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53 Cards in this Set

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Problem with immunoassays
High concentration of the analyte gives false negatives (exceed the binding antibody & the signal bearing antibody) - why we do dilutions
Analytic Sensitivity
Low analytic sensitivity - lowest analyte concentration that will yield a result other than zero
Heterophile antibodies
can cause significant interference in any immunoassay - antibodies which have broad reactivity, cross species
Sandwich assays can give both falsse + & -
CEA
Normal <3, >20 ng/ml rare except malignancy
CEA - elevated in which cancers
Colon -affected by tumor stage (higher with distant mets), grade (higher with well diffed), ploidy(higher with aneuploid), site (left >right), obstruction (inc with bowel obstruction), liver function(higher with dysfunction), higher preop CEA = worse outcome
CEA - elevated in which nonneoplastic conditons
Smoking, PUD, IBD, pancreatitis, hypothyroidism, biliary obstruction, cirrhosis
CEA -other malignancies
WD gastric adenoca, breast, lung, pancreas, Medullary thyroid, cervical adeno, urothelial
NOT ELEVATED IN ESOPH
AFP-physiologic
fetal serum - from fetal liver & yolk sac, reaches adult levels @ 1 yr
AFP - elevated, non-neoplastic
usu no more than 100mg/dl
pregnancy, hepatitis, cirrhosis
AFP elevated - malignancy
usu>500, but can overlap lower
HCC, yolk sac, hepatoblastoma
AFP form produced by HCC
L3 variant binds to Lens culinaris lectin
PSA Grey Zone
4-10 ng/ml
30-40% will have cancer
Age specific PSA
increases senstivity in young men, increases specifiicty in older men
PSA density
PSA/volume of prostate
Works well for small prostates
>0.15 abnormal doesn't perform better than PSA
PSA in serum
protease, mostly bound to proteins - antichymotropsin, alpha2macroglobin, alpha1 protein inhibiitor
PSA velocity
rate of change in successive PSAs
>0.75 ng/ml/yr - abnormal
Free PSA
Low free PSA - more likely to have cancer
helps when PSA <10
cannot do after manipulation - wait weeks
process within 2 hrs or freeze
pro-PSA
anomolous clipping truncated forms
increase in pro-PSA & truncated forms in prostate cancer
works if PSA btwn 2.5-4.0
PSA recurrence
3 consective increases in PSA
single rise to trigger hormone therapy
PSA post prostatectomy
Should be undetectable -
CA 15-3, 27.29 (perferred)
MUC1 protein - breast cancer
30% low stage breast ca
70% advanced stage breast ca
CA 15-3 (25 U/mL) & 27.29 (100 u/ml)
CA 15-3, CA 27.29 - elevated in nonmalignant conditions
benign ovarian cysts, b9 breast, b9 liver,
CA15-3, sarcoid, lupus, cirrhosis
Hormone - ER, PR
ER/PR - + respond to hormonal therapy(estrogen deprivation, anti-estrogens(tamoxifen, aromatase inhibitors)
Hormone Her-2-Neu
codes for epidermal growth factor - ErbB2 - gene amplification - overexpression - poor prognostic factor- Herceptin effective in treating, FISH, IHC,
CA 19-9
Lewis a blood group Ag
80-90% pancreatic cancer (20lb wt loss, bili >3 & CA19-9 >37 = PPV for pancreatobiliary ca)
also esoph & instestines
>1000 diagnostic malignancy
CA 19-9 nonmalignancies
<100 ng/ml
pancreatitis, cholestasis, cholangitis, cirrhosis
CA 125
nonmucinous ovarian epithelial tumors
Not good screening - stage I less than 50% elevated CA 125
<35 U/ml is normal
CA 125 uses
>65 U/ml with pelvic mass - PPV >95% for malignancy
Fall during tx - tx efficacy
persistant elevated >35 U/ml predicts residual disease
Rising CA 125 suggests relapse
CA 125 b9 conditions
pregnancy, fibroids, b9 cysts, PID, ascites, endometriosis), endometrial ca, breast ca, fallopian tube ca, pancreas ca, colon ca
EGFR
epidermal growth factor receptor - use in colon, lung, h&n, esophagus
thyroglobulin
tumor recurrence in follicular cancers
increase in anti-tgb antibodies suggests recurrence
all functional thyroid tissue is ablated
Can be affected by anti-tgb ab
Tumor Associated Trypsin Inhibitor
Mucinous ovarian CA - 50% stage I & 100% stage IV
60% gastric infiltrating carcinomas
urothelial ca - 20% low-grade vs 80% high stage
70% in RCC
85-90% pancreatic adeno ca & pancreatitis
hCG
pregnancy, chorioca, trophoblastic disease
marijuana use - low levels
15% pure seminomas
Beta 2 microglobulin
elevated with increased cell turnover
solid tumors
heme
multiple myeloma
monitor renal transplant rejection
inflammatory states (RA, SLE, IBD)
Lipid Associated Sialic Acid in Plasma
highly non specific
alk phos
osteoblastic activity (active paget's osteogenic sarcoma, bone mets)
sensitive liver fxn (hepatic mets)
Alk Phos - Regan isoenzyme
Placental type alk phos
Neuroendocrine Tumors -Carcinoids
produce serotonin
tryptophan to 5-HTP by tryptophane hydoxylase
5-HTP to 5-HT by dopa-decarboxylase
5-HT to H-HIAA by renal tubular MAO
Foregut carcinoids
produce 5-HT, histamine, catecholamines, 5-HTP
Midgut carcinoids
distal duodenum, jejunum, ileum, appendix, right colon - only 5-HT - portal circulation - cleared by liver unless liver with mets or more distal - carcinoid syndrome
Hindgut carcinoids
usu non secretory - hCG
Urine 5-HIAA or 5-HT
can be wnl in 20-30% with carcinoid tumor esp. foregut & hindgut
Falsely elevated in tryptophan diet
Plt serotonin most accurate marker for carcinoid tumor
Other peptides elevated in carcinoid
synapto, neuropeptide K, pancreatic polypeptide, chromogranin A
Markers for medullary thyroid cancer
plasma calcitonin (>10ng/L); CEA
thyroglobulin negative
Calcitonin elevated in non-neoplastic conditions
Hashimotos, c-cell hyperplasia, small cell lung, breast, CRF, & ZE syndrome
Paraganglioma & Pheochromocytoma
pheos - secrete norepi & epi
paragang - secrete epi
norepi to epi by PNMT
epi, norepi & VMA
Assay interference for metanephrines, catehcholamines & VMA
imipriamine, reserpine, guanethidine, NTG, MAOI
Most accurate for initial screening for pheo/paraganglioma
free plasma metanephrine - long term catecholamine secretion
Neuroblastoma markers
Urine VMA & HVA
HVA - byproduct dopa & dopamine
VMA - byproduct norepi & epi
Neuroblastoma markers HVA:VMA ratio & other serum markers
low VMA:HVA ratio - poor prognosis
NSE. LDH, ferritin
Urine Markers for TCC
NMP 22 (NuMA - monitoring of pts with bladder cancer) -
BTA - complement factor H & CFH-rp in urine -
Urothelial FISH
high incidence of aneuploidy in TCC - 3, 7, 17 & 9
Urine PCA3/DD3 for Prostate Cancer
PCA3 gene, DD3 - mRNA,