Excerpt from Gynecologic Tumor Markers


Synonyms, Key Words, and Related Terms: biomarkers, immunohistologic markers, cancer antigen 125, CA125, CA-125, topoisomerase II, Melan-A, inhibin-alpha, carbohydrate antigen 19-9, CA19-9, CA 19-9, CA15-3, CA 15-3, CA27-29, CA 27-29, ferritin, beta human chorionic gonadotropin, bhCG, urinary gonadotropin fragment, UGF, urinary gonadotropin peptide, UGP, carcinoembryonic antigen, CEA, alpha-fetoprotein, AFP, human placental lactogen, hPL, human placental alkaline phosphatase, hPLAP, tumor-associated trypsin inhibitor, TATI, cyclin E, lysophosphatidic acid, LPA, insulinlike growth factor–binding protein-3, IGFBP-3, OVX1, macrophage colony-stimulating factor, M-CSF, anti-cytokeratin, anticytokeratin CAM 5.2, S-100, S100, homatropine methylbromide, HMB45, squamous cell carcinoma antigen, SCC-Ag, muscle-specific actin, MSA, smooth muscle actin, SMA, vimentin, desmin, human milk fat globule antigen-1 HFMG-1, HFMG-2, epithelial membrane antigen, EMA, B72.3, Leu-M1, LeuM1

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Tumor markers indicate biological changes that signal the existence of malignancy in a host organism. These substances can usually be detected in elevated quantities in the blood, urine, or body tissues of patients with certain types of cancer. Tumor markers are produced by the tumor itself or by the body in response to the presence of cancer or certain benign conditions. Following the development of monoclonal antibodies, an array of new tumor markers has been discovered during the past 2 decades.

Tumor markers can be used to (1) screen a healthy or high-risk population for the presence of cancer, (2) assist in confirming a diagnosis of cancer or of a specific type of cancer, (3) assist in determining a patient’s prognosis, and (4) monitor the disease course in a patient in remission or in a patient who is undergoing surgery, radiation, or chemotherapy. Currently, tumor markers are primarily used to help assess tumor response to treatment and to check for recurrence.

Most studies focus on either endometrial or ovarian carcinoma. Other gynecologic malignancies (eg, cervical, vulvar, vaginal) have a much smaller representation in the medical literature. Some markers show promise as prognostic indicators.

The following are important gynecologic tumor markers:

  • Cancer antigen 125 (CA125)

  • Topoisomerase II

  • Melan-A and inhibin-alpha

  • Carbohydrate antigen 19-9

  • Ferritin

  • Beta chorionic gonadotropin (hCG)

  • Urinary gonadotropin fragment

  • Carcinoembryonic antigen (CEA)

  • Alpha-fetoprotein (AFP)

  • Others

    • Tumor-associated trypsin inhibitor

    • Cyclin E

    • Lysophosphatidic acid

    • Insulinlike growth factor–binding protein-3

    • OVX1

    • Macrophage colony-stimulating factor

Immunohistochemical markers useful or relevant in the differential diagnosis of gynecological lesions include the following:

  • Vulva and cervix

    • Paget disease versus superficial spreading melanoma - Anticytokeratin, S-100, homatropine methylbromide

    • Cervical intraepithelial neoplasia versus invasive carcinoma - Anticytokeratin smooth muscle actin (SMA), collagen type IV, CEA

    • Minimal-deviation endocervical adenocarcinoma versus benign endocervical glands - Blood group antigens

    • Endocervical adenocarcinoma versus endocervical microglandular hyperplasia - Human milk fat globule antigen-1

    • Endocervical adenocarcinoma versus endometrial adenocarcinoma - Glial fibrillary acidic protein, keratin, vimentin, CEA, S-100

  • Uterine corpus

    • Endometrial carcinoma versus atypical hyperplasia - Human milk fat globule antigen-1, human milk fat globule antigen-2, blood group–related antigens

    • Poorly differentiated endometrial carcinoma versus malignant mixed mesodermal tumor - Keratin, muscle-specific actin, SMA, myoglobin

    • Stromal sarcoma versus leiomyosarcoma - Keratin, vimentin, muscle-specific actin, SMA, desmin

  • Ovaries

    • Surface epithelial carcinoma versus granulosa cell tumor - Vimentin, keratin

    • Nonmucinous carcinoma versus mucinous carcinoma - Keratin, vimentin, glial fibrillary acidic protein, CA125, CEA, S-100, epithelial membrane antigen

    • Germ cell tumor versus carcinoma - Human placental alkaline phosphatase

    • Dysgerminoma versus embryonal carcinoma - Keratin, AFP

    • Yolk sac tumor versus clear cell carcinoma - AFP, LeuM1

    • Thecoma-fibroma versus leiomyoma - Vimentin, muscle-specific actin, SMA

    • Metastatic gastrointestinal carcinoma versus primary mucinous carcinoma - Keratin, CEA, glial fibrillary acidic protein

  • Placenta

    • Partial mole versus complete mole - hCG, human placental lactogen, human placental alkaline phosphatase

    • Trophoblast versus decidual cell - Keratin, human placental lactogen, hCG

  • Cytology

    • Carcinoma cells versus mesothelial cells - B72.3 .....

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