Tumor markers: CA, CEA, transcript analyses, norms
In real life in connection with the growth of cancer pathology, identifying a malignant process is at the stage of its origin is of great importance. Given the prevalence of cancer in female reproductive organs, there are tumor markers for women who sometimes are «life-saving straw», allowing to grasp and to prevent the spread of cancer throughout the body, that is, as the saying goes, «be destroyed at the root».
What are tumor markers?
The main goal of tumor markers is the earliest detection of malignant substances when other methods to identify it, because of the small size and lack of clinical manifestations is not yet possible. That is, there lives a person and doesn’t know what «evil» has arisen and is able to kill a living organism, unless urgent action is taken.
However, probably the reader would like to know what are tumor markers and what types they are:
- There are tumor markers for women, as the reproductive organs of the female body more susceptible to other malignant processes, such as CA-125, HE4 heavily produced by tumor tissue of the ovary.
- Men in this respect less vulnerable, but also have very sensitive organ – the prostate gland, so they often have to take the PSA test (PSA).
- Opukholeobrazovanie the remaining antigens, not especially concerning the sexual sphere, which is synthesized in the tumor cells of the stomach, intestines, pancreas, and sex have not.
The tumor markers are macromolecules (antigens), mainly containing protein and carbohydrate or lipid component. With the development of the cancer process (not necessarily malignant) they are actively synthesized by tumor cells in the place of localization and the concentration in serum is significantly increased.
In such cases, the patient does not need to participate in the diagnosis, to put a diagnosis, and even more so to impose the death penalty, the tumor may be quite benign. On the other hand, one should not gain time and to postpone a comprehensive examination, in most cases, these diseases do not pass.
Cancer patients must be tested to identify the level of all available tumor markers that can give information about the different types of tumors, localized in a particular place. Thus, several types of tumor markers can participate in the diagnosis of a single process or, conversely, a single marker can provide the variety of the hearth.
What diseases can be determined using tumor markers?
Regardless of the type of tumor markers, for the performance of its functions of the diagnostician, they must meet certain requirements which they must meet:
However, it should be borne in mind that the fact that the increase in the concentration of antigen is not complete and irrefutable proof of the presence of cancer, because the level of tumor markers are often increased in tumors is not malignant origin. Meanwhile, if using the test runs in parallel with other diagnostic methods, there is a high probability of finding nediagnostirovannoe the tumor, which is characteristic for a particular type of tissue or organ, regardless of localization of the pathological process and to predict its behavior in the patient. To solve such problems using different types of tumor markers:
- Those seeking trouble in the female body (tumor markers for breast cancer, cervical, ovarian);
- Monitoring the condition of the prostate by known men prostate specific antigen (PSA, PSA), whose concentration in the blood increases quite sharply at the beginning of tumor development (normal is 2.5 ng/ml to 40 years, 4.0 ng/ml – 50). PSA levels are increased in benign processes (hyperplasia – BPH), and the larger the gland the higher the PSA;
- Antigens associated with cancer at other sites, e.g., tumor markers of the gastrointestinal tract, or the tumor markers of inflammation in the intestines, stomach, etc.
Except for the early diagnosis of pathological processes of the nature of the tumor, tumor markers solve other problems:
The «female» tumor markers
High molecular weight glycoprotein produced by epithelial cancer cells, localized in the ovary, as well as other cells that originated from Müller duct.
In healthy women, the blood concentration of this antigen opukholeobrazovanie almost never exceeds 35 U/ml, but in patients with ovarian cancer (especially serous adenocarcinoma of the ovaries), its content increases significantly.
Example of the relationship of level of CA-125 at different nature of the process in the ovaries:
CA-125 shows a positive Association with benign processes of the genital organs, as well as with tumors of other localizations: breast, lungs, liver, gastrointestinal tract. The increase in the level of tumor marker CA-125 is observed in some diseases of autoimmune origin and pregnancy.
Highly specific, associated with carcinoma of the breast (KMG), marker, which, however, is not only on the surface of cells in the area of malignancy, but (in much smaller quantities!) is synthesized by cells of normal epithelium in breast, lung, pancreas, ovaries, bladder, large intestine.
A glycoprotein inhibitor of protein is present in normal epithelial tissues on the genital organs, pancreas, upper respiratory tract.
The content of HE4 increases sharply when the cancer processes, localized in the ovary and endometrium. The sensitivity of this tumor marker is much higher for early stage epithelial ovarian cancer than CA-125 (50% of cases of ovarian cancer are HE4 was elevated, while CA-125 is not «felt» the emergence of the tumor and remained at the normal level).
Meanwhile, the use of these markers in combination with each other significantly improves diagnostic capabilities, including differential (allows to distinguish benign from malignant processes) and monitoring the effectiveness of therapeutic interventions.
Marker SCC (SCCA — squamous cell carcinoma antigen)
It is believed antigen of squamous cell carcinoma of any localization (lungs, ear, nasopharynx, esophagus, cervix), that is, it is a glycoprotein, which is produced by any tissue squamous. For SCC no stranger to physiological challenges, for example, he takes part in the differentiation of normal squamous epithelium and is synthesized by the salivary glands.
