening: Serum ProGRP is generally not used for lung cancer screening.
Auxiliary Diagnosis: Serum ProGRP is a preferred marker for small cell lung cancer (SCLC), aiding in the auxiliary diagnosis of the disease.
Prognosis Assessment: Elevated serum ProGRP levels suggest a poor prognosis for small cell lung cancer.
Treatment Efficacy and Recurrence Monitoring: Serum ProGRP is used to assess SCLC treatment efficacy and monitor recurrence. Testing is recommended every 3 months for the first 2 years after treatment.
Cancer Antigen 125 (CA 125)
Screening: Serum CA 125 is generally not used for ovarian cancer screening.
Auxiliary Diagnosis: Serum CA 125 is a preferred marker for epithelial ovarian cancer (EOC), with elevated levels indicating disease presence.
Prognosis Assessment: Elevated serum CA 125 levels are associated with a poor prognosis for EOC.
Treatment Efficacy and Recurrence Monitoring: Serum CA 125 is used to monitor EOC treatment efficacy and recurrence. Testing is recommended every 3 months for the first 2 years after treatment.
Cancer Antigen 15-3 (CA 15-3)
Screening: Serum CA 15-3 is generally not used for breast cancer screening.
Auxiliary Diagnosis: Serum CA 15-3 is a preferred marker for breast cancer, particularly metastatic breast cancer.
Prognosis Assessment: Elevated serum CA 15-3 levels suggest a poor prognosis for breast cancer.
Treatment Efficacy and Recurrence Monitoring: Serum CA 15-3 is used to monitor breast cancer treatment efficacy and recurrence. Testing is recommended every 3 months for the first 2 years after treatment.
Cancer Antigen 19-9 (CA 19-9)
Screening: Serum CA 19-9 is generally not used for pancreatic cancer screening.
Auxiliary Diagnosis: Serum CA 19-9 is a preferred marker for pancreatic cancer, aiding in the auxiliary diagnosis of the disease.
Prognosis Assessment: Elevated serum CA 19-9 levels are associated with a poor prognosis for pancreatic cancer.
Treatment Efficacy and Recurrence Monitoring: Serum CA 19-9 is used to monitor pancreatic cancer treatment efficacy and recurrence. Testing is recommended every 3 months for the first 2 years after treatment.
Prostate-Specific Antigen (PSA)
Screening: Serum PSA combined with digital rectal examination (DRE) is used for prostate cancer screening in men aged 55 to 69. Shared decision-making is crucial, considering individual risk factors.
Auxiliary Diagnosis: Serum PSA is a specific marker for prostate cancer, helping in the auxiliary diagnosis of the disease.
Prognosis Assessment: Elevated serum PSA levels suggest a poor prognosis for prostate cancer.
Treatment Efficacy and Recurrence Monitoring: Serum PSA is used to monitor prostate cancer treatment efficacy and recurrence. Testing is recommended every 3 months for the first 2 years after treatment.
Conclusion
In summary, tumor markers play a crucial role in cancer diagnosis, prognosis assessment, and treatment monitoring.
While they are valuable tools, it’s important to interpret results in conjunction with clinical findings and other diagnostic methods.
The application of tumor markers varies for different types of cancer, and their effectiveness is often enhanced when used in combination with imaging studies and other clinical assessments.
Regular monitoring and collaboration between healthcare professionals contribute to more accurate diagnosis and timely intervention, ultimately improving patient outcomes in the complex landscape of cancer management.
Tumor Markers: Understanding 10 Common Markers and Their Clinical Significance
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