Rapid Review·General Pathology
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NEOPLASIA
T2High yieldSerum Tumor Markers
P222
Focus on
Why tumor markers are for following disease and never for finding it.
Key takeaways
The governing rule
The governing rule for tumor markers
they must NOT be used as the primary tool for diagnosis or screening.- They exist to monitor recurrence and response to therapy.
- Definitive diagnosis is always by biopsy.
- Many have non-neoplastic associations, which is exactly why they fail as screening tests.
Markers by tumor group
Bone, liver and germ cell tumors
| Marker | Association | Notes |
|---|---|---|
| Alkaline phosphatase | Bone or liver metastases, Paget disease of bone, seminoma (PLAP) | Exclude hepatic origin by checking GGT |
| α-fetoprotein | HCC, yolk sac (endodermal sinus) tumor, mixed germ cell tumor, ataxia-telangiectasia, neural tube defects | Made by the fetus; ↑ in neural tube and abdominal wall defects, ↓ in Down syndrome |
| hCG | Hydatidiform mole, choriocarcinoma, testicular cancer, mixed germ cell tumor | Produced by syncytiotrophoblasts |
| LDH | Testicular germ cell tumors, dysgerminoma, others | Indicator of tumor burden |
Carcinomas
| Marker | Association | Notes |
|---|---|---|
| CA 15-3 / CA 27-29 | Breast cancer | Surveillance only |
| CA 19-9 | Pancreatic adenocarcinoma | Surveillance only |
| CA 125 | Epithelial ovarian cancer | Also ↑ in endometriosis and PID |
| CEA | Colorectal and pancreatic cancer | Very nonspecific; minor associations with gastric, breast, medullary thyroid |
| PSA | Prostate cancer | Also ↑ in BPH and prostatitis; uncertain risk-benefit for screening |
Neuroendocrine tumors
| Marker | Association | Notes |
|---|---|---|
| Calcitonin | Medullary thyroid carcinoma, with or without MEN2A/2B | "Calci2nin" for MEN2 |
| Chromogranin | Neuroendocrine tumors | Pairs with synaptophysin |
| Neuron-specific enolase | Small cell lung cancer, carcinoid, neuroblastoma | Neuroendocrine lineage |
A 25-year-old man has a testicular mass and a markedly raised α-fetoprotein. Which germ cell tumor component does the AFP point to?
Yolk sac (endodermal sinus) tumor, alone or as part of a mixed germ cell tumor. A pure seminoma does not raise AFP.
How it's tested
The governing principle is that tumor markers are for surveillance, not detection.
A stem offers "measure serum CEA" to diagnose a colonic mass. That is wrong; the answer is colonoscopy with biopsy. CEA's legitimate use is post-resection monitoring, where a rising level signals recurrence.
Also know the germ-cell logic cold: AFP is elevated in yolk sac tumors and never in a pure seminoma. If a testicular mass looks like a seminoma but AFP is high, it contains a nonseminomatous component and must be treated as such.
Go deeper
First Aid "Tumor markers" table; Pathoma Ch. 3. Anchor that markers monitor recurrence and treatment response — they do NOT diagnose or screen — and the germ-cell logic (AFP in yolk sac tumors, never in a pure seminoma).
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