Analysis of the tumor marker SCC is prescribed mainly for monitoring the pathological process and the effectiveness of remedial measures all squamous cell cancers, but as more carcinoma of other organs prefer the cervix, the test usually undergoes a material taken from women. In addition, the marker has a very important prognostic value, because it is the content of the test sample corresponds to the degree of histological differentiation of cancer.
Normal values of SCC does not exceed 2.5 ng/ml. the High content of this tumor marker can be detected in the serum of pregnant women (first trimester), in benign skin tumors, bronchial asthma and renal or hepatic insufficiency.
«Recognize» the tumor, regardless of gender
A «female» tumor markers may recognize different location of the cancer, but there are antigens associated with tumors, which are a little attracted to their genitals or not attracted at all, and a place to grow they choose anywhere in the intestine, liver, gall bladder. Basically, gender of patient for them is not important, if the pathology does not concern the reproductive sphere, because women the list of diseases that may indicate increased concentration of tumor markers is much wider, than the reader himself can verify:
Became one of the first markers that became known as the tumor (Tatarinov Yu., 1964). This glycoprotein in normal condition is produced in the fetus in utero, into the blood of a pregnant woman, he gives a positive result, which is quite understandable.
The appearance of alphafetoprotein other people in a concentration above 10 IU/ml may indicate problems in the liver, (hepatitis, cirrhosis, hepatocellular carcinoma, hepatoblastoma), gastrointestinal tract (ulcerative colitis, tumors of the gastrointestinal tract) and also a malignant form of leukemia, breast and lung. Normal values in men and women differ somewhat, AFP is significantly increased during pregnancy, so normal in these women is determined by a special table.
CEA (CEA, removeability antigen)
Its concentration should not exceed 5 ng/ml, however, this rule does not apply to pregnant women. In nonpregnant patients CEA is increased in cancer of the ovary, uterus, breast.
If you increase this indicator it is also possible to suspect cancer of the colon, liver, pancreas, however, it should be borne in mind that, like other tumor markers, CEA is increased in benign processes in the digestive tract (Crohn’s disease, diverticulum of Mekele, peptic ulcer 12 duodenal ulcer and stomach), as well as pancreatitis and cirrhosis. In smokers, the level of CEA in the serum is also markedly increased.
Antigen associated with tumors of the pancreas, liver, gallbladder and biliary tract, stomach, lower intestine (rectum and sigmoid), that is, to some extent, it is considered a tumor marker the gastrointestinal tract. However, in addition, the concentration of CA-19-9 is increased in cancer of the breast, ovary, uterus and metastases of carcinomas of different localization in the liver.
The tumor marker is up to 10 U/ml, increasing levels up to 1000 U/ml or more suggests that the malignancy has reached the lymphatic system, but the tumor can still be removed (5% of the patients), increasing the concentration of 10,000 U/ml indicates a hematogenous dissemination.
19-9 tumor marker is not suitable for screening studies and bad finds tumors in the early stages of development, so it is mainly used to monitor the course of treatment in combination with other tumor-associated antigens (CA-125, CEA, HE4, AFP). When interpreting the results in relation to the CA-19-9, you should remember to consider the fact of its rare occurrence in certain blood groups (A/b in the system of Lewis) when he is simply not produced, regardless of whether healthy or ill.
Tumor markers of the gastrointestinal tract, detected in cases similar to the CA-19-9, but it is more sensitive and can be used to diagnose malignancy at an early stage of its development. In addition, is often found in high concentration (30 IU/ml) in benign lesions of the stomach and intestines.
This glycoprotein Express various carcinoma localized in the breast and pancreas, stomach, large intestine, lungs, ovaries, endometrium. Marker is often used in combination with CA-125 and CEA for monitoring therapy of cancer.
Obviously, when the diagnosis of cancer is a preference-one, more sensitive to the particular tumor antigen, which is called the main (CA-15-3, PSA, HE4), while others are of secondary importance and are meant to assist the chief in carrying out their tasks (often REA). In addition, some tumor-associated antigens are able to detect disease at the earliest stages (HE4, AFP, PSA), when others serve to monitor the effectiveness of therapy (CA-125, CA-19-9, SCC). Meanwhile, tumor markers sometimes change places, that is, the secondary becomes the primary in relation to a particular pathology, whereas in other cases, the main solves a minor problem (CA-125).
To the patient to interpret the result is undesirable, although in most cases people are trying to do. All the nuances of the research knows the doctor, we give only a brief summary table that contains the list of antigens (not all), the upper limit of normal and the main purpose of the marker.
