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Tumor Markers

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Tumor Markers

Tumor cell clusters from ascites fluid: nuclei colored in blue, tumor-specific markers colored in red and green

Image by Matthias Bojar

What Are Tumor Markers?

BRCA1 and BRCA2 are genes that produce proteins that help repair damaged DNA.

Image by TheVisualMD

What Are Tumor Markers?

A tumor marker is anything present in or produced by cancer cells or other cells of the body in response to cancer or certain benign (noncancerous) conditions that provides information about a cancer, such as how aggressive it is, what kind of treatment it may respond to, or whether it is responding to treatment.

Tumor markers have traditionally been proteins or other substances that are made at higher amounts by cancer cells than normal cells. These can be found in the blood, urine, stool, tumors, or other tissues or bodily fluids of some patients with cancer. Increasingly, however, genomic markers (such as tumor gene mutations, patterns of tumor gene expression, and nongenetic changes in tumor DNA) that are found in tumors themselves and in tumor fragments shed into bodily fluids are being used.

Many different tumor markers have been characterized and are in clinical use. Some are associated with only one type of cancer, whereas others are associated with multiple different cancer types.

Source: National Cancer Institute (NCI)

Additional Materials (8)

T cell nuclear dynamics

Evilonan/Wikimedia

Tumor initiation

Anna Engler /Wikimedia

9:15

Tumor Markers in Cancer Detection, Diagnosis and Management

USMLEVideoLectures/YouTube

2:42

What Are Tumor Markers for Breast Cancer?

Breast Cancer Answers®/YouTube

3:07

What to Know About Germ Cell Tumor Markers, with Timothy Gilligan, MD

Cancer.Net/YouTube

4:49

Clinical Chemistry - Tumor Markers as Diagnostic Tests for Cancer

قناة لابوتيوب LaboTube Channel/YouTube

1:11

What is a Tumor Marker?

CancerCenter/YouTube

9:47

Tumor Markers in Cancer diagnosis and Monitoring

Pathology Simplified/YouTube

How Is It Used in Cancer Care?

Circulating Tumor DNA

Image by Jonathan Bailey, NHGRI

How Are Tumor Markers Used in Cancer Care?

There are two main types of tumor markers: circulating tumor markers and tumor tissue markers.

Circulating tumor markers can be found in the blood, urine, stool, or other bodily fluids of some patients with cancer. Circulating tumor markers are used to:

estimate prognosis
determine the stage of cancer
detect cancer that remains after treatment (residual disease) or that has returned after treatment
assess how well a treatment is working
monitor whether the treatment has stopped working

Although an elevated level of a circulating tumor marker may suggest the presence of cancer and can sometimes help to diagnose cancer, this alone is not enough to diagnose cancer. For example, noncancerous conditions can sometimes cause the levels of certain tumor markers to increase. In addition, not everyone with a particular type of cancer will have a higher level of a tumor marker associated with that cancer. Therefore, measurements of circulating tumor markers are usually combined with the results of other tests, such as biopsies or imaging, to diagnose cancer.

Tumor markers may also be measured periodically during cancer therapy. Such “serial measurements,” which show how the level of a marker is changing over time, are usually more meaningful than a single measurement. For example, a decrease in the level of a circulating tumor marker may indicate that the cancer is responding to treatment, whereas an increasing or unchanged level may indicate that the cancer is not responding.

Circulating tumor markers may also be measured periodically after treatment has ended to check for recurrence (the return of cancer).

Examples of commonly used circulating tumor markers include calcitonin (measured in blood), which is used to assess treatment response, screen for recurrence, and estimate prognosis in medullary thyroid cancer; CA-125 (measured in blood), to monitor how well cancer treatments are working and if cancer has come back in ovarian cancer; and beta-2-microglobulin (measured in blood, urine, or cerebrospinal fluid), to estimate prognosis and follow response to treatment for multiple myeloma, chronic lymphocytic leukemia, and some lymphomas. Additional circulating tumor markers are described in the list of tumor markers in common use.

Tumor tissue (or cell) markers are found in the actual tumors themselves, typically in a sample of the tumor that is removed during a biopsy. Tumor tissue markers are used to:

diagnose, stage, and/or classify cancer
estimate prognosis
select an appropriate treatment (e.g., treatment with a targeted therapy)

Tumor tissue markers that indicate whether someone is a candidate for a particular targeted therapy are sometimes referred to as biomarkers for cancer treatment. Tests for these biomarkers are usually genetic tests that look for changes in genes that affect cancer growth.

Examples of tumor tissue markers that are used as biomarkers for cancer treatment include estrogen receptor and progesterone receptor, which are tested for to determine whether someone with breast cancer should get treatment with hormone therapy; FGFR3 gene mutation analysis, to help determine treatment for patients with bladder cancer; and PD-L1, to see if people with any of a number of cancer types are candidates for treatment with an immune checkpoint inhibitor.

Because some tumors shed cells and genetic material into blood, it is sometimes possible to examine biomarkers in blood samples. Although these "liquid biopsies" are not yet routinely used, they have several potential advantages. Because they don’t involve surgery, they can be done more frequently than standard biopsies. They can also be performed when surgical biopsies cannot, such as when tumors are difficult to reach or patients can’t tolerate surgery.

Liquid biopsy tests can often detect multiple cancer-associated biomarkers. For example, the Foundation One Liquid CDx test is approved for the detection of genetic mutations in 324 genes and two genomic signatures in any solid tumor type. The test can also identify which patients with non-small cell lung cancer, melanoma, breast cancer, colorectal cancer, or ovarian cancer may benefit from 15 different FDA-approved targeted treatment options.

Source: National Cancer Institute (NCI)

Additional Materials (2)

2:42

What Are Tumor Markers for Breast Cancer?

Breast Cancer Answers®/YouTube

4:49

Clinical Chemistry - Tumor Markers as Diagnostic Tests for Cancer

قناة لابوتيوب LaboTube Channel/YouTube

What Are Some Examples?

Urine in Vial

Image by TheVisualMD

What Tumor Markers Are Currently Being Used, and for Which Cancer Types?

A number of tumor markers are currently being used for a wide range of cancer types. See the list of tumor markers in common use for more information. Although most of these can be tested in laboratories that meet standards set by the Clinical Laboratory Improvement Amendments, some cannot be and may therefore be considered experimental.

Source: National Cancer Institute (NCI)

Additional Materials (3)

Blood in Vial

TheVisualMD

9:15

Tumor Markers in Cancer Detection, Diagnosis and Management

USMLEVideoLectures/YouTube

3:07

What to Know About Germ Cell Tumor Markers, with Timothy Gilligan, MD

Cancer.Net/YouTube

Tumor Markers in Common Use

Screening for Cancer

Image by TheVisualMD

Tumor Markers in Common Use

A tumor marker is anything present in or produced by cancer cells or other cells of the body in response to cancer or certain benign (noncancerous) conditions that provides information about a cancer, such as how aggressive it is, whether it can be treated with a targeted therapy, or whether it is responding to treatment.

Listed below are tumor markers that are in common use, mainly to determine treatment or to help make a diagnosis of cancer. New tumor markers frequently become available and may not be reflected on this list.

This list does not include the many tumor markers that are tested by immunophenotyping and immunohistochemistry to help diagnose cancer and to distinguish between different types of cancer. Some tumor markers listed below are targets for targeted therapy in multiple cancers but serve as tumor markers for only a subset of cancers.

ALK gene rearrangements and overexpression

Cancer types or cancer-like conditions: Non-small cell lung cancer, anaplastic large cell lymphoma, histiocytoses
What's analyzed: Tumor
How used: To help determine treatment and prognosis

Alpha-fetoprotein (AFP)

Cancer types: Liver cancer and germ cell tumors
What's analyzed: Blood
How used: To help diagnose liver cancer and follow response to treatment; to assess stage, prognosis, and response to treatment of germ cell tumors

B-cell immunoglobulin gene rearrangement

Cancer type: B-cell lymphoma
What's analyzed: Blood, bone marrow, or tumor tissue
How used: To help in diagnosis, to evaluate effectiveness of treatment, and to check for recurrence

BCL2 gene rearrangement

Cancer types: Lymphomas, leukemias
What’s analyzed: Blood, bone marrow, or tumor tissue
How used: For diagnosis and planning therapy

Beta-2-microglobulin (B2M)

Cancer types: Multiple myeloma, chronic lymphocytic leukemia, and some lymphomas
What's analyzed: Blood, urine, or cerebrospinal fluid
How used: To determine prognosis and follow response to treatment

Beta-human chorionic gonadotropin (Beta-hCG)

Cancer types: Choriocarcinoma and germ cell tumors
What's analyzed: Urine or blood
How used: To assess stage, prognosis, and response to treatment

Bladder Tumor Antigen (BTA)

Cancer types: Bladder cancer and cancer of the kidney or ureter
What's analyzed: Urine
How used: As surveillance with cytology and cystoscopy of patients already known to have bladder cancer

BRCA1 and BRCA2 gene mutations

Cancer types: Ovarian and breast cancers
What's analyzed: Blood and/or tumor
How used: To help determine treatment

BCR-ABL fusion gene (Philadelphia chromosome)

Cancer types: Chronic myeloid leukemia, acute lymphoblastic leukemia, and acute myelogenous leukemia
What's analyzed: Blood or bone marrow
How used: To confirm diagnosis, predict response to targeted therapy, help determine treatment, and monitor disease status

BRAF V600 mutations

Cancer types or cancer-like conditions: Cutaneous melanoma, Erdheim-Chester disease, Langerhans cell histiocytosis, colorectal cancer, and non-small cell lung cancer
What's analyzed: Tumor
How used: To help determine treatment

C-kit/CD117

Cancer types: Gastrointestinal stromal tumor, mucosal melanoma, acute myeloid leukemia, and mast cell disease
What's analyzed: Tumor, blood, or bone marrow
How used: To help in diagnosis and to help determine treatment

CA15-3/CA27.29

Cancer type:Breast cancer
What's analyzed:Blood
How used:To assess whether treatment is working or if the cancer has recurred

CA19-9

Cancer types: Pancreatic, gallbladder, bile duct, and gastric cancers
What's analyzed:Blood
How used:To assess whether treatment is working

CA-125

Cancer type: Ovarian cancer
What's analyzed: Blood
How used:To help in diagnosis, assessment of response to treatment, and evaluation of recurrence

CA 27.29

Cancer type: Breast cancer
What's analyzed:Blood
How used:To detect metastasis or recurrence

Calcitonin

Cancer type:Medullary thyroid cancer
What's analyzed:Blood
How used:To aid in diagnosis, check whether treatment is working, and assess recurrence

Carcinoembryonic antigen (CEA)

Cancer types:Colorectal cancer and some other cancers
What's analyzed:Blood
How used: To keep track of how well cancer treatments are working and check if cancer has come back or spread

CD19

Cancer types:B-cell lymphomas and leukemias
What's analyzed:Blood and bone marrow
How used:To help in diagnosis and to help determine treatment

CD20

Cancer type:Non-Hodgkin lymphoma
What's analyzed:Blood
How used: To help determine treatment

