Tumor markers and its significance in clinical practice

Monday, May 11th, 2009

– Dr Prasanna Kumar K. BHMS, MD( Hom)

Knowledge of tumor markers is essential in diagnosis and to determine the prognosis of a cancer.  Many carcinomas finally land up in Homoeopathic clinic for gentle palliation when they have no other choice. Hence it is essential for a Homoeopath to have a thorough knowledge of various tumor markers and its significance so that we can scientifically palliate carcinoma cases.

What are tumor markers?
Tumor markers are substances, usually proteins that are produced by the body in response to cancer growth or by the cancer tissue itself. Some tumor markers are specific, while others are seen in several cancer types. Many of the well-known markers are also seen in non-cancerous conditions. There are only a handful of well-established tumor markers that are being routinely used by physicians. Many other potential markers are still being researched. Some marker tests cause great excitement when they are first discovered but, upon further investigation, prove to be no more useful than markers already in use.

The goal is to be able to screen for and diagnose cancer early, when it is the most treatable and before it has had a chance to grow and spread. So far, the only tumor marker to gain wide acceptance as a general screen is the Prostate Specific Antigen (PSA) for men. Other markers are either not specific enough (too many false positives, leading to expensive and unnecessary follow-up testing) or they are not elevated early enough in the disease process.

Tumor markers are not diagnostic in themselves. A definitive diagnosis of cancer is made by looking at biopsy specimens (e.g., of tissue) under a microscope.

Clinical uses of tumor markers:
Screening:

*  Most markers are not suited for general screening, but some may be used in those with a strong family history of a particular cancer. In the case of genetic markers, they may be used to help predict risk in family members. PSA testing for prostate cancer is an example.

Helps in diagnosis:

*  In a patient that has symptoms, tumor markers may be used to help identify the source of the cancer, such as CA-125 for ovarian cancer, and to help differentiate it from other conditions. Remember that tumor markers cannot diagnose cancer themselves but aid in this process

Stage:

* If a patient does have cancer, tumor marker elevations can be used to help determine how far the cancer has spread into other tissues and organs.

Determine prognosis:

* Some tumor markers can be used to help doctors determine how aggressive a cancer is likely to be.

Guide Treatment:

* Some tumor markers, such as Her2/neu, will give doctors information about what treatments their patients may respond to (for instance, breast cancer patients who are Her2/neu positive are more likely to respond to Herceptin treatment).

Monitor Treatment:

* Tumor markers can be used to monitor the effectiveness of treatment, especially in advanced cancers. If the marker level drops, the treatment is working; if it stays elevated, adjustments are needed. The information must be used with care, however. CEA, for instance, is used to monitor colorectal cancer, but not every colorectal cancer patient will have elevated levels of CEA.

Determine recurrence:

* Currently, one of the biggest uses for tumor markers is to monitor for cancer recurrence. If a tumor marker is elevated before treatment, low after treatment, and then begins to rise over time, then it is likely that the cancer is returning. (If it remains elevated after surgery, then chances are that not all of the cancer was removed.)

SOME IMPORTANT TUMOR MARKERS USEFUL IN CLINICAL PRACTICE:

Untitled Document

Tumor Markers Cancers Non neoplastic conditions Importance Sample

taken

Alpha

fetoprotein

Hepatoma

Gonadal germ cell tumor

Pregnancy Helps to diagnose, monitor treatment, and determine recurrence Blood
CA-19.9 Colon,

Pancreatic

Breast

Pancreatitis

Ulcerative colitis

Stage disease, monitor treatment, and determine recurrence Blood
CA-125 Ovarian cancer,

Lymphoma

Menstruation,

Peritonitis

Pregnancy

Help diagnose, monitor treatment, and determine recurrence Blood
Calcitonin Thyroid medullary carcinoma Also elevated in pernicious anemia and thyroiditis Help diagnose, monitor treatment, and determine recurrence Blood
CEA-

(Carcino-embryonic antigen)

Colon, Pancreas, lung, breast, ovary. Pancreatitis,Hepatitis,

inflammatory bowel disease  and in cigarette smokers

Monitor treatment and determine recurrence Blood
HCG

(Human chorionic gonadotropin)

Gestational trophoblastic disease,

Gonadal germ cell tumor

Elevated in pregnancy testicular failure Help diagnose, monitor treatment, and determine recurrence Blood, urine
Monoclonal immunoglobulins Multiple myeloma Infections Help diagnose,

monitor treatment, and determine recurrence

Blood, urine
NSE (Neuron-specific enolase) Neuroblastoma, small cell lung cancer May be better than CEA for following this particular kind of lung cancer Monitor treatment Blood
PSA

(Prostate specific antigen), total and free

Prostate cancer Elevated in benign prostatic hypertrophy, prostatitis and with age Screen for and help diagnose, monitor treatment, and determine recurrence Blood
Prostatic acid phosphatase (PAP) Metastatic prostate cancer, myeloma, lung cancer Not widely used anymore, elevated in prostatitis and other conditions Help diagnosis Blood

HOMOEOPATHIC PERSPECTIVE:

It is not uncommon to find carcinoma patients coming to Homoeopathic clinics with a desperate hope of getting relief/palliation. Many carcinoma patients during their first presentation will have significant metastasis.  So the chemo/radiotherapy in such patients will be ineffective.  Many economically deprived patients cannot afford the sophisticated treatments.
The very principle of Homoeopathy of giving the patient a rapid, gentle healing holds good for cure as well as palliation. There are enough medicines in our literature/text books which can be used effectively in such disorders. What Homoeopath required to do is documentation.  Periodically examining the tumor marker levels will make a better documentation and if a thorough study is done we will have a scientific evidence  to restate our stand in management of malignancies.

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