Table: major tumor markers, the allowable concentration values, the combination of:
|CA-125||35 IU/ml||Ovarian cancer||+||HE4, SCC|
|CA-15-3||30 U/ml||Breast cancer||+||REA|
|CA-19-9||10 U/ml||Cancer of the digestive tract + AFP||In combination with CEA||AFP (d)
|SA-242||30 IU/ml||Testimony similar CA-19-9||In combination with CA-19-9||—|
|CA-72-4||—||Carcinomas of the gastrointestinal tract, breast, ovary||+||SCC, CA-125, CEA (m)|
|AFP||10 IU/ml (at the end of pregnancy up to 250 IU/ml)||Testicular cancer, teratoma, liver metastases||+||HCG|
|HE4||70 Pmol/l, 140 Pmol/l in postmenopausal women||Ovarian cancer in early stages||+||—|
|SCC||2.5 ng/l||Squamous cell carcinoma of any localization||+||HE4, CA-125, CA-72-4|
|DOG||2.5 ng/ml to 40 years, 4 ng/ml after 50 years||Prostate cancer||+||DOG free|
|REA||5 ng/ml (except pregnant women)||Cancer of the ovary, uterus, breast, lung||+||SCC, HE4, CA-125, CA-15-3|
Full interpretation of the analysis for tumor markers does laboratory doctor and the oncologist who is overseeing the treatment, conducts regular monitoring of the level of tumor markers in cases of suspected relapse, that is, constantly monitors the condition of the patient.
That patients did not rush to put a diagnosis, we believe it is useful to recall: the concentration of tumor markers is often increased in benign processes, localized in different organs, during pregnancy, and in a certain age period (menopause, menopause).
These tumor markers is not all antigens are capable of recognizing malignant processes of various localizations. The article does not focus on such tumor markers as:
- Of NSE, NSE (neurospecific enolase), which may increase in diseases of nonneoplastic nature as it is very sensitive to any damage to nervous tissue (ischemia, subarachnoid hemorrhage, epilepsy), and increases in lung cancer, carcinoma of the pancreas and thyroid gland. The combination of pro-GRP significantly increases the diagnostic significance;
- Pro-GRP – evidence is such as NSE, however, this analysis is rather rare and the cost is almost 2 times higher than that of NSE (NSE ≈ 1550 rubles, pro-GRP ≈ 3000 rubles);
- The tumor marker S-100 is indicated for the detection of neuroendocrine tumors;
- Beta-2-microglobulin (B-2-MG) is a marker that is able to recognize multiple myeloma and lymphoma;
- Other rare tumor markers that often do in specialized clinics, and basic health centers makes no sense to purchase test kits, because tests of this kind are assigned rarely.
Analysis for tumor markers is not a new one
The most gentle, simple and affordable way to detect premalignant and malignant process is the implementation into clinical diagnostic practice a multi-step screening events who are searching for high-risk groups in relation to cancer pathology. Such survey also to individuals who already have some suspicious symptoms indicating not harmless nature of the disease. Mainly this task effectively solve the methods of clinical laboratory diagnostics, determining a quantitative value of tumor markers with the help of specially developed test systems for enzyme immunoassay (ELISA).
The holding of the IFA requires a certain time, because at first the patient should take a blood test for tumor markers (blood from a vein on an empty stomach), after which the technician will handle it (centrifugation, separation of serum, which will go to research), and then the doctor will proceed with the work if there are a sufficient number of samples, and interpretation of the obtained results. This means that one patient’s reaction is usually not put, because the panel is designed for approximately 40 people. However, in cancer clinics or in laboratories with a large workload it is possible to obtain results on the same day.
To make the analysis possible and urgently in some health centres that provide urgent investigation, however, this price is for tumor markers will increase significantly. In extreme cases, if the patient is not willing to wait (very impatient patients), some tumor markers revealed rapid method (qualitative analysis). However, it should be noted that it is considered to be preliminary, and therefore cannot serve as a basis for diagnosis. Meanwhile, its result can be used as a starting point for further search. This method is often used when urologists examining men who have problems with the prostate gland. If there is a laboratory, equipped with special test strips for the detection of PSA (prostatic specific antigen), within a relatively short time (up to 1 hour) can confirm or dispel doubts about a doctor.
What analyses to hand over? Table — informative tumor markers for localization:
How much analysis?
Price analysis for tumor markers may range from 290 rubles per AFP Bryansk to 600 rubles in St. Petersburg. Value is determined such criteria as the level of laboratory, cost of reagents (test system), the status of the clinic, the urgency (which can be done HE4 in Moscow for 1 day, paying 1300r. or to put in another regional center, 800 p., but to wait 5-7 days). In short, to call something a specific amount problematic, however we will give some examples:
- PSA total – 360 – 600 roubles;
- REA – 500 – 850 p.;
- CA-125 – R. 550-900;
- Sa-15-3 – 600 – 900 R.;
- Sa-72-4 – 1000 – 1300r.;
- SA-242 – 700 – 950 R.;
- SA-19-9 – 600 – 950 R.
Price analysis for tumor markers is purely indicative, the exact amount can always be found in a medical facility where the patient intends to appeal. Analysis for tumor markers to monitor the course of the disease and monitoring the effectiveness of therapeutic measures the patient himself does not appoint, it is within the competence of the attending physician, who monitors the treatment process, and knows when what the deadlines need to conduct such research.