CD22

Cancer types:B-cell lymphomas and leukemias
What's analyzed: Blood and bone marrow
How used:To help in diagnosis and to help determine treatment

CD25

Cancer type:Non-Hodgkin (T-cell) lymphoma
What's analyzed: Blood
How used:To help determine treatment

CD30

Cancer types:Classic Hodgkin lymphoma, B-cell and T-cell lymphomas
What's analyzed:Tumor
How used:To help determine treatment

CD33

Cancer type:Acute myeloid leukemia
What's analyzed:Blood
How used:To help determine treatment

Chromogranin A (CgA)

Cancer type: Neuroendocrine tumors
What's analyzed:Blood
How used: To help in diagnosis, assessment of treatment response, and evaluation of recurrence

Chromosome 17p deletion

Cancer type: Chronic lymphocytic leukemia
What's analyzed: Blood
How used:To help determine treatment

Chromosomes 3, 7, 17, and 9p21

Cancer type:Bladder cancer
What's analyzed:Urine
How used:To help in monitoring for tumor recurrence

Circulating tumor cells of epithelial origin (CELLSEARCH)

Cancer types:Metastatic breast, prostate, and colorectal cancers
What's analyzed: Blood
How used:To inform clinical decision making, and to assess prognosis

Cytokeratin fragment 21-1

Cancer type:Lung cancer
What's analyzed:Blood
How used:To help in monitoring for recurrence

Cyclin D1 (CCND1) gene rearrangement or expression

Cancer types:Lymphoma, myeloma
What’s analyzed:Tumor
How used:To help in diagnosis

Des-gamma-carboxy prothrombin (DCP)

Cancer type:Hepatocellular carcinoma
What's analyzed:Blood
How used:To monitor the effectiveness of treatment and to detect recurrence

DPD gene mutation

Cancer types:Breast, colorectal, gastric, and pancreatic cancers
What's analyzed: Blood
How used: To predict the risk of a toxic reaction to 5-fluorouracil therapy

EGFR gene mutation

Cancer type:Non-small cell lung cancer
What's analyzed:Tumor
How used: To help determine treatment and prognosis

Estrogen receptor (ER)/progesterone receptor (PR)

Cancer type:Breast cancer
What's analyzed:Tumor
How used: To help determine treatment

FGFR2 and FGFR3 gene mutations

Cancer type: Bladder cancer
What's analyzed:Tumor
How used:To help determine treatment

Fibrin/fibrinogen

Cancer type:Bladder cancer
What's analyzed:Urine
How used:To monitor progression and response to treatment

FLT3 gene mutations

Cancer type:Acute myeloid leukemia
What's analyzed:Blood
How used: To help determine treatment

Gastrin

Cancer type:Gastrin-producing tumor (gastrinoma)
What's analyzed:Blood
How used:To help in diagnosis, to monitor the effectiveness of treatment, and to detect recurrence

HE4

Cancer type: Ovarian cancer
What's analyzed: Blood
How used:To plan cancer treatment, assess disease progression, and monitor for recurrence

HER2/neu gene amplification or protein overexpression

Cancer types:Breast, ovarian, bladder, pancreatic, and stomach cancers
What's analyzed:Tumor
How used:To help determine treatment

5-HIAA

Cancer type:Carcinoid tumors
What's analyzed:Urine
How used:To help in diagnosis and to monitor disease

IDH1 and IDH2 gene mutations

Cancer type:Acute myeloid leukemia
What's analyzed:Bone marrow and blood
How used:To help determine treatment

Immunoglobulins

Cancer types:Multiple myeloma and Waldenström macroglobulinemia
What's analyzed: Blood and urine
How used:To help diagnose disease, assess response to treatment, and look for recurrence

IRF4 gene rearrangement

Cancer types:Lymphoma
What’s analyzed:Tumor
How used:To help in diagnosis

JAK2 gene mutation

Cancer type:Certain types of leukemia
What's analyzed:Blood and bone marrow
How used:To help in diagnosis

KRAS gene mutation

Cancer types:Colorectal cancer and non-small cell lung cancer
What's analyzed: Tumor
How used:To help determine treatment

Lactate dehydrogenase

Cancer types:Germ cell tumors, lymphoma, leukemia, melanoma, and neuroblastoma
What's analyzed:Blood
How used:To assess stage, prognosis, and response to treatment

Microsatellite instability (MSI) and/or mismatch repair deficient (dMMR)

Cancer types: Colorectal cancer and other solid tumors
What's analyzed: Tumor
How used: To guide treatment and to identify those at high risk of certain cancer-predisposing syndromes

MYC gene expression

Cancer types:Lymphomas, leukemias
What’s analyzed:Tumor
How used:To help in diagnosis and to help determine treatment

MYD88 gene mutation

Cancer types:Lymphoma, Waldenström macroglobulinemia
What’s analyzed: Tumor
How used:To help in diagnosis and to help determine treatment

Myeloperoxidase (MPO)

Cancer type: Leukemia
What’s analyzed: Blood
How used:To help in diagnosis

Neuron-specific enolase (NSE)

Cancer types: Small cell lung cancer and neuroblastoma
What's analyzed:Blood
How used: To help in diagnosis and to assess response to treatment

NTRK gene fusion

Cancer type:Any solid tumor
What’s analyzed:Tumor
How used:To help determine treatment

Nuclear matrix protein 22

Cancer type: Bladder cancer
What's analyzed: Urine
How used:To monitor response to treatment

PCA3 mRNA

Cancer type: Prostate cancer
What's analyzed:Urine (collected after digital rectal exam)
How used:To determine need for repeat biopsy after negative biopsy

PML/RARα fusion gene

Cancer type: Acute promyelocytic leukemia (APL)
What's analyzed: Blood and bone marrow
How used:To diagnose APL, to predict response to all-trans-retinoic acid or arsenic trioxide therapy, to assess effectiveness of therapy, to monitor minimal residual disease, and to predict early relapse

Prostatic Acid Phosphatase (PAP)

Cancer type:Metastatic prostate cancer
What's analyzed:Blood
How used: To help in diagnosing poorly differentiated carcinomas

Programmed death ligand 1 (PD-L1)

Cancer types: Non-small cell lung cancer, liver cancer, stomach cancer, gastroesophageal junction cancer, classical Hodgkin lymphoma, and other aggressive lymphoma subtypes
What's analyzed:Tumor
How used: To help determine treatment

Prostate-specific antigen (PSA)

Cancer type: Prostate cancer
What's analyzed:Blood
How used: To help in diagnosis, to assess response to treatment, and to look for recurrence

ROS1 gene rearrangement

Cancer type: Non-small cell lung cancer
What's analyzed:Tumor
How used:To help determine treatment

Soluble mesothelin-related peptides (SMRP)

Cancer type:Mesothelioma
What's analyzed:Blood
How used: To monitor progression or recurrence

Somatostatin receptor

Cancer type:Neuroendocrine tumors affecting the pancreas or gastrointestinal tract (GEP-NETs)
What's analyzed:Tumor (by diagnostic imaging)
How used:To help determine treatment

T-cell receptor gene rearrangement

Cancer type:T-cell lymphoma
What's analyzed:Bone marrow, tissue, body fluid, blood
How used: To help in diagnosis; sometimes to detect and evaluate residual disease

Terminal transferase (TdT)

Cancer types: Leukemia, lymphoma
What’s analyzed: Tumor, blood
How used:To help in diagnosis

Thiopurine S-methyltransferase (TPMT) enzyme activity or TPMT genetic test

Cancer type:Acute lymphoblastic leukemia
What's analyzed: Blood and buccal (cheek) swab
How used: To predict the risk of severe bone marrow toxicity (myelosuppression) with thiopurine treatment

Thyroglobulin

Cancer type:Thyroid cancer
What's analyzed:Blood
How used:To evaluate response to treatment and to look for recurrence

UGT1A1*28 variant homozygosity

Cancer type:Colorectal cancer
What's analyzed: Blood and buccal (cheek) swab
How used:To predict toxicity from irinotecan therapy

Urine catecholamines: VMA and HVA

Cancer type: Neuroblastoma
What's analyzed:Urine
How used:To help in diagnosis

Urokinase plasminogen activator (uPA) and plasminogen activator inhibitor (PAI-1)

Cancer type:Breast cancer
What's analyzed:Tumor
How used:To determine aggressiveness of cancer and guide treatment

FoundationOne CDx (F1CDx) genomic test

Cancer type:Any solid tumor
What's analyzed: Tumor, blood
How used: As a companion diagnostic test to determine treatment

Guardant360 CDx genomic test

Cancer type: Any solid tumor
What’s analyzed: Blood
How used: As a companion diagnostic test to determine treatment and for general tumor mutation profiling

5-Protein signature (OVA1)

Cancer type:Ovarian cancer
What's analyzed:Blood
How used:To pre-operatively assess pelvic mass for suspected ovarian cancer

17-Gene signature (Oncotype DX GPS test)

Cancer type:Prostate cancer
What's analyzed:Tumor
How used:To predict the aggressiveness of prostate cancer and to help manage treatment

21-Gene signature (Oncotype DX)

Cancer type:Breast cancer
What's analyzed: Tumor
How used:To evaluate risk of distant recurrence and to help plan treatment

46-Gene signature (Prolaris)

Cancer type:Prostate cancer
What's analyzed:Tumor
How used:To predict the aggressiveness of prostate cancer and to help manage treatment

70-Gene signature (Mammaprint)

Cancer type:Breast cancer
What's analyzed: Tumor
How used:To evaluate risk of recurrence

Source: National Cancer Institute (NCI)

Additional Materials (1)

Breast Cancer Genes 1 and 2

Ernesto del Aguila III, NHGRI

Tumor Marker Tests

Tumor Marker Tests

Tumor markers are substances made by cancer cells or normal cells in response to cancer in the body. These tests can help find out if your cancer has spread, if treatment is working, or if cancer has returned after you've finished treatment.

Tumor Marker Tests

Tumor markers are substances made by cancer cells or normal cells in response to cancer in the body. These tests can help find out if your cancer has spread, if treatment is working, or if cancer has returned after you've finished treatment.

These tests look for tumor markers, sometimes called cancer markers, in the blood, urine, or body tissues. Tumor markers are substances made by cancer cells or by normal cells in response to cancer in the body. Some tumor markers are specific to one type of cancer. Others can be found in several types of cancers.
Because tumor markers can also show up in certain noncancerous conditions, tumor marker tests are not usually used to diagnose cancer or screen people at low risk of the disease. These tests are most often done on people already diagnosed with cancer. Tumor markers can help find out if your cancer has spread, whether your treatment is working, or if your cancer has come back after you've finished treatment.
Tumor marker tests are most often used to:
- Plan your treatment. If tumor marker levels go down, it usually means the treatment is working.
- Help find out if a cancer has spread to other tissues
- Help predict the likely outcome or course of your disease
- Check to see if your cancer has come back after successful treatment
- Screen people at high risk for cancer. Risk factors can include family history and previous diagnosis of another type of cancer

You may need a tumor marker test if you are currently being treated for cancer, have finished cancer treatment, or have a high risk of getting cancer because of family history or other reasons.

The type of test you get will depend on your health, health history, and symptoms you may have. Below are some of the most common types of tumor markers and what they are used for.

