Release date: 2015-07-02
Malignant tumors are one of the serious threats to human health, and the morbidity and mortality are increasing year by year. According to Chen Wanqing and other statistics, lung cancer, female breast cancer, stomach cancer, liver cancer, esophageal cancer, colorectal cancer and cervical cancer are the main common malignant tumors in China. Lung cancer, liver cancer, stomach cancer, esophageal cancer, colorectal cancer, female breast. Cancer and pancreatic cancer are the main causes of cancer death. A variety of markers have been discovered during tumor research, and these markers have been widely used clinically for early diagnosis of tumors, assessment of disease in patients with cancer, screening for high-risk patients, but current tumor marker screening Can you achieve the effect of early diagnosis? Is there a value for census and screening in the crowd? How to use reasonable and standardized applications? I believe that many of our clinical medical workers also have many doubts. However, scholars and different institutions in different countries still have great controversy. Therefore, there is no uniform application principle of tumor markers. Here, the author summarizes the significance and application guidelines of several common tumor markers published by domestic and foreign authorities.
Carcinoembryonic antigen (CEA)
NACB (American Society of Clinical Biochemistry) and EGTM (European Tumor Marker Organization) recommendations for the clinical application of CEA in colorectal cancer:
a. Screening for colorectal cancer with CEA is not recommended
b. Performing CEA testing before surgery for colorectal cancer patients can help to evaluate the patient's pathological condition and determine the treatment plan
c. CEA testing should not be performed immediately after surgery
d. After the tumor resection of liver metastasis, the test results of CEA can be used as clinical indicators.
e. CEA testing can be performed during treatment to monitor treatment response and progression.
Prostate specific antigen (PSA)
a. NACB and EGTM agree with the American Cancer Society's diagnostic recommendations for prostate cancer. PSA should not be used alone, but should be evaluated in conjunction with DRE.
b. For very small tumors, PSA testing will give contradictory results, and low Cut-off values ​​(2 ng/ml) are not recommended.
c. NACB emphasizes that the age and race-specific reference range should be used for each PSA analysis test, while EGTM does not recommend the age-specific reference range.
d. When serum total PSA level is 4 ~ 10ng / ml, and DRE (digital rectal examination) is negative, it is recommended to use the percentage of free PSA to help distinguish BPH (benign prostatic hyperplasia) and prostate cancer, but in various cases The medical decision boundary of the free and total PSA test results was verified.
e. It is recommended to take a blood sample before prostate compression and several weeks after prostatitis healing.
AFP
National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Liver Cancer, American Association for the Study of Liver Diseases (AASLD) HCC Clinical Treatment Guidelines, British Gastroenterology Association (BSG) Treatment Guidelines, Consensus developed by the American Academy of Surgeons (ACS), four international The guidelines confirm the value of serum alpha-fetoprotein (AFP) in early screening and early monitoring of HCC based on evidence-based medical evidence. They point to HBV and/or HCV infection in men ≥35 years old. In high-risk groups of alcohol, AFP and liver ultrasound are usually performed every 6 months. For patients with AFP > 400 μg/L and no hepatic masses found by ultrasound, pregnancy, active liver disease, and gonad embryo-derived tumors should be excluded. If excluded, CT and/or MRI should be performed. If AFP is elevated but does not reach the diagnostic level, in addition to the above-mentioned circumstances that may cause AFP increase, the dynamic changes of AFP should be closely followed to shorten the interval of ultrasound examination to 1~2 months, CT and if necessary ) MRI examination. If the liver cancer is highly suspected, it is recommended to perform DSA hepatic arterial iodine angiography.
Thyroglobulin (Tg) and calcitonin (Calcitonin)
China's 2012 edition of the "Guidelines for the Diagnosis and Treatment of Thyroid Nodules and Differentiated Thyroid Carcinomas" and the American Thyroid Association (ATA) affirmed serum thyroglobulin (Tg) and calcitonin in the third edition of the Thyroid Nodules and DTC Management Guide. Calcitonin) Significance in the diagnosis and treatment of thyroid cancer Serum marker detection can better improve the sensitivity of assisted diagnosis. In thyroid cancer-associated serum markers, Tg and Calcitonin are important markers for postoperative monitoring of DTC (differentiated thyroid cancer) and MTC (thyroid medullary carcinoma) screening, respectively, due to their specificity and sensitivity. Sensitive indicators are receiving more and more attention in the clinic. In patients with DTC who underwent total or near total thyroidectomy combined with radioactive iodine (RAI), Tg was tested for TTC recurrence or residual after TSH stimulation (THS > 30 mIU/L) and no Tg antibody was present. Sensitivity and specificity are highest. In the absence of antibodies, if Tg < 0.5 ng / L after TSH stimulation, the patient is 98% -99.5% in the absence of tumor survival. If Tg is >2 ng/L after TSH stimulation, especially >10 ng/L or continuous elevation, Tg is a highly sensitive indicator of persistent tumor persistence. The Guide recommends that after the patient's postoperative serum TSH levels are met, Tg and Tg antibodies (TgAb) should be performed every 6-12 months during follow-up to maintain serum Tg levels below 2 ng/ml. In the follow-up of DTC patients, the same method must be followed for Tg and TgAb testing, and patients should be re-evaluated if changes occur. If the Tg level continues to increase, the possibility of thyroid tissue or tumor residual, recurrence or growth should be considered and further evaluated in conjunction with other tests such as neck ultrasound.
