Which tumor marker is used as a screen for choriocarcinoma

Note: Observe the date of the beta-HCG study carefully. Record a preoperative study only. Beta-HCG is also used as a marker postoperatively to monitor residual tumor and the effectiveness of therapy. In patients with choriocarcinoma who have had a hysterectomy and oophorectomy , the presence of beta-HCG will confirm the patient has residual cancer that requires further treatment. In patients with testicular cancer who have had an orchiectomy , the presence of beta-HCG will confirm the patient has residual cancer that requires further treatment.

However, when beta-HCG does not exist in the serum, the presence of active cancer cannot be excluded, especially in patients who have been previously treated. Elevated levels suggest catecholamine -secreting tumor such as neuroblastoma or ganglioneuroma ; high levels rule out pheochromocytoma.

A blood chemistry study, usually part of a liver panel, useful in assessing liver and pulmonary disease. All tumors produce LDH. There are five tissue-specific isoenzymes that can be identified and measured. The distribution of isoenzymes is as follows:. A series of blood chemistry tests measuring enzymes excreted by the liver during abnormal functioning due to metastases, obstruction or other conditions.

Also called: liver panel. A liver panel may contain any of the following tests. If any one of these tests is outside the normal range of values, the test should be reported as abnormal. Elevated level indicates presence of small cell carcinoma of lung and neuroblastoma; of secondary use in testicular neoplasms; nonspecific to central nervous system tumors. Presence of abnormal chromosome in bone marrow confirms diagnosis of chronic myelogenous leukemia ; absence of Ph1 chromosome does not rule out CML.

Differentiates the source of tumor among liver, bone , and germ cell origin ; non-diagnostic by itself, it helps confirm malignancy in a small number of patients. Elevated levels of this circulating hormone are found in squamous cell cancer and in breast cancer.

Progesterone receptor assay increases the reliability of estrogen receptor assay results: a positive progesterone receptor assay indicates greater likelihood that the patient will respond to hormone therapy. Test results — negative: 5 fmoles or less. Test may not be performed if tumor is less than 1. Types of PRA: Quantified measured in femtomoles or fmoles ; Immunohistochemical—a qualitative measurement of the observed number of hormone responsive cells, reported as positive or negative.

Differentiates cell type for endocrine-secreting tumors; elevated in insulinoma and islet cell tumors. Tumor marker assay test of blood serum for antigen released from cells in prostate tissue.

Value may be elevated in benign prostatic hypertrophy ; greatest elevation occurs in stage C and D prostate cancer. After radical prostatectomy or radiation therapy , rising levels of PSA indicate residual disease or recurrence. Note: test results may be affected by recent prostatic massage or palpation; PSA level should be assayed before digital rectal examination.

Normal range: 0 - 4. Therefore any patient with an elevated AFP must have a nonseminomatous component of testis cancer. AFP can be elevated in patients with a number of other malignancies, including with hepatocellular liver carcinoma, cancer of the stomach, pancreas, biliary tract and lung. In addition, AFP elevation is associated with a number of nonmalignant diseases, including diseases of the liver and the rare diseases ataxic telangiectasia and hereditary tyrosinemia.

HCG is a glycoprotein produced by the placenta to maintain the corpus luteum during pregnancy. HCG can be elevated in a number of other malignancies, including cancers of the liver, lung, pancreas and stomach. In germ cell tumors of the testis, including both seminomas and NSGCT, cancerous cells can transform into syncytiotrophoblasts a normal component of the placenta and secrete HCG. However, HCG-producing seminoma approximately 15 percent of seminomas has the same prognosis as seminoma that does not produce HCG.

Three consecutive elevations of the PSA level indicate biochemical relapse in previously irradiated patients. Thus, management decisions must include consideration of a patient's age and comorbid conditions.

Confusion exists about the value of tumor markers in a patient with cancer of unknown primary. Intuitively, a panel of tumor markers should help to establish the origin of the tumor. Unfortunately, most tumor markers are too nonspecific for this purpose. However, with adenocarcinoma in older men, significant PSA elevations have sufficient specificity to make the diagnosis of prostate cancer. Marked elevations of these tumor markers signify the presence of an extragonadal germ cell tumor.

In women with peritoneal carcinomatosis or malignant ascites, treatment for ovarian cancer is instituted if the CA level is elevated. Tumor markers in common use are summarized in Table 4. Consider in patients at high risk for recurrence; obtain CA In patients at high risk for recurrence, obtain CEA level every 2 to 3 months for at least 2 years. Poorly differentiated cancer of unknown primary; patients with cirrhosis and a liver mass. Essential in patients treated for nonseminomatous germ cell tumor; very helpful in patients treated for hepatocellular carcinoma.

Poorly differentiated cancer of unknown primary; gestational trophoblastic disease. Essential in patients treated for nonseminomatous germ cell tumor or gestational trophoblastic disease.

Adjunct for diagnosis of pelvic mass in postmenopausal women; malignant ascites in women with cancer of unknown primary. Obtain PSA level every 6 months for 5 years, then annually. Information from references 1 , 5 , 8 , 12 , 16 , 24 , 26 , 27 , and 39 through Already a member or subscriber?

Log in. Interested in AAFP membership? Learn more. Medical Center. EVAN D. He completed an internal medicine residency and an oncology fellowship at the University of California, San Francisco, School of Medicine.

JOHN G. Prichard completed a family practice residency and an internal medicine fellowship at Ventura County Medical Center. Address correspondence to Greg L. Perkins, M. The authors indicate that they do not have any conflicts of interests. Sources of funding: none reported. The authors thank Janet Parker for research assistance in the preparation of the manuscript. J Clin Oncol. Comparison of the diagnostic accuracy of CA Clin Chem.

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