CA 125 (cancer antigen 125)
Tumor marker for:	ovarian cancer
Used to:	See if cancer treatment is working See if cancer has come back after you've finished treatment

CA 15-3 and CA 27-29 (cancer antigens 15-3 and 27-29)
Tumor markers for:	breast cancer
Used to:	Monitor treatment in women with advanced breast cancer

PSA (prostate-specific antigen)
Tumor marker for:	prostate cancer
Used to:	Screen for prostate cancer Help diagnose prostate cancer Monitor treatment Check to see if cancer has come back after you've finished treatment

CEA (carcinoembryonic antigen)
Tumor marker for:	colorectal cancer, and also for cancers of the lung, stomach, thyroid, pancreas, breast, and ovary
Used to:	See if cancer treatment is working See if cancer has come back after you've finished treatment

AFP (Alpha-fetoprotein)
Tumor marker for:	liver cancer, and cancers of the ovary or testicles
Used to:	Help diagnose liver cancer Find out if cancer has spread (the stage of cancer) See if cancer treatment is working Predict chances for recovery

B2M (Beta 2-microglobulin)
Tumor marker for:	multiple myeloma, some lymphomas, and leukemias
Used to:	See if cancer treatment is working Predict chances for recovery

Depending in what type of test you had and how it was used, your results may:
- Help diagnose the type or stage of your cancer.
- Show whether your cancer treatment is working.
- Help plan future treatment.
- Show if your cancer has returned after you've finished treatment.
If you have questions about your results, talk to your health care provider.
Tumor markers can be very useful, but the information they provide can be limited because:
- Some noncancerous conditions can cause tumor markers.
- Some people with cancer don't have tumor markers.
- Not all types of cancer have tumor markers.
So, tumor markers are almost always used with other tests to help diagnose and monitor cancer.
1. Tumor Markers - National Cancer Institute [accessed on Oct 04, 2018]
2. Tumor Markers [accessed on Oct 04, 2018]

Additional Materials (7)

3:07

What to Know About Germ Cell Tumor Markers, with Timothy Gilligan, MD

Cancer.Net/YouTube

6:33

Why Don't We Have Cancer-Sniffing Dogs?

SciShow/YouTube

9:15

Tumor Markers in Cancer Detection, Diagnosis and Management

USMLEVideoLectures/YouTube

9:47

Tumor Markers in Cancer diagnosis and Monitoring

Pathology Simplified/YouTube

4:49

Clinical Chemistry - Tumor Markers as Diagnostic Tests for Cancer

قناة لابوتيوب LaboTube Channel/YouTube

2:25

Understanding CA-125 Screening for Ovarian Cancer

Roswell Park Comprehensive Cancer Center/YouTube

1:49

Tracking cancer with a blood test

Cancer Research UK/YouTube

Alpha Fetoprotein (AFP) Tumor Marker Test

Alpha Fetoprotein (AFP) Tumor Marker Test

Also called: AFP Tumor Marker, Alpha-Fetoprotein Tumor Marker, Alpha-Fetoprotein-L3 Percent

An AFP (alpha-fetoprotein) tumor marker test measures the level of AFP in your blood. High levels of AFP can be a sign of liver cancer, cancer of the ovaries or testicles, and noncancerous liver disorders.

Alpha Fetoprotein (AFP) Tumor Marker Test

Also called: AFP Tumor Marker, Alpha-Fetoprotein Tumor Marker, Alpha-Fetoprotein-L3 Percent

An AFP (alpha-fetoprotein) tumor marker test measures the level of AFP in your blood. High levels of AFP can be a sign of liver cancer, cancer of the ovaries or testicles, and noncancerous liver disorders.

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Use the slider below to see how your results affect your health.
ng/mL
8.3
Your result is Normal.
AFP is normally elevated in pregnant women since it is produced by the fetus. However, AFP is not usually found in the blood of adults.
Related conditions
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Use the slider below to see how your results affect your health.
%
10
Your result is Negative.
Normal results can vary depending on the method used for testing by the laboratory.
Related conditions
An AFP tumor marker test may be used during the diagnosis and/or treatment of cancer of the liver, ovaries, or testicles that make high levels of AFP. It is used to:
- Help confirm or rule out a cancer diagnosis when used with other exams and tests.
- Predict how cancer may behave over time.
- Monitor cancer treatment. AFP levels often go up if cancer is growing and go down when treatment is working.
- Check whether cancer has returned after treatment.
In certain cases, results from an AFP tumor marker test may be used to guide treatment choices for specific types of cancer. The test may also be used to monitor your health if you have chronic (long lasting) hepatitis or cirrhosis of the liver. These conditions aren't cancer, but they increase your risk of developing liver cancer.
You may need an AFP tumor marker test if:
- A physical exam and/or other tests suggest that you may have cancer of the liver, ovaries, or testicles.
- You are currently being treated for a cancer that causes high AFP levels. Measuring your AFP test can show how well your treatment is working.
- You have completed treatment for a cancer that increased your AFP level. You may need an AFP tumor marker test from time to time to check whether your cancer is coming back.
If you have chronic hepatitis or cirrhosis, you have a higher risk of developing liver cancer. A very high level of AFP or a sudden increase can be an early sign of liver cancer. Most medical experts don't recommend measuring AFP levels to screen for cancer in these diseases. But, some health care providers may still use an AFP tumor marker test with other tests to watch for liver cancer.
If you haven't been diagnosed with cancer, test results that show:
- High levels of AFP may be a sign of cancer of the liver, ovaries, or testicles. But having a high AFP level doesn't mean you have cancer or that you will get cancer. Liver injury and liver diseases that aren't cancer can also cause high AFP levels. Less often, high levels of AFP may be a sign of other cancers, including lymphoma or lung cancer. Your provider will use your medical history and other test results to make a diagnosis.
- Normal levels of AFP mean you're less likely to have a cancer that causes high AFP levels. But a normal test result doesn't rule out cancer because some people with these cancers have normal AFP levels.
If you're being treated for a cancer that increased your AFP levels, you may be tested several times during treatment. Your provider will look at all your AFP test results to see how your levels have changed over time. If your results show:
- Your AFP levels are increasing, it may mean that your treatment isn't working.
- Your AFP levels are decreasing, it may mean your treatment is working.
- Your AFP levels have stayed the same, it may mean your disease is stable and hasn't gotten better or worse.
If you've finished treatment for cancer that caused high AFP levels and your test results are:
- Not normal, it may mean that you still have some cancer in your body.
- Higher now than they were shortly after treatment, it may mean your cancer is growing again.
If you have a long-lasting liver disease that's not cancer, you may need other tests to check for liver cancer if your test results show a sudden increase in AFP or your level is very high.
Ask your provider to explain what your test results mean for your health.
1. Alpha Fetoprotein (AFP) Tumor Marker Test: MedlinePlus Medical Test [accessed on Feb 12, 2024]
2. Lab Tests Online: Alpha-fetoprotein (AFP) Tumor Marker [accessed on Aug 24, 2018]
3. URMC / Encyclopedia / Alpha-Fetoprotein Tumor Marker (Blood) [accessed on Aug 24, 2018]
4. Arrieta, Oscar et al. “The Progressive Elevation of Alpha Fetoprotein for the Diagnosis of Hepatocellular Carcinoma in Patients with Liver Cirrhosis.” BMC Cancer 7 (2007): 28. PMC. Web. 24 Aug. 2018. [accessed on Aug 24, 2018]
5. AAFP: Serum Tumor Markers; Am Fam Physician. 2003 Sep 15;68(6):1075-1082. [accessed on Aug 24, 2018]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (6)

Genes and Genetic Defects

Genetic testing isn't new. In the 1960s, doctors were able to test newborn babies for certain rare single-gene disorders, such as phenylketonuria (PKU), a rare metabolic disease that causes mental retardation. (PKU can be prevented with a special diet if it's detected early, which was why it was critical to test newborns.)

Image by TheVisualMD

This browser does not support the video element.

Prenatal Diagnostic Testing

If a pregnant woman has an abnormal genetic screening test result, a doctor may suggest a prenatal diagnostic test be done to determine with more certainly whether or not a fetus has a particular disorder. There are two main diagnostic testing procedures, chorionic villus sampling (CVS) and amniocentesis. Both of these tests involve collecting a sample from inside the womb, which is then examined to detect diseases such as Down Syndrome, Edwards Syndrome, neural tube defects, cystic fibrosis, fragile-x, and spinal muscular atrophy. Prenatal diagnostic tests provide valuable information on the health of the fetus and can help alleviate the stress of expectant parents.

Video by TheVisualMD

Mapping Your Future: Screening for Disease Risk

Image by TheVisualMD

Amniocentesis

Amniocentesis is a prenatal test that gathers information about a fetus` health from a sample of amniotic fluid. Amniotic fluid is the fluid that surrounds the fetus in the uterus. It contains cells from the fetus that naturally slough off during development. If a woman is at high risk for a genetic disease, a doctor may recommend an "amnio" to determine whether a fetus has certain genetic disorders, such as cystic fibrosis, among other diseases.

Image by TheVisualMD

Megacystis

Megacystis in fetus : Ultrasound revealing megacystis in a fetus with Down syndrome.

Image by X.Compagnion

Maternal Serum Screening (MSS)

Video by Washington State Department of Health/YouTube

Genes and Genetic Defects

TheVisualMD

4:34

Prenatal Diagnostic Testing

TheVisualMD

Mapping Your Future: Screening for Disease Risk

TheVisualMD

Amniocentesis

TheVisualMD

Megacystis

X.Compagnion

3:57

Maternal Serum Screening (MSS)

Washington State Department of Health/YouTube

Beta 2 Microglobulin (B2M) Tumor Marker Test

Beta 2 Microglobulin (B2M) Tumor Marker Test

Also called: Beta-2 Microglobulin, β2-Microglobulin, B2M, B2MG, Thymotaxin

The test measures the amount of beta-2 microglobulin (B2M) in your body fluids, usually in the blood. B2M is found on most of the cells in your body in small amounts. High levels of B2M in body fluids may be indicative of certain cancers. The B2M tumor marker is used to determine prognosis and follow response to treatment.

Beta 2 Microglobulin (B2M) Tumor Marker Test

Also called: Beta-2 Microglobulin, β2-Microglobulin, B2M, B2MG, Thymotaxin

The test measures the amount of beta-2 microglobulin (B2M) in your body fluids, usually in the blood. B2M is found on most of the cells in your body in small amounts. High levels of B2M in body fluids may be indicative of certain cancers. The B2M tumor marker is used to determine prognosis and follow response to treatment.