Calcitonin is an important tumor marker for MTC and is associated with a positive tumor size. The concentration of serum calcitonin in normal humans should be less than 10 ng/L. The serum Calcitonin level in MTC patients is usually higher, often higher than 100 ng/L, and its elevation is related to tumor burden, which can be used as a MTC-specific tumor marker. The European Consensus Society (ETA) published the European Consensus on the Management of Patients with Follicular Epithelial-Differentiated Thyroid Cancer. It is recommended to use Calcitonin for screening of patients with thyroid nodules. Carcinoembryonic antigen (CEA) levels were elevated in the census, and PET-CT examinations excluded cases of digestive tract tumors. For example, elevated levels of Calcitonin were mostly MTC.
CA153
The NACB guidelines indicate that a large number of studies have established the detection advantages of CA15-3 for breast cancer metastasis. It has been used for the evaluation of 60 to 80% of patients with breast cancer metastasis. The results of the study indicate that CA15-3 can be used to monitor the progression and regression of disease during the treatment of breast cancer patients. The EGTM guidelines recommend the use of both CA15-3 and CEA to increase the sensitivity of clinical testing. The simultaneous use of CA15-3 and CEA in clinical practice can detect more patients with early recurrent tumors than CA15-3 alone. Currently CA15-3 is mainly used to monitor breast cancer activity. Future work is to develop guidelines for the clinical significance of CA15-3 for follow-up monitoring of treatment and prognosis.
CA125
CA125 lacks sensitivity in early disease (only 50% of stage I patients have elevated CA125) and specificity. The EGTM guidelines recommend not using CA125 for large-scale population screening and occasional ovarian cancer screening. If the patient's serum CA125 level is twice the baseline level, physical examination, TVS, and CT should be performed immediately. Any abnormality in these tests prompted a need for laparoscopy and abdominal surgery.
CA125 is helpful in the differential diagnosis of primary and malignant pelvic masses in postmenopausal women. Women with postmenopausal pelvic masses with significantly elevated serum CA125 levels should be immediately asked by a surgical specialist for a thorough abdominal examination, mass sampling, and resection and cytoreductive surgery. In the course of the first cytoreductive surgery and cytotoxic chemotherapy, the rate of CA125 reduction is an independent prognostic factor in many cases and helps doctors make the appropriate decision whether to increase chemotherapy in subsequent treatments. After treatment surgery and cytotoxic chemotherapy, CA125 should be measured every 3 months. If CA125 is higher than 35U/ml, or higher than the baseline level, further examination and possible laparoscopy should be performed to see if the patient needs to Perform chemotherapy. In 90% of cases, the increase in the level of CA125 during chemotherapy was associated with the development of the disease, indicating that chemotherapy was not effective. However, the development of the disease may not be accompanied by an increase in CA125 and, if possible, physical examination and image analysis.
Squamous cell carcinoma antigen (SCCA)
The NACB guidelines state that SCCA results can be used with caution to monitor prognostic changes in clinical cases or to determine adjuvant therapy in high-risk patients. An elevated serum SCCA level in patients with confirmed stage IB or IIA cervical cancer indicates a 3-fold increased risk of disease recurrence and is indicative of tumor size, grade, or lymph node metastasis as a non-independent indicator. The results of SCCA can be used with caution in the monitoring of patient recurrence. In 76% of cases, the persistently elevated SCCA value indicates the development or recurrence of the disease, with a false positive rate of 2.8 to 5%. Therefore, patients who are scheduled for radiation therapy or surgery can detect serum SCCA levels every three months to determine their treatment options, but there are currently no documents on the clinical use of SCCA.
Source: Medical Cancer Channel
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