Tumor Marker:- Part 3 – Alk.phosphatase, CK, LDH, Acid phosphatase, and PSA
- There are various specific tumor markers for various types of malignancies.
- Following is the list of tumor markers.
- Alkaline phosphatase.
- Creatinine Kinase.
- Lactate dehydrogenase.
- Prostatic acid phosphatase.
- Prostatic specific antigen.
- Adrenocorticotropic hormone.
- Calcitonin.
- HCG
- Carcinoembryonic antigen (CEA).
- AFP
- CA 15-3
- CA 19-9
- CA 50
- CA 72-4
- CA 125
- CA 549
Alkaline Phosphatase
- Alkaline phosphatase is present in all the tissue but the maximum amount found in the liver, bone, and placenta.
- The liver isoenzyme is more stable than the bone isoenzyme.
- Placental isoenzyme is produced by the trophoblastic cells.
- placental isoenzyme is also raised in pregnant women.
- This was discovered by the Fishman in 1968.
- This was the first tumor marker along with AFP and CEA.
- Alkaline phosphatase marker is raised in:
- Metastatic tumors of bone or liver.
- Prostatic cancer with bone metastasis. There is osteoblastic activity and markedly raised the level.
- Breast cancer metastasis to the bone with osteolytic activity and mildly raised level.
- Leukemia, Lymphoma, and sarcoma with metastases to the liver.
- This may be raised in other malignancies like ovarian, lung, trophoblastic, gestation tumors, seminoma, Hodgkin’s lymphoma, and GIT tumors.
- Normal (Source2)
- Adult = 30 to 120 units/L
- Old people = Higher than the adult’s value.
- Children / adolescent:
- <2 years = 85 to 235 units/L.
- 2 to 8 years = 65 to 210 units/L.
- 9 to 15 years = 60 to 300 units/L.
- 16 to 21 years = 30 to 300 units/L.
Creatine Kinase (CK)
- Creatine kinase is the enzyme that activates creatine in the muscles by transferring a high energy phosphate group in the reaction. This reaction is reversible.
- Creatine + ATP ↔ Creatine phosphate + ADP
- CK is found in high concentration in the heart muscles, skeletal muscles, and the brain.
- Creatine kinase is a dimer consisting of two subunits (polypeptide chains):
- CK – M
- CK – B
- There are three isoenzymes:
- CK-1 (BB). is present in the brain, prostate, GIT, bladder, lungs, uterus, and placenta.
- CK-2 (MB) is present in high concentrations in the cardiac muscles.
- CK-3 (MM) is present in the cardiac and skeletal muscles.
- This is raised in:
- Prostatic cancer.
- Small cell carcinoma of the lung.
- Maybe elevated in the cancers of the breast, ovary, stomach, and colon.
- Normal Total CPK (Source 2):
- Adult/elderly
- Male = 55 to 170 units/L
- Female = 30 to 135 units/L
- Values are higher after the exercise.
- Newborn = 68 to 580 units/L
- Adult/elderly
Lactate Dehydrogenase (LDH)
- This is an enzyme in the action of the glycolytic pathway, and it is released when there is cell membrane damage.
- LDH is found in the cells of Herat, RBCs, kidneys, liver, brain, lungs, and skeletal muscles.
- When there is an injury to cells then LDH enters into the blood.
- This not a good indicator of the cell injury because of its presence in most of the tissue.
- Its level correlates with the tumor mass and gives a prognostic indicator of the progress of the disease.
- LDH isoenzymes are:
- LDH-1 is 17 to 27% and the main source is the heart.
- LDH-2 is 27 to 37%. it is present in the reticuloendothelial system. This is the main component of LDH.
- LDH-3 is 18 to 25% and is mainly present in the lung.
- LDH-4 is 3 to 8%, is present in the kidney, pancreas, and placenta.
- LDH-5 is 0 to 5%, is present in the skeletal muscles and liver.
- Isoenzyme LD-5 is associated with liver metastasis.
- LDH is a nonspecific tumor marker and is raised in:
- Liver cell carcinoma.
- Lymphomas.
- Acute leukemias.
- Germ cell testicular tumors.
- Breast cancer.
- Colon cancer.
- Stomach cancer.
- Lung cancer.
- An elevated level of LDH in the urine indicates neoplasm or injury to the urogenital system.
- LD – 5 positive in the spinal fluid indicates metastasis to the central nervous system.
- Normal LDH level (Source 2):
- Adult/elderly = 100 to 190 units/L at 37 °C
Neuron-specific Enolase (NSE)
- This is a glycolytic enzyme found in:
- Small cell lung cancer.
- Neuroblastoma.
- Pheochromocytoma.
- Carcinoid.
- Medullary carcinoma of the thyroid.
- Melanoma.
- pancreatic endocrine tumors.
Prostatic acid phosphatase
- Acid phosphatase is found in many tissues, including the liver, blood vessels, red blood cells, platelets, and bone marrow.
- The maximum concentration is found in the prostate gland.
- The estimation of acid phosphatase is advised for:
- The diagnosis of prostatic carcinoma.
- Staging of the prostatic carcinoma.
- To monitor the efficacy of the treatment of prostatic carcinoma.
- The level is raised when the prostatic carcinoma has metastasized beyond the capsules to the other parts of the body, especially to the bone.
- In the case of complete curative surgery of prostatic cancer, the acid phosphatase decreases to normal in several days.
- When the patient is treated with estrogen therapy, then it returns to normal in several weeks.
- Prostatic acid phosphatase (PAP) is a better indicator and most clinically significant.
- PAP is more accurate than the total acid phosphatase.
- This is produced primarily by the prostate and raised in:
- Prostatic cancer.
- Osteogenic sarcoma.
- Multiple myelomas.
- metastasis to bone.
Prostatic specific antigen (PSA)
- PSA is a glycoprotein normally found in the cytoplasm of the prostatic epithelial cells.
- This antigen is detected in all males but its level is markedly increased in prostatic carcinoma.
- Its level is related to the size of the tumor.
- The use of PSA:
- This is specific for the diagnosis of prostatic cancer.
- It is used to detect, stage, and monitor the treatment of prostatic carcinoma.
- Its use is more specific for monitoring of the treatment.
- The sensitivity of PSA is 70% at the cut off value of 4.0 µg/L.
- Specificity more than 90%, if cut off value, is raised to 8 µg/L.
- The level of PSA correlates with the stage of the disease.
- Measure PSA:
- Every 3 months after the surgery during the first year.
- After 4 months in the second year.
- After 6 months every year.
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