Cancer part 3

Problem 4. cancer profiles or

testing panels.
to increased clinical sensitivity but !
• Gastrointestinal – CEA (GGT)
• Testis – hCG, AFP, CEA
• Prostate – PSA, ACP,
Prolactin, FSH, LH,
Testosterone,
Androstenedione. (at SWH)
 Problem 4. Cancer markers in
test “profiles”:
• Test A = 95% clin. sensitivity
• Test B = 80% clin. sensitivity
• Together = 99% clin. sensitivity
But
• Test A = 90% clin. specificity
• Test B = 95% clin. specificity
• Together = 85% clin. specificity
Therefore:
sensitivity increased, specificity decreased
 Problems 5. Prevalence of
cancer.
• USA NIH, new cases in the year 2001
• All sites 0.46%
• Lung bronchus in men 0.10%
• Prostate 0.17%
• Breast 0.12%
• Colon and rectum in men 0.06%
• Ovary, stomach, pancreas 0.01%
 Problem 5. Prevalence of
cancer
• % of non institutional patients who have
ever been diagnosed with cancer = 6.6
• % of current patients in home care with
cancer as the primary diagnosis = 5.0
 Problems 6. laboratory use in
chemotherapy treatments:
• Measurement of chemotherapeutic
agents : methotrexate, 5-Fluorouracil
• Tests for functions of organs damaged
by chemotherapy:
Liver Test – ALT
Renal Function Test – creatinine
• Tumour necrosis syndrome: LD, uric
acid, complete Blood Count.
Cisplatinum causing low s-Na:
 Problem 7. Paraneoplastic
syndrome
• Develops in association with tumour.
• Seen in 7-15% of patients, e.g.:
Calcium abnormal, caused by PTH like protein.
Electrolytes abnormal by ADH.
Cortisol abnormal by ACTH.
Hypoglycaemia by Insulin like Growth Factor.
Gynecomastia by hCG.
Extra pituitary acromegaly by growth hormone.
 Paraneoplastic syndrome
(continued)
• Hormones, continued
Polycythaemia by erythropoietin EPO
Hypertension by renin.
• Trace metals:
Decreased: Zn, Fe
Increased: Cu
• Lipids:
Decreased: cholesterol.
Problems with cancer markers 8
- genetic testing.
• Assesses potential for cancer.
• Expensive to do. Patent issues.
• Quality control lacking.
• Proven familial cancers not common
(5%?)
• Impact of genetic testing on populations’
health is not yet clear.
 Some familial cancers
Syndrome Cancers Gene marker
Melanoma Melanoma, pancr MTS1/p16
Some breast / ovary Breast, ovary + BRCA1
Hereditary breast Breast + BRCA 2
Hereditary non Colon, uterine, + MSH2,MLH1P
polyposis colon MS1,PMS2
Li-Fraumeni Brain,sarcoma+ p53
Mult Endocrine Neo Medul thyroid + RET
 A cancer screening success
• Human papilloma virus, some types cause
• Cervical and other genital cancers.
• Screening available now.
• At risk if early sexual activity and multiple
partners.
• Poor do not use the service.
 Cancer:
Cancer problems with
diagnosis and treatment
• Cancer is many diseases.
• Is early cancer diagnosis a benefit?
• Chemotherapy - how much is needed?
– when does it work?
– the long term effects.
• Radiation and surgery – slash and burn.
• Transplants – a solution to organ failure but
“future shock” is increased rate of cancer.
 Summary: laboratory cancer
markers, continued
• Limited use in screen for disease.
• Useful in prognosis, monitoring disease.
• Usually found too late for easily tolerated
therapy.
• Cancer understanding has been much
improved.
• Treatment is not much improved.
• Prevention is best.
Coal miner’s lung