tumor markers itb des2010
TRANSCRIPT
-
8/8/2019 Tumor Markers ITB DES2010
1/24
LECTURE
Trilis Yulianty M.Kes
1 Desember 2010
Trend jumlah penderita kanker terusmeningkat, thn 2020 mencapai 16 juta,2/3nya di negara industri baru / negaraberkembang (The International Agency for
esearc on ancer
Di Indonesia : prevalensi 4,3/1000, .
(Riskesdas 2007)
-
8/8/2019 Tumor Markers ITB DES2010
2/24
e o em..
Sebagian besar didiagnosis pada stadium
lanjut
Belum tersedia terapi yang efektif untuk
perlu sarana deteksi dini untukperlu sarana deteksi dini untuk
Anti Cancer Res, 2004
-
8/8/2019 Tumor Markers ITB DES2010
3/24
PencitraanPencitraan
Teknik Imaging :
--osco
Anti Cancer Res, 2004
Nodul 2mm
Kelemahan teknik encitraan :
Mahal
Kuran sesuai untuk skrinin o ulasi skalabesar
Perlu ukuran tumor tertentu a ar terdeteksi Pemeriksaan Tumor MarkerTumor Marker
men adi ilihan lain untuk skrinin karenabersifat nonnon--invasifinvasif & mudah dilakukan& mudah dilakukan
Anti Cancer Res, 2004
-
8/8/2019 Tumor Markers ITB DES2010
4/24
umor ar er a e
What areWhat are
dikeluarkan oleh sel tumor (kanker) atau oleh
bagian tubuh lainnya sebagai respon terhadap
adanya pertumbuhan tumor (kanker)
Mencerminkan ukuran & sifat kanker (agresivitas,diferensiasi, respon terapi, potensi metastasis,
mutasi genetik, dll)
Dapat dideteksi di dalam sel / cairan tubuh
(peripheral blood, in lymph nodes, in bone
, ,
-
8/8/2019 Tumor Markers ITB DES2010
5/24
Screening for cancer
Diagnosing cancer
Evaluation Cancer Pro nosis
Predicting of Therapeutic response
Detection tumor recurrence/ remission
-
agents
SEJARAHSEJARAH
1846 - Bence-Jones Protein
1940 - Acid Phosphatase
1960 - Alpha-fetoprotein (AFP)
1965 - arcinoem ryonic ntigen
1975 - Monoclonal Antibodies
, ,
1970-1980 Oncogenes & Tumor Suppressor Genes
2001 - resentMicroarra s Mass S ectrometr
Neural Network, Multiparametric Analysis,
Bioinformatics
-
8/8/2019 Tumor Markers ITB DES2010
6/24
1. Enzim (PSA)
2. Hormon (hCG)
3. Antigen onkofetal (AFP, CEA)
-. , ,
5. Blood Group antigen (CA 19-9)
Anti Cancer Res, 2004
1. rgan spec c an umor spec c
2. Positive only when malignancy is
presen
3. Positive early in the development of
ma gnancy
4. Easy to measure in blood
Robins, Basic Pathology 7th edition
Laposata, Lab Medicine
-
8/8/2019 Tumor Markers ITB DES2010
7/24
Tumor marker yang saat ini ada tidak spesifik organ
CA 15-3
CA 27.29
ER & PRHER2/neu
c-er -
BRCA1
-
8/8/2019 Tumor Markers ITB DES2010
8/24
- cancer antigen 15-3
Reference value
98.7% general population < 30 U/ml
Indication: breast cancer
At the time of suspected breast cancer
na e o e ec oca ze or me as a c reas cancer
Prognostic value
CA15-3 > 50 U/ml = high suspicion of metastasis with poor
prognosis
CA15-3 Follow-up: 6 weeks after surgery
Clinical follow-up
3yrs a year then every 6 months
> 50% of reference value predict reccurence or metastasis
The association of CA15-3 and CEA assays = increasesensitivity by 10%
Monthly assay during chemotherapy in metastasis stages
High correlation with the clinical response to treatment
Non-specific increases
Liver cirrhosis, acute hepatitis, severe chronic hepatitis
Other metastasis: pancreas, ovary, colorectal, lung,stomach and uterus = rarely > 50 U/ml exceptpancreas a enocarcinoma
-
8/8/2019 Tumor Markers ITB DES2010
9/24
.
