Term
low free PSA fraction or elevated bound PSA fraction
PSAfree:PSAtotal <10%
correlates with? |
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Definition
Prostate cancer
PSA=protease-->minimize the viscosity of the ejaculate |
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Term
Prostatic manipulation and instrumentation --> effect
- PSAtotal
- PSAfree |
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Definition
- minimal
- markedly=> measure before/several weeks after manipulation |
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Term
Specimen handling
PSAfree |
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Definition
processed within 2hrs / freeze
-->less stable than bound PSA |
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Term
| When % PSAfree measurement-->advantage? |
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Definition
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Term
PSAtotal = 2.5 - 4.0
?test can improve prostate Ca diagnosis |
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Definition
increased pro-PSA and truncated PSA isoforms1
1pPSA-->anomalous clipping |
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Term
| Correlation between PSA and tm reccurence |
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Definition
weak in first 5yrs post treatment
preop--> PSA ~ tumor volume and stage
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Term
| Nonneoplastic coditions a/w elevated CEA1 |
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Definition
Smoking, peptic ulcer dz,IBD,pancreatitis, hypothyroidism, biliary/bowel obstruction, cirrhosis
1CEA < 10ng/mL |
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Term
| CEA elevations in malignancies other than colon |
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Definition
| Gastric(well diff, intest. type), breast, lung,pancreas,cervical,urothelial, MTC |
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Term
Colorectal Ca and degree of CEA elevation
Affected by? |
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Definition
Tumor stage, grade, site (L>R), ploidy
obstruction,liver function (metabolism) |
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Term
| post-treatment surveillance of colorectal Ca |
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Definition
serial CEA measurements
most sensitive--> liver mets
poorly sensitive--> locoregional recurrence |
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Term
Thyroglobulinserum - Cause of
1. Underestimation
2. Overestimation |
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Definition
Anti-thyroglobulin Ab's->10% (nml Indiv.),>20%Pt w thyroid Ca
2. Macro-thyroglobulin
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Term
Pt w PTC/FTC and anti-thyroglobulin Ab's
Tumor marker? |
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Definition
Serial quantitative [anti-thyroglobulin Ab]serum
increase<--Ag stimulation<-- recurrence |
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Term
| Marker for mucinous ovarian Ca, Urothelial Ca & RCC |
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Definition
Tumor-Associated Trypsin Inhibitor (TATI)
also in pancreatic adenoca-->limited specificity (pancreatitis)
gastric ca (60%) --> diffuse, infiltrative,signet ring |
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Term
| TATI expression and tumor prognosis |
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Definition
| Adverse prognostic factor |
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Term
| Nonneoplastic cause of TATI elevation |
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Definition
Renal failure
Pancreatitis--> degree of elevation ~ severity |
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Term
CA 125
Major role in monitoring of which Pt |
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Definition
Non-mucinous epithelial ovarian neoplasm
elevated only ~ 50% --> stage I dz |
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Term
elevated CA 125
Nonneoplastic causes |
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Definition
| Pregnancy,fibroids, benign ovarian cysts, pelvic inflammation, ascites, endometriosis |
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Term
elevated CA 125
In which nonovarian neoplasms? |
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Definition
| Fallopian tube, endometrium, pancreas,breast, colon |
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Term
post-menopausal woman w palpable adnexal mass & CA 125> 65 U/mL
Dx? |
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Definition
Ovarian malignancy ( epithelial, non-mucinous)
PPV >95% |
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Term
| Serum markers for breast Ca |
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Definition
CA27.29 (more sensitive &specific), CA15-3
--> different epitopes of a single Ag = protein product of breast ca assoc MUC1 gene |
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Term
elevated CA27.29/15-3
nonneoplastic causes? |
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Definition
benign ovarian cysts, liver dz, benign breast dz
CA 15-3--> sarcoidosis and lupus |
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Term
elevated CA27.29
non-breast malignancies |
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Definition
| Colon, stomach, pancreas, prostate, lung |
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Term
| Best prognostic markers in breast cancer |
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Definition
IHC: ER, PR, Her-21 (c-erb-2) Nc staining % of tm cells
--> correlates well with biochemical assays (ligand binding)
1IHC & / FISH -->Rx: trastuzumab |
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Term
| Her-2 assesment in breast cancer |
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Definition
IHC:Only membranous staining-->only Inv. component
0-3+ --> 2+ => FISH |
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Term
| Best marker for pancreticobiliary adenoca and assesment to treatment response |
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Definition
CA19-9 >10001 U/L
1not seen in benign dz ( <100 U/L) |
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Term
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Definition
= Lewis blood group Ag
not produced by Le- people |