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Use the slider below to see how your results affect your health.
μg/mL
2.7
Your result is Normal.
Healthy people have small amounts of B2M in their blood. Normal results vary based on the laboratory and the method used.
Related conditions
{"label":"B2M (cerebrospinal fluid) reference range","scale":"lin","step":0.1,"hideunits":false,"items":[{"flag":"normal","label":{"short":"Normal","long":"Normal","orientation":"horizontal"},"values":{"min":0.7,"max":1.8},"text":"Normal results vary based on the laboratory and the method used.","conditions":[]},{"flag":"abnormal","label":{"short":"High","long":"High","orientation":"horizontal"},"values":{"min":1.8,"max":5},"text":"Increased levels of B2M means that a disease is likely to be present, and further testing needs to be done. Usually, higher levels correspond with higher stages of the disease; hence, worse prognosis.","conditions":["Non-Hodgkin lymphoma","Acute lymphocytic leukemia","HIV progression","Chronic inflammation","Multiple sclerosis","Acute viral infection","Neurologic processes"]}],"units":[{"printSymbol":"\u03bcg\/mL","code":"ug\/mL","name":"microgram per milliliter"}],"value":1.3,"disclaimer":"Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are \"within normal limits.\""}[{"normal":0},{"abnormal":0}]
Use the slider below to see how your results affect your health.
μg/mL
1.8
Your result is Normal.
Normal results vary based on the laboratory and the method used.
Related conditions
{"label":"B2M (urine) reference range","scale":"lin","step":0.1,"hideunits":false,"items":[{"flag":"normal","label":{"short":"Normal","long":"Normal","orientation":"horizontal"},"values":{"min":0,"max":300},"text":"Healthy people have small amounts of B2M in their blood. Normal results vary based on the laboratory and the method used.","conditions":[]},{"flag":"abnormal","label":{"short":"High","long":"High","orientation":"horizontal"},"values":{"min":300,"max":500},"text":"Increased urine B2M levels indicate kidney damage, and further testing needs to be done. Usually, higher levels correspond with higher stages of the disease; hence, worse prognosis.","conditions":["Renal tubular damage","Pyelonephritis","Balkan nephropathy","Exposure to cadmium","Exposure to mercury","Exposure to lithium","Aminoglycoside toxicity"]}],"units":[{"printSymbol":"\u03bcg\/L","code":"ug\/L","name":"microgram per liter"}],"value":150,"disclaimer":"Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are \"within normal limits.\""}[{"normal":0},{"abnormal":0}]
Use the slider below to see how your results affect your health.
μg/L
300
Your result is Normal.
Healthy people have small amounts of B2M in their blood. Normal results vary based on the laboratory and the method used.
Related conditions
A beta-2 microglobulin tumor marker test measures the amount of a protein called beta-2 microglobulin (B2M) in your body fluids. The test usually uses a sample of your blood. It may also be done using urine (pee) or in rare cases cerebrospinal fluid (CSF).
B2M is a type of tumor marker. Tumor markers are substances that are often made by cancer cells or by normal cells in response to cancer in the body. B2M is found on most of the cells in your body. Normally, you have only small amounts of B2M in your blood and urine. High levels of B2M in body fluids are often caused by these blood and bone marrow cancers:
- Multiple myeloma
- Chronic lymphocytic leukemia (CLL)
- Certain types of lymphoma
A beta-2 microglobulin tumor marker test can't diagnose cancer or any other condition. That's because there are so many conditions that can cause high levels of B2M. But if you've already been diagnosed with one of these blood and bone marrow cancers, a B2M test can provide important information about your cancer including:
- How much cancer you have in your body and how fast it's growing
- How your cancer may behave in the future
- How much your treatment is helping
This information can help you and your health care provider plan your care.
Other names: total beta-2 microglobulin, β2-microglobulin, B2M, B2MG, thymotaxin
A beta-2 microglobulin tumor marker test is most often used if you have been diagnosed with certain cancers of the bone marrow or blood. Testing your B2M levels can help:
- Find out how much cancer is in your body
- Predict how your cancer will develop
- Pick your treatment and check whether it's working
- Check whether cancer has spread to your brain and/or spinal cord (This is done only if you have symptoms.)
A beta-2 microglobulin test usually uses a sample of your blood. In certain cases, you may need to provide a 24-hour urine sample, which means collecting all your urine for a full day. If your provider suspects that cancer has spread to your brain or spine, you may have a cerebrospinal fluid (CSF) analysis.
For a blood test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
For a 24-hour urine sample, you will be given a special container to collect your urine and instructions on how to collect and store your samples. Your provider will tell you what time to start. The test generally includes the following steps:
- To begin, urinate (pee) in the toilet as usual. Do not collect this urine. Write down the time you urinated.
- For the next 24 hours, collect all your urine in the container.
- During the collection period, store the urine container in the refrigerator or in a cooler with ice.
- 24 hours after starting the test, try to urinate if you can. This is the last urine collection for the test.
- Return the container with your urine to your provider's office or the laboratory as instructed.
For a cerebrospinal fluid (CSF) analysis, a provider will do a procedure called a spinal tap (also known as a lumbar puncture). A spinal tap is usually done in a hospital. A provider numbs your skin with medicine and uses a thin, hollow needle to remove some fluid from between the bones in your lower spine. You usually go home the same day.
If your B2M levels were measured to learn about your cancer:
- The higher your B2M levels, the more cancer you have in your body. Higher levels are linked to cancers that tend to grow faster.
- If you have multiple myeloma, higher levels of B2M are linked with kidney problems.
If your B2M levels were measured to check how well your treatment is working, your provider may look at several test results over time to look for a trend:
- Increasing B2M levels may mean your treatment is not working.
- Decreasing B2M levels may mean your treatment is working.
- B2M levels that don't change may mean that your disease is stable and hasn't gotten better or worse.
If you have questions about your test results, talk with your provider.
B2M levels may be higher than normal in many conditions that aren't cancer. The amount of B2M in body fluids may be measured in conditions such as:
- Kidney disease
- HIV/AIDS
- Multiple sclerosis
1. Beta 2 Microglobulin (B2M) Tumor Marker Test: MedlinePlus Medical Test [accessed on Jan 20, 2024]
2. Tumor Marker Tests in Common Use - NCI. National Cancer Institute. Dec 7, 2023 [accessed on Jan 20, 2024]
3. Beta 2 Microglobulin (B2M) Test. City of Hope. [accessed on Jan 20, 2024]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (1)

Electrophoresis - concentration - b-Globulin

TheVisualMD

CA-125 Blood Test

CA-125 Blood Test

Also called: CA-125 Tumor Marker, Glycoprotein Antigen, Ovarian Cancer Antigen

This test measures the amount of a protein called CA-125 in the blood. CA-125 levels are high in many women with ovarian cancer. It is not a screening test, but it can help find out if cancer treatment is working.

CA-125 Blood Test

Also called: CA-125 Tumor Marker, Glycoprotein Antigen, Ovarian Cancer Antigen

This test measures the amount of a protein called CA-125 in the blood. CA-125 levels are high in many women with ovarian cancer. It is not a screening test, but it can help find out if cancer treatment is working.

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Use the slider below to see how your results affect your health.
(i.U.)/mL
35
Your result is Normal.
Having a normal CA-125 result doesn't mean you don't have ovarian cancer. Some women with early ovarian cancer have a normal CA-125 level.
Related conditions
A CA-125 blood test may be used:
- To see if ovarian cancer treatment is working and to check for ovarian cancer that has come back. This is the most common use of CA-125 blood testing.
- To learn more about a growth or lump in your pelvis (the area below your belly). If a suspicious lump shows up on imaging, such as an ultrasound, your health care provider may check your CA-125 levels along with other tests to find out whether the lump could be ovarian cancer. But a CA-125 blood test alone can't diagnose cancer.
- To screen for ovarian cancer if you're risk is very high. If your family health history includes ovarian cancer, your provider may suggest a CA-125 blood test and other tests to look for signs of cancer. But a CA-125 test is not used as a routine screening test for people who don't have a high risk for ovarian cancer. That's because many common conditions that aren't cancer can also cause high CA-125 levels, such as endometriosis or even a menstrual period.
If you've been diagnosed with ovarian cancer, you may have several CA-125 blood tests:
- During your treatment to see if your cancer is going away. If CA-125 levels go down, it usually means your treatment is working
- After your treatment, to check whether your cancer has returned
If you have a lump in your pelvis that could be ovarian cancer, you may need a CA-125 test to help find out if it could be ovarian cancer. But only a biopsy can diagnose ovarian cancer.
If you have a very high risk of getting ovarian cancer, your health care provider may suggest checking your CA-125 levels. If they're high, you'll probably need more tests to find out if you have cancer. You're more likely to get ovarian cancer if you:
- Have a mother or sister, or two or more other relatives who had ovarian cancer
- Have family members who have had breast cancer or colorectal cancer (colon cancer)
- Have inherited certain gene changes or conditions that increase your risk of ovarian cancer, such as:
  Changes in your genes, including BRCA 1 or BRCA 2 genes
  Lynch syndrome (also called hereditary non-polyposis colorectal cancer), an inherited disorder that increases the risk for many types of cancer
- Have had breast, uterine (uterus), or colorectal cancer
If you're concerned about getting ovarian cancer, talk with your provider about your risk.
Your provider will review your CA-125 test results along with other information about your condition. Together, you can discuss how your results affect your diagnosis, treatment, and need for more testing.
In general:
- If you are being treated for ovarian cancer, and the results of several tests show that your CA-125 levels are going down, it usually means that the treatment is helping. If your levels go up or stay the same over time, it may mean that the treatment isn't working.
- If you have finished your treatment for ovarian cancer and your CA-125 levels begin to increase over time, your cancer may be coming back.
- If you have a high risk for ovarian cancer or have a suspicious pelvic lump, a high CA-125 levels could be a sign of cancer. Your provider will usually order more tests to make a diagnosis.
A high CA-125 level doesn't always mean cancer. Other conditions may increase CA-125, including:
- Endometriosis
- Pelvic inflammatory disease (PID)
- Uterine fibroids
- Liver disease
- Pregnancy
- Your menstrual period, at certain times during your cycle
A normal CA-125 test result doesn't rule out ovarian cancer. That's because CA-125 levels may be low in the early stages of cancer. And not everyone with ovarian cancer makes high levels of CA-125.
Talk with your provider if you have questions about your results.
1. CA 125 Blood Test (Ovarian Cancer): MedlinePlus Lab Test Information [accessed on Nov 05, 2018]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (8)

Ovarian Cancer

Ovarian cancer is the deadliest of gynecologic cancers. More than 21,000 new cases of ovarian cancer are diagnosed each year, with more than 15,000 deaths. A particular blood protein called cancer antigen 125 (CA-125) is often elevated in women with ovarian cancer, though small amounts of CA-125 are produced by normal tissues throughout the body and levels of CA-125 can be elevated by other conditions. The CA-125 test is used primarily to monitor the effectiveness of treatment for ovarian cancer. There are three different kinds of ovarian cancer: the most common type is epithelial ovarian cancer (90%) which originates from the surface epithelium of the ovary and is more likely to affect older women; germ cell ovarian cancer (5%), which originates from the cells that produce eggs and is more likely to affect younger women; and stromal ovarian cancer (5%), which originates from the connective tissue within the ovary. After age, the most important risk factor for ovarian cancer is family history. Ovarian cancer is relatively uncommon, but is the fifth leading cause of cancer death in women, partly due to diagnosis difficulty; its symptoms are vague, and ovarian cancer can shed cells that can invade other internal organs long before the presence of disease is even suspected.

