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Tumor markers are substances that may be found in the blood, urine, or tissues of patients with cancer. While they can be useful for monitoring tumor recurrence and response to therapy, they are not the primary tool for cancer diagnosis or screening. Definitive diagnosis requires a biopsy. Additionally, some tumor markers can be associated with non-neoplastic conditions.
Key Tumor Markers and Their Associations
Marker | Important Associations | Notes |
---|---|---|
Alkaline Phosphatase | Metastases to bone or liver, Paget disease of bone, seminoma (placental ALP) | Exclude hepatic origin by checking LFTs and GGT levels. |
α-Fetoprotein | Hepatocellular carcinoma, Endodermal sinus (yolk sac) tumor, Mixed germ cell tumor, Ataxia-telangiectasia, Neural tube defects | Normally made by the fetus. Transiently elevated in pregnancy. High levels are associated with neural tube and abdominal wall defects; low levels are associated with Down syndrome. |
hCG | Hydatidiform moles and choriocarcinomas (gestational trophoblastic disease), testicular cancer, mixed germ cell tumor | Produced by syncytiotrophoblasts of the placenta. |
CA 15-3/CA 27-29 | Breast cancer | |
CA 19-9 | Pancreatic adenocarcinoma | |
CA 125 | Ovarian cancer | |
Calcitonin | Medullary thyroid carcinoma (alone and in MEN2A, MEN2B) | |
CEA | Colorectal and pancreatic cancers. Minor associations include gastric, breast, and medullary thyroid carcinomas. | Carcinoembryonic antigen. Very nonspecific. |
Chromogranin | Neuroendocrine tumors | |
LDH | Testicular germ cell tumors, ovarian dysgerminoma, other cancers | Can be used as an indicator of tumor burden. |
Neuron-Specific Enolase | Neuroendocrine tumors (e.g., small cell lung cancer, carcinoid tumor, neuroblastoma) | |
PSA | Prostate cancer. Also elevated in BPH and prostatitis. Questionable risk/benefit for screening. Marker for recurrence after treatment. | Prostate-specific antigen. |
Points to Remember