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Term
AFP - physiologic effect
Site of synthesis? |
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Definition
Major component of fetal serum --> ~ albumin
Yolk sac, fetal liver/GI tract
undetectable-->post partum, adults < 5.4ng/mL
benign conditions < 100 ng/mL |
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Term
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Definition
Yolk sac tm--> [AFP] ~ prognosis
HCC -->[AFP] ~ overlap w benign dz
Hepatoid variant of gastric Ca |
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Term
| low level elevation of hCG in non-pregnant woman |
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Definition
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Term
| Marker for monitoring transplant rejection |
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Definition
beta2-Micoglobulin --> surface-most nucleated cells
-->non-covalent link to MHC I
Increased cell turnover1 => elevated beta2M2
1solid tm & hematolymphoid neoplasms,2renal isufficiency |
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Term
Raised Alkaline Phosphatase
Causes |
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Definition
-->osteoblastic activity (osteogenic sarcoma, bone mets,
active Paget disease of bone)
~ Liver function--> hepatic mets (carcioids~prognosis) |
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Term
| Pt with gonadal/urologic cancer and elevated placental-type alkaline phosphatase |
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Definition
| Regan isoenzyme of Alk Phos |
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Term
modest quantity of 5-HT(serotonin), histamine, catecholamines &5-HTP
Dx: Tumor? Location? |
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Definition
Carcinoid
Foregut: stomach, proximal duodenum and lung
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Term
Only serotonin production in high quantities
Dx: Tumor? Location? |
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Definition
Carcinoid
Midgut: distal duodenum,jejunum,ileum,appendix,right colon |
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Term
Carcinoid tumor
non secretory for indoles
Location? |
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Definition
Distal 1/3 of transverse, descending colon,sigmoid colon and rectum
~hCG |
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Term
| Most accurate marker for detection of carcinoid tm |
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Definition
Platelet serotonin
--> take up serotonin from the serum @ constant rate
--> not affected by diet (tryptophan rich) |
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Term
Urine test
elevated 5-HIAA
DDx: |
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Definition
Carcinoid --> 20-30% ~ normal (foregut,hindgut)
False elevation--> tryptophan rich diet
5-HT--> platelets -->some 5-HT--> renal tubules => 5-HIAA |
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Term
Plasma marker in neuroendocrine tm
--> Tm burden and treatment response |
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Definition
Chromogranin A
Small cell NE, pheo,carcinoid,islet cell tm
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Term
Increased [Calcitonin]plasma
DDx? |
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Definition
MTC
Hashimoto, C-cell hyperplasia, breast ca
20 -->chronic renal failure, Zollinger-Ellison syndrome |
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Term
[Calcitonin]plasma < 10ng/L
more sensitive test? |
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Definition
provocative testing - pentagastrin/omeprazole/Ca++
--> in MEN II families |
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Term
MTC
Marker of worse prognosis |
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Definition
| high CEA => greater de-differentiation |
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Term
Tumor with secretion of:
Epinephrine & norepinephrine
Dx? |
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Definition
Pheochromocytoma--> adrenal medulla --> norepinephrine --PNMT-->epinephrine
Extra-adrenal tm --> mainly norepinephrine |
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Term
|
Definition
Paraganglioma1/Pheochromocytoma2/ Neuroblastoma3
--> fractionation of catecholamines/metanephrines
1norepinephrine--> normetanephrine --> VMA
2epinephrine--> metanephrine --> VMA
3also homovanillic acid--> metabolic product of DOPA & dopamine |
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Term
Most accurate test for initial screening of
tumors of chromaffin cells |
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Definition
1.free Metanephrineplasma
2. Metanephrine/Catecholamineurine
plasma catecholamines --> poor sensitivity --> episodic release
plasma metanephrines--> long term catecholamine secretion |
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Term
free Metanephrineplasma Metanephrine/Catecholamineurine
--> equivocal results --> ?test to clarify tests? |
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Definition
| Clonidine suppression test |
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Term
| low VMA:HVA and prognosis |
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Definition
<-- poorly difeerentiated Neuroblastoma
=> worse prognosis |
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Term
Monitoring of patients w known hx/o urothelial Ca
Marker? DDx of + results |
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Definition
urinary NMP22--> sensitive,nonspecific (1-6wks post Sx)
Inflammation-->rapid cell turnover --> false +
Leukocytes--> false + |
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Term
Bladder tumor antigen
false + |
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Definition
| Stone disease, inflammation, BPH |
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Term
| Urine test for Prostatic adenoCa |
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Definition
PCA3/DD3
RNA fro urine sediment--> quantitative real time PCR
=> # DD3 RNA transcripts (nontranslated mRNA) |
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Term
elevated [PSA]serum 1 in prostatic adenoca
Cause? |
|
Definition
1Increase leakage into the extracellular matrix
KLK3 gene (encodes PSA) --> not upregulated in Prostate adenoca
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