Image by TheVisualMD

CA-125: Ovaries and Uterus

The cancer antigen 125 test (CA-125) is used to monitor treatment for ovarian cancer. If blood levels of CA-125 fall during treatment, it usually means the cancer is responding; if levels rise after treatment is complete, it may indicate that the cancer has returned.

Image by TheVisualMD

CA-125: Uterus and Ovaries in Ultrasound

When ovarian cancer is suspected, a doctor will typically perform a pelvic exam to check for masses or growths on the ovaries. Other diagnostic tests include a transvaginal ultrasound, which produce detailed images of the ovaries and other reproductive organs.

Image by TheVisualMD

CA-125: Female Reproductive System - A carbohydrate antigen that occurs in tumors of the ovary as well as in breast, kidney, and gastrointestinal tract tumors and normal tissue. While it is tumor-associated, it is not tumor-specific and may have a protective function against particles and infectious agents at mucosal surfaces. (NCBI/NIH)

As our understanding of cancer has deepened and treatment options expanded, the emphasis has shifted to early detection and aggressive treatment. The hope is that earlier and more accurate diagnoses will push survival rates for ovarian cancer higher.

Image by TheVisualMD

Ovarian Cancer Fact Sheet

Ovarian cancer is cancer that begins in the ovaries. The ovaries make female hormones and produce a woman’s eggs. Ovarian cancer is a serious cancer that is more common in older women. Treatment is most effective when the cancer is found early.

Document by Office on Women's Health, U.S. Department of Health and Human Services

Ovarian Cancer: Symptoms and Treatment

Video by MainMD/YouTube

Premature Ovarian Aging and Early Menopause

Video by Center for Human Reproduction/YouTube

Ovarian cancer: beyond resistance

Video by nature video/YouTube

Ovarian Cancer

TheVisualMD

CA-125: Ovaries and Uterus

TheVisualMD

CA-125: Uterus and Ovaries in Ultrasound

TheVisualMD

CA-125: Female Reproductive System - A carbohydrate antigen that occurs in tumors of the ovary as well as in breast, kidney, and gastrointestinal tract tumors and normal tissue. While it is tumor-associated, it is not tumor-specific and may have a protective function against particles and infectious agents at mucosal surfaces. (NCBI/NIH)

TheVisualMD

Ovarian Cancer Fact Sheet

Office on Women's Health, U.S. Department of Health and Human Services

3:04

Ovarian Cancer: Symptoms and Treatment

MainMD/YouTube

5:09

Premature Ovarian Aging and Early Menopause

Center for Human Reproduction/YouTube

2:22

Ovarian cancer: beyond resistance

nature video/YouTube

CA 15-3 Test

CA 15-3 Test

Also called: CA 15-3 Tumor Marker, Cancer Antigen 15-3, Cancer Antigen-Breast

CA 15-3 testing is mostly used in women who have been diagnosed with invasive breast cancer to monitor the response to treatment and to help watch for recurrence of the disease.

CA 15-3 Test

Also called: CA 15-3 Tumor Marker, Cancer Antigen 15-3, Cancer Antigen-Breast

CA 15-3 testing is mostly used in women who have been diagnosed with invasive breast cancer to monitor the response to treatment and to help watch for recurrence of the disease.

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Use the slider below to see how your results affect your health.
(i.U.)/mL
30
Your result is Normal.
Normal results vary based on the laboratory and the method used.
Related conditions
Suggests limited tumor burden (less cancer is present)
Suggests breast-cancer patient is responding well to treatment
Normal values of CA 15-3 are less than 30 units/mL. However, reference ranges can slightly vary from laboratory to laboratory.
Usually, the more advanced the breast cancer is, the higher the CA 15-3 level will be. The highest levels of CA 15-3 often are seen when the disease has already spread to other tissues (metastasized).
Nevertheless, besides breast cancer, CA 15-3 levels can be mild to moderately increased in other conditions, including:
- Colon cancer
- Lung cancer
- Pancreatic cancer
- Ovarian cancer
- Prostate cancer
- Liver cancer
- Liver disease (hepatitis, cirrhosis)
- Benign breast disease

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (5)

Cancer

National Human Genome Research Institute (NHGRI)

CA 15-3: Breast Tumor Size When Found by Imaging or Touch

TheVisualMD

Sensitive content

This media may include sensitive content

CA 15-3: Breast Tissue and Lymph Node Network

TheVisualMD

2:42

What Are Tumor Markers for Breast Cancer?

Breast Cancer Answers®/YouTube

1:36

Biomarker Testing

Merck/YouTube

CA 19-9 Blood Test

CA 19-9 Blood Test

Also called: CA 19-9 Tumor Marker, Carbohydrate Antigen 19-9, Pancreatic Cancer Antigen

CA 19-9 testing is mostly used to monitor the effectiveness of treatment in individuals who have been diagnosed with pancreatic cancer. However, this antigen can also be elevated in other conditions, diseases, or types of cancer.

CA 19-9 Blood Test

Also called: CA 19-9 Tumor Marker, Carbohydrate Antigen 19-9, Pancreatic Cancer Antigen

CA 19-9 testing is mostly used to monitor the effectiveness of treatment in individuals who have been diagnosed with pancreatic cancer. However, this antigen can also be elevated in other conditions, diseases, or types of cancer.

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Use the slider below to see how your results affect your health.
U/mL
35
75
Your result is Low.
Low amounts of CA 19.9 may be detected in healthy people. Low or stable counts may also indicate positive response to treatment or stabilized tumor growth.
Related conditions
CA 19-9 blood tests may be used to:
- Monitor certain types of cancer and cancer treatment. CA 19-9 levels often go up as cancer grows and go down as tumors shrink.
- Help predict how cancer may behave over time.
- Check whether cancer has returned after treatment.
- Help diagnose certain cancers and other diseases when used with other tests.
Some people do not make CA 19-9 even when they have a cancer that usually produces high levels of CA 19-9. For these people, a CA 19-9 tumor marker test is not useful.
You may need a CA 19-9 blood test if you've been diagnosed with pancreatic cancer or another type of cancer that causes high CA 19-9. These include cancers of the:
- Bile duct
- Colon and rectum
- Stomach
- Ovaries
- Bladder
During cancer treatment, your health care provider may test you on a regular basis to see if your treatment is working.
After your treatment is complete, you may need to have CA 19-9 tests to check whether the cancer has come back. High levels of CA 19-9 may be one of the first signs that cancer cells are growing again.
If you're being treated for cancer, you may be tested several times during your treatment. Your provider will look at all your test results to see how your CA 19-9 levels have changed. Your results may show:
- Your levels of CA 19-9 are increasing. This may mean your tumor is growing, and/or your treatment is not working. More tests are usually needed to find out for sure.
- Your levels of CA 19-9 are decreasing. This may mean your tumor is shrinking and your treatment is working.
- Your levels of CA 19-9 have stayed the same. This may mean your disease is stable and hasn't gotten better or worse.
- Your CA 19-9 levels decreased after treatment, but increased later. This may mean your cancer has come back or grown. You'll need more tests to check whether cancer is really causing the higher level of CA 19-9.
If you don't have cancer but your test results show a high level of CA 19-9, you may not a health problem that needs treatment. Healthy people can have high CA 19-9 levels. But high levels may be a sign of a condition, such as:
- Pancreatitis, inflammation of the pancreas
- Gallstones
- Bile duct disease, including a blockage or infection
- Liver disease
- Cystic fibrosis
Talk with your provider about what your results may mean.
If your provider thinks you may have one of these conditions, you will probably need other tests to find out for sure.
1. CA 19-9 Blood Test (Pancreatic Cancer): MedlinePlus Lab Test Information [accessed on Nov 05, 2018]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (7)

Pancreatic Cancer

Pancreatic Cancer: In Situ : The summary staging system categorizes cancer (shown here in the pancreas) according to its spread. In situ cancer is present only in cells in which it began.

Image by TheVisualMD

Amylase, Pancreatic Cancer

Amylase is one of several enzymes produced by the pancreas and secreted into the digestive tract to help break down nutrients (amylase is also produced by the salivary glands). The enzyme is usually present in the blood and urine only in small quantities, but when pancreatic tissue is injured, inflamed (pancreatitis) or when the pancreatic duct is blocked or a tumor is present, amylase can leak into the blood and urine. As cancerous tissue overwhelms the pancreas, its function is compromised and enzyme levels fall.

Image by TheVisualMD

Sensitive content

This media may include sensitive content

Pancreas joined to the small bowel after pylorus preserving surgery for pancreatic cancer

Diagram showing the pancreas joined to the small bowel after pylorus preserving surgery for pancreatic cancer

Image by Cancer Research UK / Wikimedia Commons

Pancreatic Cancer

Cancer Types _ Pancreatic Cancer Cells or Tissue _ Abnormal Cells or Tissue

Image by Dr. Lance Liotta Laboratory _ NCI

Doctor explains Ca 19-9 blood test used in PANCREATIC CANCER | LAB TESTS explained

Video by Doctor O'Donovan/YouTube

Diagnosing Pancreatic Tumors and Cysts - Mayo Clinic

Video by Mayo Clinic/YouTube

T1 stage - the tumor is inside the pancreas and is 2cm or less in any direction.

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TNM Staging for Pancreatic Cancer

TNM stands for Tumour, Node, Metastasis. This system describes the size of a primary tumour (T), whether there are lymph nodes with cancer cells in them (N) and whether the cancer has spread to a different part of the body (M).

Interactive by Cancer Research UK

Pancreatic Cancer

TheVisualMD

Amylase, Pancreatic Cancer

TheVisualMD

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Pancreas joined to the small bowel after pylorus preserving surgery for pancreatic cancer

Cancer Research UK / Wikimedia Commons

Pancreatic Cancer

Dr. Lance Liotta Laboratory _ NCI

5:17

Doctor explains Ca 19-9 blood test used in PANCREATIC CANCER | LAB TESTS explained

Doctor O'Donovan/YouTube

5:55

Diagnosing Pancreatic Tumors and Cysts - Mayo Clinic

Mayo Clinic/YouTube

TNM Staging for Pancreatic Cancer

Cancer Research UK

CEA Test

CEA Test

Also called: Carcinoembryonic Antigen, CEA Assay, CEA Tumor Marker

A CEA (carcinoembryonic antigen) test measures CEA in a sample of blood or other body fluid. It helps check if treatment for certain cancers is working. The test is most commonly used in colorectal cancer.

CEA Test

Also called: Carcinoembryonic Antigen, CEA Assay, CEA Tumor Marker

A CEA (carcinoembryonic antigen) test measures CEA in a sample of blood or other body fluid. It helps check if treatment for certain cancers is working. The test is most commonly used in colorectal cancer.

