Alpha-fetoprotein (AFP )
Alpha-fetoprotein (AFP) is a fetal globulin synthesized by the fetal liver, gastrointestinal tract and yolk sac. Within a year after birth, AFP in a normal serum is decreased to a barely detectable level. Elevated serum AFP levels may be observed in patients with nonseminomatous testicular carcinoma. A few other common cancers, usually with hepatic metastasis, increase AFP levels. These include carcinoma of stomach, gallbladder, prostrate and bronchi. Increase AFP levels have also been reported in non-malignant diseases.
Carcinoembryonic antigen (CEA)
Carcinoembryonic antigen (CEA), is normally present at very low concentration in the blood of healthy adults. The level of serum CEA is elevated in many gastrointestinal cancers, such as, colon cancer, pancreatic cancer and gastric cancer, and there have been some positive cases of lung cancer, uterine cancer, ovarian cancer and embryonic carcinoma. Since the positive rate is low in benign diseases, CEA assay is widely used as an effective clinical test for diagnosing, assessing therapeutic effects and monitoring these malignancies. Preoperative CEA levels may be of prognostic value since the level of elevation is correlated with body burden of tumor.
Total PSA (Prostate Specific Antigen)
Prostate Specific Antigen (PSA) is a single chain glycoprotein confined to the cytoplasm of prostatic acinar cells and ductal epithelium. The presence of PSA has been demonstrated in normal, benign hyperplastic and malignant prostatic tissue in metastatic prostatic carcinoma and also in prostatic fluid as well as seminal plasma. Elevated serum PSA levels have been reported in patients with prostate cancer, benign prostatic hypertrophy or inflammatory conditions of their genitourinary tissues. Especially in patients treated with hormone therapy, concurrent serial determinations of PSA and PAP may provide additional clinical value in monitoring patients with prostatic cancer.
Free PSA
Prostate specific antigen (PSA) is confined to the cytoplasm of prostatic acinar cells and ductal epithelium. The presence of PSA has been demonstrated in normal, benign hyperplastic and malignant prostatic tissue in metastatic prostatic carcinoma and in prostatic fluid and seminal plasma.
In the blood, PSA, which is immunoreactive, exists in two forms: complex PSA in which PSA is bound plasma proteins and free PSA. In patients with prostate cancer, the ratio of complex PSA is high, so ascertaining free/total PSA (%) (F/T %) is clinically useful in differentiating prostate cancer from benign prostatic hyperplasia. It has been reported that determination of the ratio of free PSA to total PSA, which is lower in the case of prostate cancer than BPH is considered to be an effective tool for discriminating benign prostatic diseases from prostate cancer.
Prostatic Acid Phosphatase (PAP)
Prostrate cancer is the second most common type of cancer found in male. PAP concentrations were found to be elevated in many men with primary prostatic carcinoma and metastatic lesions of the prostate. Thus it was suggested that PAP may be significant tumor marker. PAP is released into the blood stream by the primary tumors or following relapse of a prostatic malignancy. Therefore, sensitive and accurate measurement of serum PAP is essential in monitoring the effectiveness of therapy.
OVCA (CA125 like)
CA 125 is a glycoprotein, an antigen that plays an important role of tumor marker or biomarker. Elevated serum levels of CA 125 are associated with greater than 80% of nonmucinous epithelial ovarian neoplasm. Elevated serum levels of CA 125 are also associated with other gynecological neoplasm's, primarily endometrium and fallopian tube carcinomas and certain tumors of the pancreas, liver, colon, breast and lung. Recent studies indicate that monitoring serial determinations of CA 125 in conjunction with chemotherapy may have clinical value in deciding proper prognosis. Studies also suggest that long term monitoring of CA 125 in patients with known ovarian carcinomas has utility in detecting early recurrence and disease progression.
SLa (CA19-9 like)
Carbohydrate Antigen 19-9 (CA 19-9) is a digestive cancer associated antigen. CA 19-9 exists in the blood in the form of a mucinous glycoprotein. CA 19-9 is found in not only tumor tissue, but also in the pancreas, gallbladder, meconium and saliva. The level of serum CA 19-9 is elevated in pancreatic cancer, biliary cancer, colon cancer and liver cancer. Since false positive rate is less for benign diseases, measurement of CA 19-9 is widely used as an effective test for diagnosis of malignant tumors of pancreas and biliary and as an efeective tool to make a decision of medical treatment effectiveness and to do follow-ups.
