Tumor Markers

Nagalase- an enzyme found in animals and bacteria that plays a role in regulating infectivity and immunosuppression. It can be used to assess tumor burden and aggressiveness, and to monitor response to treatment as well as tumor growth or recurrence. It can be used non-specifically for most solid and blood tumors. It is not usually effective for assessing superficial skin cancers, as most of these have not shed cancer cells into the blood stream unless they become more invasive. Nagalase can also be elevated in a viral disease.

 

AFP (alpha-fetoprotein)- hepatocellular (some primary liver cancers), non-seminomatous germ cell tumor (NSGCT), ovarian, gastric, and pancreato-biliary cancers

 

Bence-Jones Proteins or Monoclonal Immunoglobulins- Multiple Myeloma, Waldenstrom’s macroglobulinemia and chronic lymphocytic leukemia

 

Beta-2-microglobulin (B2M)- multiple myeloma, some lymphomas, chronic lymphocytic leukemia (CLL), and other inflammatory infections/ disorders such as HIV and CMV

 

BCR-ABL- chronic myeloid leukemia (CML), and BCR-ABL-positive acute lymphocytic leukemia (ALL)

 

Breast cancer gene expression tests (Oncotype DXÒ and MammaprintÒ)- breast cancer treatment monitoring and recurrence, may help avoid chemotherapy

 

BTA (Bladder Tumor Antigen)- bladder cancer, or kidney/ ureter cancers

 

CA 19-9- pancreatic ductal adenocarcinoma and biliary tree, gastric, liver, colorectal, lung and thyroid cancer

 

CA 15-3- breast cancer (usually later in the disease), lung, ovarian, endometrial, bladder and gastrointestinal cancers

 

CA-125- ovarian, endometrial/ uterine/ cervical, breast, gastric, colorectal, pancreas, liver and lung  cancers

 

CA 27.29- Breast (best for recurrence or metastasis), colon, gastric, liver, lung, pancreatic, ovarian and prostate cancers

 

Calcitonin- medullary thyroid cancer

 

CEA (Carcinoembryonic antigen)- colorectal, pancreatic, gastric, hepatobiliary, breast, lung, bladder, kidney, thyroid, head and neck, cervical, ovarian, liver, lymphoma and melanoma cancer.

 

Chromagranin A- carcinoid tumors, neuroblastoma, neuroendocrine tumors and small cell lung cancer

 

Cytokeratin Fragment 21-1 (blood test)- lung, urologic, gastrointestinal and gynecologic cancers

 

DCP (Des-gamma-carboxy prothrombin)- hepatocellular carcinoma

 

EGFR mutation- non-small cell lung cancer, possible head and neck cancer

 

Estrogen and Progesterone- breast cancer

 

Fibrin/ Fibrinogen- bladder cancer treatment response

 

Gastrin- G-cell hyperplasia, gastrin-producing tumor (gastrinoma)

 

hCG (human chorionic gonadotropin)- testicular and trophoblastic disease, germ cell tumor, choriocarcinoma and gestational trophoblastic neoplasia

 

HER2- breast, gastric and esophageal cancer

 

5-HIAA- carcinoid tumors

 

HPV (Human Papilloma Virus)- gynecologic, anal, penile and head and neck cancers

 

HVA (Homovanillic Acid)- neuroblastoma

 

JAK2 mutation- certain types of leukemia and myeloproliferative neoplasms

 

KRAS mutation- colon and non-small cell lung cancer

 

LDH- lymphoma, melanoma, acute leukemia, testicular and seminoma (germ cell tumors), nruoblastoma

 

Monoclonal immunoglobulins- multiple myeloma, Waldentrom’s macroglobulinemia

 

NSE- small cell lung cancer, neuroblastoma

 

NMP 22- bladder cancer

 

PAP (Prostatic Acid Phosphatase)- metastatic prostate cancer, myeloma, lung cancer and osteogenic sarcoma

 

PSA (Prostate Specific Antigen)- prostate

 

SCC-A- cervical cancer

 

SMRP (Soluble mesothelin-related peptides)- Mesothelioma

 

T-cell receptor gene rearrangement- T-cell lymphoma

 

Tg (Thyroglobulin)- thyroid cancer

 

Urine catecholamines: VMA (Vanillylmandelic Acid)- neuroblastoma, pheochromocytoma, ganglioneuroma, rhabdomyosarcoma, PNET

 

TUMOR MARKERS BY CANCER TYPE

 

BREAST CANCER: 

CA 27.29

CA 15.3

CEA

CA 19-9

 

PANCREATIC CANCER:

CA 19-9*

CEA

CA 125

*https://pmc.ncbi.nlm.nih.gov/articles/PMC4419808/

*https://pmc.ncbi.nlm.nih.gov/articles/PMC6987233/

 

COLORECTAL CANCER:

CEA

CA 125 *

CA 19-9

CA 242*

*superior per https://pubmed.ncbi.nlm.nih.gov/33935125/

 

GLIOBASTOMA CANCER:

No tumor markers currently available, especially if the blood-brain barrier is intact.

 

OTHER TESTS: 

Full body PET (positron emission tomography) scan- uses a radioactive tracer that is administered through an IV along with glucose.  As cancer cells love glucose, they will preferentially uptake the tracer. This can help identify tumors and metastatic disease. The PET scan will also give the FDG, which is how much radioactive tracer was taken up by the cells, indicating metabolic activity of the cells (higher in cancer cells). There are standard values for those areas of the body that typically have a higher FDG uptake because they normally have higher glucose needs (spleen, liver and brain). The Pet scan will also list the SUV (standard uptake value) a ratio that defines the activity of the FDG in a specific area on the PET scan. This also can be indicative of metabolic activity. In Houston, Texas, a PET scan will cost approximately $1400.

Prenuvo- a whole body scan that assesses your neck, chest abdomen, pelvis and legs. It can assess for solid tumors, metabolic disorders such as fatty liver, spinal degeneration, non-cancerous conditions such as cysts, hematomas or abscesses, auto-immune disorders or brain aneurysms. The cost is $2499.