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Use the slider below to see how your results affect your health.
ng/mL
3
5
20
Your result is Normal.
Related conditions
CEA stands for carcinoembryonic antigen. CEA is a protein that is a type of "tumor marker." Tumor markers are substances that are often made by cancer cells or by normal cells in response to cancer.
High levels of CEA are normal in healthy, unborn babies. After birth, CEA levels become very low or disappear completely. So, healthy adults should have little or no CEA in their bodies.
Cancers that may cause high levels of CEA include cancers of the:
- Colon and rectum (colorectal or bowel cancer)
- Prostate
- Ovary
- Lung
- Thyroid
- Liver
- Pancreas
- Breast
If you've been diagnosed with a cancer that can cause high CEA levels, CEA testing may help your health care provider learn more about your cancer and chance of recovery. The test is often used with other tests to check if cancer treatment is working.
CEA tests are not used to screen for or diagnose cancer. That's because:
- Cancers that often cause high CEA levels don't always cause high levels. You can have normal CEA test results even though you have one of these cancers.
- Many other health problems that aren't cancer can make CEA levels rise, including certain conditions that affect your liver, digestion, or breathing.
Most CEA tests use a sample of your blood to measure your CEA level. Sometimes the test uses a sample of fluid from your spine, chest, or abdomen (belly), but this is less common.
A CEA test is mostly used in people who have been diagnosed with cancers that often increase CEA levels. It's most commonly used in colorectal cancer. A provider may order a CEA test along with other tests to:
- Learn more about a cancer soon after it has been diagnosed. CEA levels can help predict the likelihood of recovery and/or the chance that cancer will come back after treatment.
- Check how well cancer treatment is working.
- See if cancer has returned after treatment.
If you've been diagnosed with a type of cancer that can cause high CEA levels, you may need CEA testing:
- Before treatment to:
  Help understand how serious your cancer is.
  Help guide treatment decisions.
  Get a measurement of your CEA level before treatment to compare with CEA levels after treatment.
- During cancer treatment to see if the treatment working.
- After treatment to check whether cancer has come back. You may need to have tests on a regular schedule.
To understand your CEA test results, your provider will consider the results of other tests and exams. Ask your provider to explain what your test results mean for your health and treatment.
If you had a test before starting cancer treatment, in general:
- A low level of CEAmay mean your tumor is small and the cancer has not spread to other parts of your body. But some cancers don't make much CEA, so your provider may use other tests to learn more about how much cancer you have and if it's spread.
- A high level of CEAmay mean you have a larger tumor and/or your cancer has spread. You'll need other tests to confirm how serious your cancer is.
If you had a test to monitor your cancer during or after treatment, your provider will compare your current CEA test results with your past test results. In general:
- Decreases in CEA over time often mean that treatment is working.
- Increases in CEA or high levels that stay highmay mean that treatment isn't working. For example, if you had surgery for colorectal cancer, these levels may mean that the entire tumor wasn't removed or the cancer is growing back.
- Decreases in CEA after treatment followed by increasesmay mean cancer has come back.
CEA levels that remain high or increase after treatment don't always mean that treatment isn't working, or cancer is growing. So, if your CEA levels don't come down, your provider will likely order other tests to find out why.
If you have questions about your results, talk with your provider.
1. CEA Test: MedlinePlus Medical Test [accessed on Mar 09, 2023]
2. https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis/tumor-markers-fact-sheet [accessed on Mar 13, 2019]
3. https://www.labcorp.com/test-menu/21906/carcinoembryonic-antigen-cea [accessed on Oct 03, 2019]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (20)

Carcinoembryonic Antigen (CEA): CEA in Colorectal Cancer Staging and Treatment

CEA tests are not used to screen for colorectal cancer, but they're frequently performed after the cancer has been diagnosed. CEA is useful in staging--performing tests to determine if the cancer has spread within the intestine or to distant parts of the body. CEA may also be used for treatment planning, as elevated levels may indicate a poorer prognosis. After surgery, CEA levels may be measured periodically to see if the cancer has spread. It is important to note that CEA is not a perfect predictor of how a patient will respond to treatment, nor is it conclusive in determining if cancer has spread. The American Society of Clinical Oncologists (ASCO) states that CEA should not be used as the sole basis for decision-making in colorectal cancer.

Image by TheVisualMD

Carcinoembryonic Antigen (CEA): CEA Testing During Chemotherapy

Whether CEA is tested during systemic treatment for colorectal cancer depends on the stage of the cancer. After surgery, the American Society of Clinical Oncologists (ASCO) recommends that patients with stage II or stage III cancer have a CEA test every 3 months, for a minimum of 3 years. However, if the patient is receiving chemotherapy, CEA testing should be delayed until after chemotherapy is completed. On the other hand, CEA is the marker of choice for monitoring stage IV (metastatic) colorectal cancer during systemic treatment. Patients with metastatic cancer, in which the cancer has spread to distant parts of the body, should have a CEA test every 1-3 months during chemotherapy to see if the treatment is working and whether the cancer is still spreading. ASCO recommends other tests be done in conjunction with the CEA tests.

Image by TheVisualMD

The Importance of Good Bowel Preparation During Colonoscopy

Video by Johns Hopkins Medicine/YouTube

Colon cancer: Essential facts

Video by Institute for Cancer Genetics and Informatics/YouTube

The Colon and Colon Cancer

Video by Armando Hasudungan/YouTube

Colon Cancer: Don't Ignore Your Symptoms

Video by American Cancer Society/YouTube

Colorectal Cancer Screening

Video by Mechanisms in Medicine/YouTube

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Treating Colon Cancer

This animation explains how colon cancer forms and how it can be treated through chemotherapy and surgery.

Video by TheVisualMD

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Colorectal Cancer Screening

Colorectal cancer is one of the few preventable forms of cancer thanks to effective screening. For many people, screening for colorectal cancer is an unpleasant thought, but knowing your options and taking a pro-active approach especially if you're over 50 can save your life. In this video, you can learn the "ins and outs" of colonoscopy, as well as learn about a new technique called virtual colonoscopy, which uses high-tech CT scans to screen the colon.

Video by TheVisualMD

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Colorectal Cancer Clip 6

Colorectal Cancer Clip 6

Video by TheVisualMD

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Dr. O'Kieffe and patient on preparing for a colonoscopy

A recent colonoscopy patient and gastroenterologist Dr. Donald O'Kieffe of Metro Gastroenterology, Chevy Chase, MD, explain what's involved in the preparation for your screening.

Video by TheVisualMD

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Dr. Klein on who should be screened

Dr. Mark Klein, a radiologist and colorectal cancer screening specialist at Washington Radiology Associates in Washington, DC, discusses who should be screened for colorectal cancer, and when.

Video by TheVisualMD

Colon cancer staging

Colon cancer staging : After colon cancer has been diagnosed, the next step is to perform tests to determine if the cancer has spread within the intestine or to distant parts of the body. This is called staging. Staging helps the doctor to decide the most appropriate treatment for the cancer at its current stage.

Image by TheVisualMD

Colorectal Cancer Types of Surgery

Surgery is the main treatment for colorectal cancer. Polyps and very early stage cancers (Stage 0 and some early Stage I tumors) can be removed during a colonoscopy, using a variety of techniques. In late Stage I and in Stage II and III cancer, the cancerous part of the colon is removed surgically. The surgeon may perform a resection, consisting of a partial colectomy (removing the cancer and a small amount of healthy tissue around it) and an anastomosis (sewing the parts of the colon back together). Nearby lymph nodes may also be removed and biopsied. If it isn't possible to perform a resection (for instance, if the cancer is at the outlet of the rectum), a colostomy may be performed. In a colostomy, a portion of the large intestine is brought through the abdominal wall to carry stool out of the body, where it empties into a special bag. The colostomy may be temporary in order to allow the colon or rectum time to heal after surgery, or it may be permanent.

Image by TheVisualMD

Colon Anatomy & Function

Image by TheVisualMD

Colostomy

Colostomy Illustration

Image by Blausen.com staff. \"Blausen gallery 2014\". Wikiversity Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762

Colorectal Cancer

Colorectal cancer refers to cancer of the colon and cancer of the rectum. The colon is the longest part of the large intestine, and the rectum is the last several inches of the large intestine, closest to the anus.

Image by TheVisualMD

What Is Colorectal Cancer?

The process of cell growth in the body is normally an orderly one. Cells grow and divide as necessary to produce more cells as they are needed. Cells that are old or damaged die, and are replaced with new cells.

Image by TheVisualMD

Treating Colorectal Cancer

There are three main treatment options for colorectal cancer:

Image by TheVisualMD

Colorectal Cancer Spread to Body Stage 4

Cancer spreads in three ways: by invading surrounding tissue, by invading the lymph system and traveling through lymph vessels to other places in the body, and by invading veins and capillaries and traveling through the bloodstream to other places in the body. Stage IV: Cancer may have spread to nearby lymph nodes and has spread to other parts of the body, such as the liver or lungs. Stage IV colorectal cancer is not considered curable. Image 5 of 5.

Image by TheVisualMD

Carcinoembryonic Antigen (CEA): CEA in Colorectal Cancer Staging and Treatment

TheVisualMD

Carcinoembryonic Antigen (CEA): CEA Testing During Chemotherapy

TheVisualMD

1:23

The Importance of Good Bowel Preparation During Colonoscopy

Johns Hopkins Medicine/YouTube

2:49

Colon cancer: Essential facts

Institute for Cancer Genetics and Informatics/YouTube

10:05

The Colon and Colon Cancer

Armando Hasudungan/YouTube

6:06

Colon Cancer: Don't Ignore Your Symptoms

American Cancer Society/YouTube

2:42

Colorectal Cancer Screening

Mechanisms in Medicine/YouTube

3:45

Treating Colon Cancer

TheVisualMD

4:13

Colorectal Cancer Screening

TheVisualMD

0:05

Colorectal Cancer Clip 6

TheVisualMD

0:48

Dr. O'Kieffe and patient on preparing for a colonoscopy

TheVisualMD

0:21

Dr. Klein on who should be screened

TheVisualMD

Colon cancer staging

TheVisualMD

Colorectal Cancer Types of Surgery

TheVisualMD

Colon Anatomy & Function

TheVisualMD

Colostomy

Blausen.com staff. \"Blausen gallery 2014\". Wikiversity Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762

Colorectal Cancer

TheVisualMD

What Is Colorectal Cancer?

TheVisualMD

Treating Colorectal Cancer

TheVisualMD

Colorectal Cancer Spread to Body Stage 4

TheVisualMD

Prostate-Specific Antigen (PSA) Test

Prostate-Specific Antigen (PSA) Test

Also called: PSA, Prostate-Specific Antigen, Total PSA

Prostate-specific antigen (PSA) test is a blood test that checks the level of PSA in the blood. PSA is a protein made by the prostate gland. The amount of PSA may be higher in men who have prostate cancer, benign prostatic hyperplasia (BPH), or infection or inflammation of the prostate.

Prostate-Specific Antigen (PSA) Test

Also called: PSA, Prostate-Specific Antigen, Total PSA

Prostate-specific antigen (PSA) test is a blood test that checks the level of PSA in the blood. PSA is a protein made by the prostate gland. The amount of PSA may be higher in men who have prostate cancer, benign prostatic hyperplasia (BPH), or infection or inflammation of the prostate.

