Cancer Screening Tests

CANCER SCREEN TESTS – TUMOR MARKERS (MARCERS)

• Tumor markers are molecules found in higher than normal amounts in the tissues, serum, urine, or other body fluids of cancer patients.
• Tumor markers can be used in the diagnosis of cancer, in determining the pre-diagnosis, in guiding the treatment and in the follow-up of the response.
• In the UK, 15 million people a year are asked for tumor markers.
• 10% of tumor marker requests are suitable in a study conducted in Greece
• Annual cost ≈ $400,000 (excluding unnecessary testing at follow-up)
• 26% of all CA15-3s were requested by male patients
• 17%-26% of all CA125s were requested in male patients.
• PSA was requested in some of the female patients.
• Only 1944 (19%) of 10291 patients for whom tumor markers were requested had a diagnosis of cancer.

WHY SHOULD WE SELECTIVELY USE TUMOR / CANCER SCREENING TESTS?

• High measurements can cause unnecessary anxiety and additional testing. Cost and unnecessary morbidity to the patient (State of Disease)
• Normal measurements can give a false sense of confidence, that is, even if these tests are normal, it does not mean that there is no cancer or tumor, it should be evaluated together with the clinic. (“false sense of security”)

INTENDED USE OF CANCER SCREENING TESTS

• SCREENING – EARLY DIAGNOSIS
• DIGNOSIS
• DETERMINATION OF PREDICTION
• FOLLOWING THE TREATMENT RESPONSE
• DETERMINATION OF RECURRENCES

SCAN

• To provide early diagnosis of cancer in symptomatic asymptomatic individuals
• PSA (Prostate Antigen)
• Other markers have no place in screening average risk patients
• CEA, CA19-9, CA15-3, CA125, AFP

CANCER/TUMORS SCREENING IN HIGH RISK PATIENTS

• AFP: Hepatocellular carcinoma screening with US and AFP in people with chronic hepatitis, chronic liver disease
• CA125: Ovarian cancer screening is performed with transvaginal US+CA125 in people with known BRCA mutations or hereditary non-polyposis colorectal cancer syndromes

HELPER DIAGNOSIS IN SYMPTOMATIC PATIENT

• Not all tumor markers should be requested as panels.
• CA125 in men
• PSA in women

CLINICAL SCENARIO MARKERS TO AID DIAGNOSIS IN SYMPTOMATIC PATIENTS

Ascites, encephalopathy, jaundice, weight loss in patients with chronic hepatitis or cirrhosis AFP Hepatocellular cancer Persistent or progressive abdominal and urinary symptoms, bloating, pelvic mass CA 125 Ovarian cancer

Weight loss with progressive obstructive jaundice, abdominal or low back pain, CA 19-9 Pancreatic Cancer GI bleeding, nausea, vomiting, abdominal mass, CEA Colon cancer

CLINICAL SCENARIO MARKERS TO AID DIAGNOSIS IN SYMPTOMATIC PATIENT

Testicular pain, mass, swelling, stiffness AFP, B-HCG Testicular cancer Frequent urination, nocturia, dysuria, urinary retention, low back pain, weight loss, anemia PSA Prostate cancer.

When the following symptoms occur together:
anemia, low back pain, weakness, bone-related (osteolytic) lesions, increased ESR (sedim) and globulin, spontaneous fractures Paraproteins Multiple myeloma

EVALUATION OF PROGNOSIS, RESPONSE TO TREATMENT AND EARLY DETECTION OF RECURRENCES NON-CANCER CAUSES

• Many tumor markers are also temporarily elevated in benign/inflammatory diseases of the relevant organ
• CEA in colitis
• Ca19-9, cholangitis, pancreatitis
• PSA, prostatitis
• Ca15-3, benign breast diseases
• Ca125, peritonitis, PID

PSA

• Organ-specific but not cancer-specific
• Scan: Controversial,
• To prevent 1 death due to prostate cancer, it is necessary to screen 1410 people and treat 48 people
• The potential benefits and harms of screening should be explained to the people who will be offered screening.
• It can be seen in those with symptoms of prostatism.
• It is routinely used in response evaluation and follow-up of recurrences in patients diagnosed with prostate cancer.

PSA : Non-cancer causes

• Rectal touch
• Prostatitis
• Cystoscopy, TRUS, prostate biopsy
• Urine tube Carcinoembryonic antigen

CEA

• Colorectal cancer
• No place in screening and early diagnosis
• High in only 3% of early-stage colon cancers
• Monitoring response to treatment,
• Detection of recurrences
• Other gastrointestinal cancers
• Medullary thyroid cancer

CEA : Non-cancer causes

• Colitis, diverticulitis, irritable bowel syndrome
• Chronic liver disease, chronic kidney failure
• Pneumonia, pleuritis
• Congestive jaundice
• There may be slight elevation for smokers

CA15-3

• Breast cancer
• It has no place in screening and diagnosis
• Used to monitor response to treatment and to identify recurrences
• Rarely, it may be elevated in some other cancers

CA15-3 : Non-cancer causes

• Hepatitis, chronic liver disease
• Colitis
• Kidney failure
• Tuberculosis, sarcoidosis
• Some dermatological diseases

CA 125

• Ovarian cancer
• Not recommended for scanning
• Used to monitor response to treatment and to identify recurrences
• May be requested in the presence of pelvic mass or persistent/ progressive abdominal and urinary symptoms.

CA125 : Non-cancer causes

• All serosal involvement
• Non-malignant acid
• Pleuritis/pleural effusion
• Pericarditis/pericardial effusion
• Arthritis
• Benign gynecological diseases
• Menstruation, endometriosis, fibroids
• Benign gastrointestinal diseases
• Hepatitis, colitis, pancreatitis, irritable bowel syndrome, diverticulitis
• Other
• Heart failure, kidney failure

CA19-9

• Pancreatic cancer
• Used to monitor response to treatment and to identify recurrences
• Colorectal, stomach, esophageal, hepatocellular cancers

CA 19-9: Non-cancer causes

• All kinds of cholestasis and jaundice
• Cholangitis, acute/chronic pancreatitis
• Chronic liver disease
• Irritable bowel syndrome
• Diabetes

Alpha-Feto Protein (AFP)

• Hepatocellular carcinoma
• Testicular cancer
• Germ cell tumors of the ovary
• Men with poorly differentiated or fully undifferentiated tumors (especially if the tumor is located in the midline)
• AFP and BETA-HCG
• AFP should be checked in those at high risk of hepatocellular cancer.