Pros and cons of gynecologic tumor markers

Abstract

The use of a tumor marker not only depends upon its sensitivity and specificity, but also upon its ability to influence decisions between alternative plans for patient management. Use of beta human chorionic gonadotropin (hCG) for monitoring gestational trophoblastic neoplasia has set the standard to which other assays must be compared. Beta hCG and alphafetoprotein have provided useful markers for ovarian germ cell tumors. Recently, a monoclonal antibody-based immunoassay for CA 125 antigen has been used to monitor the treatment of epithelial ovarian carcinomas. Persistent elevation of CA 125 in serum has generally reflected persistence of disease at second look surveillance procedures. CA 125 levels can, however, return to within normal limits and residual disease can be found at laparoscopy or laparotomy. CA 125 shows promise for distinguishing benign from malignant pelvic masses. Trials are currently underway to evaluate the potential of CA 125 in combination with other markers to facilitate earlier detection of occult ovarian cancer.

Simultaneous Evaluation of Epithelial Cell Function by CA 125 and Stromal Cell Activity by Aminoterminal Propeptide of Type III Procollagen (PIIINP) in Ovarian Carcinoma

“…In the diagnosis of early stages of the disease, however, both markers were weak, with up to 50 % of the stage I cancers remaining undetected. PlllNP resembles CA 125 (9,10) in being an unspecific tumour marker in ovarian carcinoma because increased values have been recorded in other gynaecological cancers (7), severe pelvic inflammatory diseases (12), in pregnant patients (13) and in some non-gynaecological malignancies (14).…”

New Cancer Markers

“…PLAP, TAG 72,3, HMGI, HMG2 and CA 15-3, (for a review see ref. 30). Compared with CA 125, little work has been done to assess the clinical use of these markers.…”

Present status of serum markers

“…HCG, a normal product of human syncytiotrophoblastic cells, is a highly sensitive and specific marker for gestational trophoblastic and germ cell neoplasms [55,56]. It is a glycoprotein with a molecular weight of 39,000-45,OOO daltons with an alpha and beta chain similar to luteinizing hormone [55-571.…”

“…Elevation of this hormone, although normal in pregnancy, is abnormal in all other conditions. In patients with gestational trophoblastic neoplasms (GTN), both benign and malignant, HCG is elevated virtually 100% of the time [56,58]. It has been experimentally determined that lo4 to lo5 viable tumor cells are required to produce enough HCG to be detectable by assay [59,60].…”

“…Patients on chemotherapy are followed with weekly HCG levels and the levels are expected to fall 20% to 25% after each cycle. If they do not, or if they increase, the chemotherapy is adjusted accordingly [56]. Finally, in patients with GTN, beta HCG levels greater than 40,000 mIU/ml have been associated with a poor prognosis.…”