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Use the slider below to see how your results affect your health.
ng/mL
4
10
Your result is Normal.
PSA is always present in low concentrations in the blood of adult males. However, there is no specific normal or abnormal level of PSA in the blood, and levels may vary over time in the same man. Various factors can cause a man’s PSA level to fluctuate, such as inflammation, infections and medications among other factors.
Related conditions
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Use the slider below to see how your results affect your health.
%
10
25
Your result is Lower risk.
When total PSA is in the range of 4.0-10.0 ng/mL and free PSA is above 25% it indicates a 9% to 16% risk of prostate cancer, depending on age. Studies have shown that men with a total PSA in this "gray area" and a free PSA greater than 25% are more likely to have a benign condition than to have cancer, making a biopsy unnecessary.
Related conditions
A prostate-specific antigen (PSA) test is a blood test that measures the level of PSA in a sample of your blood. PSA is a protein made by your prostate. The prostate is a gland in the male reproductive system. It lies just below the bladder. It makes the fluid part of semen.
It's normal to have a low level of PSA in your blood. A high PSA level may be caused by:
- Prostate cancer
- An enlarged prostate (BPH) (benign prostatic hyperplasia)
- Other common prostate problems
- Taking certain medicines
A PSA test can't show what is causing abnormal PSA levels. So, if your level is high, you may need other tests.
Other names: total PSA free PSA
A PSA test is used to screen for prostate cancer. Cancer screening means looking for signs of cancer before it causes symptoms. But screening tests can't diagnose cancer. If a screening test finds signs of cancer, you'll need other tests to find out if you have cancer and how serious it may be.
Most types of prostate cancer grow very slowly. They don't spread beyond the prostate and may never cause health problems. In fact, you can live a long life with prostate cancer and never know you have it. The goal of prostate cancer screening is to help find cancers that may be more likely to spread so they can be treated early. But there are challenges and possible harms from using a PSA test to screen for prostate cancer:
- A PSA test can't tell the different between abnormal PSA levels from prostate cancer and noncancerous conditions. If your PSA level is high, a prostate biopsy is the only way to find out if the cause is cancer. And prostate biopsies have possible harms.
- A PSA test may lead to finding and treating prostate cancer that would never have affected your health. If prostate cancer is found:
  It can be difficult to tell the difference between slow-growing cancers and those that are likely to grow faster and spread in your body.
  You could have prostate cancer treatment that you never really needed. And cancer treatment may cause serious harms, such as:
  Erectile dysfunction
  Urinary incontinence
  Problems controlling your bowels (poop)
To decide whether a PSA test to screen for prostate cancer is right for you, talk with your health care provider about:
- Your risk for developing a serious type of prostate cancer. If your risk is high, the possible benefits of finding cancer early may outweigh the possible harms.
- Your general health. Are you well enough to have treatment for prostate cancer if it's found?
- Your preferences. How do you feel about the possible benefits and harms of screening, diagnosis, and treatment?
PSA testing may also be used to:
- Help diagnose the cause of prostate conditions that aren't cancer
- Monitor treatment for a prostate condition, including cancer
It's your choice whether to have a PSA test to screen for cancer. You and your prover may consider your risk for developing a serious cancer that could spread if you don't catch it early. Your risk for serious prostate cancer may be higher depending on your:
- Age. The risk of prostate cancer increases after age 50.
- Your family health history. If members of your family have had prostate cancer, your risk may be higher.
- Your race. Prostate cancer is more common in African Americans. They also have a higher risk of developing prostate cancer at a younger age and having more serious disease.
You may also have a PSA test if:
- You have symptoms of a prostate condition, such as:
  Painful or frequent urination (peeing)
  Blood in urine or semen
  Pelvic and/or back pain
- You have prostate cancer. Your provider may use PSA testing to monitor your condition or to see how well treatment is working.
There is no specific normal or abnormal level for PSA in blood. In general, the higher your PSA level, the more likely it is that you have cancer. But it's possible to have a high PSA without prostate cancer, or a low PSA with prostate cancer.
If you had a PSA test for a prostate cancer screening or because you have prostate symptoms:
- High PSA levels can mean you have prostate cancer or a prostate condition that's not cancer, such as an infection (prostatitis) or an enlarged prostate. If your PSA levels are higher than normal, your provider may talk with you about having more tests to diagnose the cause. These tests may include:
  Another PSA test, more commonly if you don't have any symptoms. PSA levels can go up and down, so it helpful to see if your PSA levels change over time.
  A digital rectal exam (DRE). For this test, your provider inserts a gloved, lubricated finger into your rectum to feel your prostate for lumps or anything unusual.
  A urine test. A sample of your urine is tested for infection.
  A prostate biopsy. A biopsy is minor surgery. A doctor removes samples of tissue from your prostate so it can be studied under a microscope to look for cancer cells. A biopsy is the only way to diagnose cancer. It may be recommended if your provider thinks you may have prostate cancer.
If you had a PSA test to monitor prostate cancer or treatment, ask your provider what a high PSA level means. Your provider will usually look at several tests results over time to get a fuller understanding of your condition.
If you have questions about your results, talk with your provider.
1. Prostate-Specific Antigen (PSA) Test: MedlinePlus Lab Test Information [accessed on Feb 29, 2024]
2. Prostate-specific antigen (PSA) blood test: MedlinePlus Medical Encyclopedia [accessed on Oct 03, 2018]
3. Prostate-Specific Antigen (PSA) Test - National Cancer Institute [accessed on Oct 03, 2018]
4. PSA - Clinical: Prostate-Specific Antigen (PSA) Diagnostic, Serum [accessed on Oct 03, 2018]
5. PSA. Lab Tests Online. [accessed on Oct 03, 2018]
6. 010322: Prostate-specific Antigen (PSA) | LabCorp [accessed on Oct 03, 2018]

Normal reference ranges can vary depending on the laboratory and the method used for testing. You must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

Additional Materials (29)

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Prostate Gland

Prostate Description Line drawing showing lateral view of the prostate gland, rectum, bladder, penis and testis.

Image by National Cancer Institute

Normal vs enlarged prostate

BPH - Prostate enlargement problems

Image by Akcmdu9

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What Is Prostate Cancer?

Delve into the prostate, understand this complex disease found in men that is challenging to diagnose and witness a cutting edge procedure that may change how prostate cancer is diagnosed in the future.

Video by TheVisualMD

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Prostate Cancer Treatment

Once someone is diagnosed with prostate cancer, the patient and his doctors decide a course of action, and create a treatment plan. Very often with prostate cancer, that means simply keeping an eye on the progression of the disease. Here, top doctors lay out the most common prostate cancer treatment options, explain the tools and methods used as well as the risk factors involved.

Video by TheVisualMD

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Standard Biopsy for Prostate Cancer

National Cancer Institute urologist and surgeon Dr. Peter Pinto explains the process of the standard multi-core or "blind" biopsy of the prostate.

Video by TheVisualMD

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Visualizing the Prostate

Unlike for many other cancers, there are no standardized imaging protocols, apart from the use of transrectal ultrasound (TRUS), for the early detection and diagnosis of prostate cancer. This is a critical need. Prostate cancer is a disease for which it is crucial to detect and diagnose cancers early and accurately, both because early prostate cancer is usually without symptoms and because treatment side effects can be severe. Fortunately, new technologies are currently being developed, and even being used in some medical facilities, with promising results. By providing more specific and accurate detection and diagnosis results, these more sophisticated forms of prostate imaging and analysis will help in detecting early cancers, and in making the decision of whether to treat for prostate cancer when abnormalities are detected.

Video by TheVisualMD

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Moving Forward with Prostate Imaging

Unlike for many other cancers, there are no standardized imaging protocols, apart from the use of transrectal ultrasound (TRUS), for the early detection and diagnosis of prostate cancer. This is a critical need. Prostate cancer is a disease for which it is crucial to detect and diagnose cancers early and accurately, both because early prostate cancer is usually without symptoms and because treatment side effects can be severe. Fortunately, new technologies are currently being developed, and even being used in some medical facilities, with promising results. By providing more specific and accurate detection and diagnosis results, these more sophisticated forms of prostate imaging and analysis will help in detecting early cancers, and in making the decision of whether to treat for prostate cancer when abnormalities are detected.

Video by TheVisualMD

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Prostate Cancer Prognosis

A cancer's stage (how far it has progressed) is a very important factor in deciding on treatment and estimating the patient's prognosis. After biopsy confirms the presence of cancer in the prostate, the cancer is staged, meaning that more tests are done to find out how far the cancer has spread in the prostate and if it has spread outside the gland to adjacent tissues or to other sites in the body.

Video by TheVisualMD

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Risks of Overdiagnosis of Prostate Cancer

University of Chicago Hospital radiologist Dr. Aytekin Oto talks about the challenge that doctors face in treating less aggressive forms of prostate cancer.

Video by TheVisualMD

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Risks of Treatment for Prostate Cancer

Prostate cancer patients are likely to have a number of treatment options to choose from. If you have prostate cancer, you may feel pressured to make a decision quickly. But take the time to learn as much as you can about prostate cancer, your prognosis, and the treatments that are appropriate for your case. Talk to your doctor and, preferably, get a second opinion as well. Bear in mind that a surgeon may tend to recommend surgery and a radiation oncologist to recommend radiation therapy. Consider your own feelings about these treatments and their possible side effects.

Video by TheVisualMD

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Treatment Options for Prostate Cancer

Prostate cancer patients are likely to have a number of treatment options to choose from. If you have prostate cancer, you may feel pressured to make a decision quickly. But take the time to learn as much as you can about prostate cancer, your prognosis, and the treatments that are appropriate for your case. Talk to your doctor and, preferably, get a second opinion as well. Bear in mind that a surgeon may tend to recommend surgery and a radiation oncologist to recommend radiation therapy. Consider your own feelings about these treatments and their possible side effects.

Video by TheVisualMD

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MRI for Prostate Cancer

A cancer's stage (how far it has progressed) is a very important factor in deciding on treatment and estimating the patient's prognosis. After biopsy confirms the presence of cancer in the prostate, the cancer is staged, meaning that more tests are done to find out how far the cancer has spread in the prostate and if it has spread outside the gland to adjacent tissues or to other sites in the body.

Video by TheVisualMD

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PET/CT for Prostate Cancer

A cancer's stage (how far it has progressed) is a very important factor in deciding on treatment and estimating the patient's prognosis. After biopsy confirms the presence of cancer in the prostate, the cancer is staged, meaning that more tests are done to find out how far the cancer has spread in the prostate and if it has spread outside the gland to adjacent tissues or to other sites in the body.

Video by TheVisualMD

Prostate Anatomy by Zones with insets

Prostate cancer usually starts in certain zones of the prostate. Knowledge of these different zones helps the doctor to decide where to biopsy tissue and where to look for cancer spread. In this image, the central zone is shown as orange, the transition zone is shown as green, and the peripheral zone is shown as yellow.

Image by TheVisualMD

Prostate Gland Zones

The prostate gland is a small gland that sits below the bladder (the gland lies close to the wall of the rectum, which allows it to be felt in a digital rectal exam). The prostate gland can be divided up in two different ways, by lobes or zones; there are four lobes and five zones. The zone system of classification is used mostly for pathology; the largest zone, the peripheral zone, comprises about three-quarters of the prostate and is where most cancer occurs.