27.29 s g y assoc a e w reas cancer, a oug
levels are elevated in several other malignancies: Colon, astric, he atic, lun , ancreatic, ovarian, and
prostate cancers
CA 27.29 also can be found in patients with benign
isor ers o t e reast, iver, an i ney, an in patients
with ovarian cysts
CA 27.29 levels hi her than 100 units er mL are rare in
benign conditions
Ca 27.29 The CA 27.29 level is elevated in approximately
-
cancer (stage I or II) and in two thirds of women
with late-stage disease (stage III or IV)
CA 27.29 lacks predictive value in the earliest
stages of breast cancer no role in screening for ordiagnosing the malignancy
in patients at high risk for recurrence of breast
cancer (stage II or III) found that CA 27.29 was
highly specific and sensitive in detecting
prec n ca me as as s.
-
8/8/2019 Tumor Markers ITB DES2010
10/24
Estrogen & progestin
receptor
Clinical utility
Predictive indicators of response to endocrine
therapies such as
tamoxifen, toremifene, droloxifene (anti estrogen)
Medroxyprogesterone acetate, megestrol acetate
(progestin mimics)
emp oye as prognos c ac ors w
other factors to distinguish breast cancers patient
those at low risk (good prognosis)
HER-2 neu onco ene usin monoclonalantibody)overexpression related to poorprognosis in breast cancer, related tora uzuma erapy
30% of breast cancers, correlation between c-
erbB-2 gene positivity, positive axillary nodestatus, reduced time to relapse and reducedoverall survival
BRCA1 gene on chromosome 17qfamilial- ,
cancer in early-onset breast cancer families high risk screening
-
8/8/2019 Tumor Markers ITB DES2010
11/24
CA 125
hE4
Screening
The problem: lack of sensitivity for early stage
disease (hanya 50% stage I yg )
EGTMguidelines:CA125Notrecommended
forgeneralpopulationscreening NIH has recommended CA 125 + TVS +
rectovaginal pelvic exam screening for
ere itary ovarian cancer syn rome
Diagnosis
Prognosis & monitoring
-
8/8/2019 Tumor Markers ITB DES2010
12/24
Annual ultrasound examination and CA 125 screening
ave een a voca e or women w ere ary
ovarian cancer syndromes Normal80% of epithelial ovarian cancer, cell types serous >
endometriod, clear cell > mucinous
PSA
Free PSA
-
8/8/2019 Tumor Markers ITB DES2010
13/24
Tissue specific antigen, produced by
prostatic alveolar and ductal epithelial cells , a
serine protease, t 1/22~3 days
Ref value : 30 days
after the radical prostatectomy, persistent
e eva e eve n ca e res ua sease
-
8/8/2019 Tumor Markers ITB DES2010
14/24
Free PSAPSA that is not bound to the plasma
an pro eases 1-an c ymo ryps n an 2-macrog o u n
An in ratio of free/total PSA is associated with increasedrobabilit of rostate cancer
97% specific for this disease, 96% sensitivity in detecting
disease
For population screening and diagnosisan increase
of 0.75 ng/ml per year in any given patient has high
sensitivit and s ecificit for rostate cancer vs BPH
especially when combined with DRE and TRUS
Afp
-
8/8/2019 Tumor Markers ITB DES2010
15/24
Alpha-Fetoprotein in HCC
Glycoprotein, found in fetal liver, yolk sac,
,
in adults a - e ~ ays
Normal serum levels
12~15th gestational 30~40 ng/ml
At birth 30 ng/ml
Alpha-Fetoprotein in HCC Increased in 70% HCC, elevated in hepatoblastoma,
20~70% germ cell tumors (yolk sac tumors, embryonalce carc noma o es s an ovary, excep
dysgerminoma
or s g + c ron c epa s c rr os s screen ng
The absolute AFP level correlates with tumor bulk
Benignconditions that cause hepatic parenchymalinflammation, hepatic necrosis and hepatic regeneration,ex. epa s, pregnancy, pr mary ary c rr os s,extrahepatic biliary obstruction
-
8/8/2019 Tumor Markers ITB DES2010
16/24
Human chorionic gonodotropin
(HCG) ycopro e n syn es ze y
syncythiotrophoblastic cells of normal placenta,
peak in the first trimester (60~90 days)
. ,
Elevated ingestational trophoblastic disease
highly suggestive), choriocarcinoma
evaluate radicality of the surgery: ex. In
testicular cancer, the presence of-HCG after
orchiectomy residual cancer and needs
further treatment
Monitor relapse (reliable indicator of Cancer
e apse
-
8/8/2019 Tumor Markers ITB DES2010
17/24
cea
Found also in 30~50% of breast cancer, small cell
lung cancer, mucinous cystadenocarcinoma of ovary,