27.29 (CA15-3 like)
Breast carcinoma-associated antigen coded by the human MUC-1gene is identified by several names including MAM 6, milk mucin, 27.29 and CA 15-3 (Fujirebio Diagnostics, Inc.). As indicated by epitope mapping, inhibition of antibody binding, tracer exchange and clinical correlation studies, 27.29 is similar, if not identical, to CA 15-3. This antigen is a glycoprotein (Molecular weight 300 - 450 kDa) which contains 20-amino-acid tandem repetitive sequence of the mucin core and carbohydrate of more than half of the molecule. The number of tandem repeats and the degree of glycosylation is variable between individuals, so that 27.29 is very heterogeneous in structure. In malignant cells, 27.29 is overexpressed on the entire cell surface, and increasing amounts are shed into the circulation. Tumors involving glandular organs, such as the breast, can produce high concentration of 27.29 in serum, making it useful as a tumor marker.
Monoclonal antibodies that recognized distinct epitopes on 27.29 and CA 15-3 antigen molecules have been used to develop immunoassays. 27.29 was developed with a monoclonal antibody that recognized an 8 amino acids in the tandem repeat portion of the polypeptide chain.. Since the antigen levels correlated closely with disease regression or progression, 27.29 proved reliable in the follow-up of patients with advanced breast cancer.
ß2-Microglobulin (BMG)
Human ß2 microglobulin is a polypeptide, identical to the light-chain of the major histocompatibility complex class antigens. BMG is expressed in all nucleated cells. Determination of serum BMG is of diagnostic value in a variety of disorders.
BMG concentrations are increased in serum and urine in inflammatory diseases, renal dysfunction, autoimmune diseases and some viral diseases. It can provide a measure of tumor burden and prognosis in patients with multiple myeloma, B cell lymphoma and chronic lymphocytic leukemia.
Squamous-cell carcinoma (SCC)
Squamous-cell carcinoma is a cancer of a kind of epithelial cell, the squamous cell.
These cells are the main part of the epidermis of the skin, and this cancer is one of the major forms of skin cancer.
However, squamous cells also occur in the lining of the digestive tract, lungs, and other areas of the body, and SCC occurs as a form of cancer in diverse tissues, including the lips, mouth, esophagus, urinary bladder, prostate, lung, vagina, and cervix, among others.
Despite sharing the name squamous cell carcinoma, the SCCs of different body sites can show tremendous differences in their presenting symptoms, natural history, prognosis, and response to treatment.
SCC is a histologically distinct form of cancer. It arises from the uncontrolled multiplication of cells of epithelium, or cells showing particular cytological or tissue architectural characteristics of squamous cell differentiation, such as the presence of keratin tonofilament bundles, ordesmosomes, structures involved in cell-to-cell adhesion.
SCC is still sometimes referred to as "epidermoid carcinoma" and "squamous cell epithelioma", though the use of these terms has decreased.
SCC-Ag or Squamous Cell Carcinoma antigen is a tumor-associated protein of squamous cell carcinoma.
Squamous cells are epithelial cells found in many parts of the body: in the mouth and on the lips, on the cervix of the uterus, as well as in the middle layers of the skin. Squamous cells are the flat, as opposed to square (cuboidal) or rectangular (columnar) epithelial cells.
As squamous epithelial cells can be found in different places in the body the squamous cell carcinomas (SCC) can also been develop in different places: in the epidermis, the oral cavity, neck and esophagus, but the most life treated SCC’s are found in the cervix of the uterus.
SCC-Ag is an excellent serological tumour marker for patients with carcinoma of the cervix.
SCC-Ag is not sufficiently sensitive (particularly in early-stage disease) or specific for cervical cancer for use in screening. The best test for screening of SCC of the cervix is the PAP smear.
Serum SSC levels correlate significantly with tumour stage and can used as a prognosis parameter, it is also useful in monitoring the course of squamous cell cervical cancer treatment and serum SCC-Ag level has a sensitivity of +/-71% and specificity of +/- 92% for detecting recurrent squamous cell cervical cancer.
PIVKA-II
PIVKAII or des-γ-carboxy prothrombin is an abnormal prothrombin with¬out carboxylation of 10 glutamic acid residues at its N-terminus and is devoid of coagulation activity, raising when there is a vitamin K deficiency in normal patients, and in hepatocellular carcinoma (HCC) cases.
HCC is responsible for half million death world-wide per year (all liver cancers represent 3 % of all cancer cases).Alpha-fetoprotein (AFP) is mostly used to detect and monitor HCC, but PIVKA-II can also be used to detect HCC.
The combined use of AFP and PIVKA-II will increases sensitivity as well as specificity for HCC, AFP is superior to PIVKA-II as a diagnostic tool for early detection of HCC.
PIVKA-II can be used as a clinical prognostic factor for recurrence and survival during treatment of HCC as PIVKA-II is more correlated with the size of the Tumor and the aggressiveness.