Image by TheVisualMD

Prostate Gland and Seminal Vesicle

Visualization reconstructed from scanned human data of a posterior view of the prostate gland, seminal vesicles, ductus deferens and Cowper's glands. The ductus deferens joins with the seminal vesicles to form the ejaculatory duct. The seminal vesicles act to secrete a thick alkaline fluid that mixes with the sperm as it passes into the ejaculatory ducts and the urethra. The prostate gland secretes a lubricant that helps to prevent infection in the urethra and protects and energizes sperm. The Cowper's gland produces a lubricating fluid which is secreted into the urethra.

Image by TheVisualMD

Male Reproductive System Showing Prostate Cancer

Three-dimensional visualization reconstructed from scanned human data. Lateral cross-section of an enlarged cancerous prostate, as well as bladder, penis, and testicles. Prostate cancer is the leading cause of cancer death in men over the age of 75 and the third leading cause of cancer death in men of all ages. Prostate enlargement in older men is usually benign but can be monitored for malignancy through the use of a blood test for prostate specific antigen (PSA) as well as through more invasive exams such as transrectal ultrasound and tranperineal biospy. Early cancers are sometimes treated with removal of the prostate while late-stage cancers are often treated with hormone and/or radiation therapy in combination with removal of the testicles (orchidectomy) to lower the level of testosterone and decrease cell growth. 2 of 2.

Image by TheVisualMD

Prostate Gland

Visualization of the prostate gland. The prostate gland is the largest accessory gland of the male reproductive system. Two thirds of the prostate is glandular while the remaining third is fibromuscular. Prostatic secretions help to prevent infection in the urethra, energizes sperm and keep the urethral lining moist.

Image by TheVisualMD

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Male Reproductive System

Three-dimensional visualization reconstructed from scanned human data. Lateral cross-section of a healthy, normal prostate, as well as bladder, penis, and testicles. Prostate cancer is the leading cause of cancer death in men over the age of 75 and the third leading cause of cancer death in men of all ages. Prostate enlargement in older men is usually benign (noncancerous) but can be monitored for malignancy through the use of a blood test for prostate specific antigen (PSA) as well as through more invasive exams such as transrectal ultrasound and tranperineal biospy. Early cancers are sometimes treated with removal of the prostate while late-stage cancers are often treated by hormone and/or radiation therapy in combination with removal of the testicles (orchidectomy) to lower the level of testosterone and decrease cell growth. 1 of 2.

Image by TheVisualMD

What Is Prostate Cancer?

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Prostate Cancer Symptoms

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Prostate Function

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Prostate Cancer Grading with Gleason Scale

After biopsy, cancer cells are graded

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Risk Factors for Prostate Cancer

Some risk factors for prostate cancer are controllable, some aren't. Knowing what the risk factors are can help you to lower your chances of getting prostate cancer and to make decisions about beginning screening. Every man should talk with his general practitioner or urologist and discuss the benefits and shortcomings of PSA screening and whether to have it. Risk factors for prostate cancer include: AGE Risk increases dramatically after age 50. RACE Men of African descent are at higher risk. LIFESTYLE Men in North America and northwestern Europe have an increased risk. FAMILY HISTORY Having a brother or father who has the disease raises risk. GENETICS Some genes have been linked to prostate cancer. DIET High-fat diet increases the chances of getting prostate cancer. HORMONES High levels of testosterone can cause or accelerate the disease.

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Prostate Cancer Symptoms

Prostate cancer usually causes no symptoms in its early stages. Often there are no symptoms until the disease has spread beyond the prostate gland. Symptoms of advanced prostate cancer can include: 1) blood in the urine or semen, 2) difficulty, pain, or frequency in urinating, 3) pain in the lower back, pelvis, hips, or thigh bones, 4) compression of the spine, 5) pain with ejaculation, and 6) anemia and fatigue.

Image by TheVisualMD

Prostate Gland

Prostate and Seminal Vesicles sagittal and axial slices : Derived from magnetic resonance imaging (MRI) data, the axial and sagittal slices (cross sections) through the prostate reveal the glandular tissue of the prostate as well as the ejaculatory ducts and the urethra. The inner coils of the seminal vesicles are also visible within the slices. Seminal fluid from the seminal vesicles mixes with sperm from the testes, via the ductus deferens, within the ejaculatory duct. The contents of the ejaculatory duct are then deposited into the urethra. There prostatic fluid is added to the mix along with contributions from the bulbourethral glands, forming semen. The prostatic urethra most often carries urine from the bladder and through the prostate.

Image by TheVisualMD

Side Effects of Treatment for Prostate Cancer

The side effects of prostate cancer treatment can be severe and sometimes permanent. They include impotence, incontinence, bleeding, and nerve damage.

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Prostate Gland

MRI Slices of the Prostate : Radiologists view different cross-sectional slices of the prostate, including the sagittal and axial slices, in order to detect any abnormalities.

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Decipher Test for Prostate Cancer Recurrence

Range of scores for the Decipher test showing low, intermediate, and high risk of prostate cancer metastasis. By estimating the future risk of prostate cancer spread and death, the Decipher test could help patients and their doctors make treatment decisions.

Image by National Cancer Institute (NCI)

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Prostate Gland

National Cancer Institute

Normal vs enlarged prostate

Akcmdu9

4:26

What Is Prostate Cancer?

TheVisualMD

2:35

Prostate Cancer Treatment

TheVisualMD

0:51

Standard Biopsy for Prostate Cancer

TheVisualMD

1:00

Visualizing the Prostate

TheVisualMD

0:34

Moving Forward with Prostate Imaging

TheVisualMD

0:39

Prostate Cancer Prognosis

TheVisualMD

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Risks of Overdiagnosis of Prostate Cancer

TheVisualMD

0:42

Risks of Treatment for Prostate Cancer

TheVisualMD

0:33

Treatment Options for Prostate Cancer

TheVisualMD

0:27

MRI for Prostate Cancer

TheVisualMD

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PET/CT for Prostate Cancer

TheVisualMD

Prostate Anatomy by Zones with insets

TheVisualMD

Prostate Gland Zones

TheVisualMD

Prostate Gland and Seminal Vesicle

TheVisualMD

Male Reproductive System Showing Prostate Cancer

TheVisualMD

Prostate Gland

TheVisualMD

Sensitive content

This media may include sensitive content

Male Reproductive System

TheVisualMD

What Is Prostate Cancer?

TheVisualMD

Prostate Cancer Symptoms

TheVisualMD

Prostate Function

TheVisualMD

Prostate Cancer Grading with Gleason Scale

TheVisualMD

Risk Factors for Prostate Cancer

TheVisualMD

Prostate Cancer Symptoms

TheVisualMD

Prostate Gland

TheVisualMD

Side Effects of Treatment for Prostate Cancer

TheVisualMD

Prostate Gland

TheVisualMD

Decipher Test for Prostate Cancer Recurrence

National Cancer Institute (NCI)

Is It Used to Screen for Cancer?

CA-125 Molecule

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Can Tumor Markers Be Used in Cancer Screening?

Because tumor markers can be used to predict the response of a tumor to treatment and for prognosis, researchers have hoped that they might also be useful in screening tests that aim to detect cancer early, before there are any symptoms.

However, studies to see whether circulating tumor markers can be used to screen for cancer have generally found that these markers don’t identify everyone with the disease (they are not sensitive enough) or that they indicate the possible presence of cancer in people who don’t have it (they are not specific enough). When a test has low specificity, people have to have further testing to determine whether cancer is present. And some screening tests based on tumor markers have been shown to lead to overdiagnosis, which happens when people are diagnosed with cancers that would never have affected them during their lifetimes.

For example, the prostate-specific antigen (PSA) test was used routinely in the past to screen men for prostate cancer. However, as more was learned about the limitations of the test (including relatively low specificity), medical groups began to recommend against using it for routine population screening.

Several liquid biopsy–based assays that test for multiple tumor markers to detect cancer early, in people without symptoms, are in development:

PapSEEK identifies ovarian and endometrial cancer–related alterations in DNA obtained from fluids collected during a routine Pap test. In a study that included women already diagnosed with cancer, the test was able to detect some endometrial and ovarian cancers at early, more treatable stages.
CancerSEEK is a blood test that detects DNA mutations and protein biomarkers linked to multiple types of cancer. In a large trial of women with no history of cancer that combined the blood test with whole-body PET imaging, 65% of cancers that were detected were at an early stage.
UroSEEK is a urine-based test that detects the most common alterations in 11 genes linked to bladder and upper tract urothelial cancers. In a study that included patients not yet diagnosed with bladder cancer but at high risk of the disease because of symptoms, UroSEEK identified 83% of those who developed bladder cancer.

Although these tests are able to detect early cancers, it is not yet known whether treating those cancers would actually reduce deaths from these cancers.

Source: National Cancer Institute (NCI)

Additional Materials (2)

1:49

BRCA Gene and Ovarian Cancer

Lee Health/YouTube

2:25

Understanding CA-125 Screening for Ovarian Cancer

Roswell Park Comprehensive Cancer Center/YouTube

What Research Is Being Done?

Graphical scheme of the possible therapeutic platform that translates EVs for liquid biopsy and drug delivery in the scenario of personalized medicine

Image by D’Agnano, I.; Berardi, A.C./Wikimedia

What research Is Under Way to Develop Additional Tumor Markers?

NCI’s Early Detection Research Network (EDRN), a collaborative consortium of academic and private-sector investigators, has focused on the systematic discovery, development, and validation of biomarkers and imaging methods to detect early-stage cancers and to assess risk for developing cancer. One goal of EDRN is to develop biomarkers that can distinguish aggressive early-stage cancers from slow-growing cancers that would never cause symptoms to reduce overtreatment.

Cancer researchers are turning to proteomics (the study of protein structure, function, and patterns of expression) and proteogenomics (the integration of proteomics with genomics and gene expression analysis, or transcriptomics) with the hope of developing novel biomarkers that can be used to identify cancer in its early stages, to predict the effectiveness of treatment, and to predict the chance of cancer recurrence.

NCI’s Clinical Proteomic Tumor Analysis Consortium (CPTAC) is using a proteogenomic approach for tumor marker discovery for a growing number of cancers, including colorectal, breast, and ovarian cancers. By systematically identifying proteins (and associated biological processes) that originate from alterations in cancer genomes, CPTAC researchers have discovered new tumor subtypes, tumor microenvironment variations, and new potential proteins for targeted drug therapy. Recent innovations have suggested that these analyses could be done on a microscale using very small amounts of tumor tissue obtain from a biopsy.

NCI’s Molecular Applications for Therapy Choice (NCI-MATCH) and NCI-COG Pediatric MATCH clinical trials are using a precision medicine approach to assign patients to treatment by gene mutations in their tumors rather than by the type of cancer they have. By analyzing the response of patients to these targeted agents, and the underlying genomic alterations associated with these responses, researchers are identifying potentially new molecular targets for cancer therapy. Companion studies associated with these trials will also allow researchers to identify new biomarkers for determining response to therapies and for predicting treatment resistance.

The NCI Cancer Moonshot Biobank is working with patient participants at community hospitals around the country to encourage them to donate tissue and blood samples over the course of their cancer treatment. The samples are sent to researchers who use them to better understand cancer and potentially identify tumor markers.

Source: National Cancer Institute (NCI)

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