How to understand tumor indicators

1. alpha-fetoprotein (AFP) AFP is the most sensitive and specific index for early diagnosis of primary liver cancer, which is suitable for large-scale census. If the AFP value in adult blood rises, it means that there is a possibility of liver cancer. The significant increase of AFP content generally indicates primary hepatocellular carcinoma, and 70~95% patients have increased AFP. The content of AFP is higher in the later stage, but negative can not rule out primary hepatocellular carcinoma. AFP level reflects the size of tumor to a certain extent, and its dynamic changes have a certain relationship with the condition, which is a sensitive index to show the therapeutic effect and prognosis judgment. An abnormally high AFP value usually indicates a poor prognosis, while an increase in AFP content indicates a worsening condition. Usually, two months after surgical resection of liver cancer, AFP value should be reduced to below 20ng/ml. If the decline is not much or it rises again, it means that the resection is not complete or there is the possibility of recurrence and metastasis. In metastatic liver cancer, the AFP value is generally lower than 350-400ng/ml. The AFP of gonadal embryonal carcinoma and ovarian endodermal sinus carcinoma in obstetrics and gynecology will also increase significantly. Moderate increase of AFP is also common in alcoholic cirrhosis, acute hepatitis and HBsAg carriers. Some digestive tract cancers can also have an increase in alpha-fetoprotein. The increase of AFP in pregnant women's serum or amniotic fluid indicates fetal spina bifida, anencephaly, esophageal atresia or multiple births, while the decrease of AFP (combined with the age of pregnant women) indicates that unborn fetuses are at risk of Down syndrome. Normal reference value: 0 ~ 1.5 ng/ml 2. Carcinoembryonic antigen (CEA) is difficult to detect in the blood of normal adults. CEA is an important tumor-associated antigen, and 70-90% of colon adenocarcinoma patients are highly positive. The positive rates in other malignant tumors are gastric cancer (60-90%), pancreatic cancer (70-80%), small intestinal adenocarcinoma (60-83%), lung cancer (56-80%) and liver cancer (62-75). The positive detection rate of CEA in gastric juice (gastric cancer), saliva (oral cancer, nasopharyngeal carcinoma) and pleural effusion (lung cancer, liver cancer) is high, because CEA in these tumor "soaking liquids" can exist before blood. CEA content is related to tumor size and metastasis, especially when liver metastasis occurs. CEA determination is mainly used to guide the treatment and follow-up of various tumors. Continuous observation of CEA concentration in blood or other body fluids of tumor patients can provide important basis for disease judgment, prognosis and curative effect observation. The detection of CEA is very sensitive to the postoperative recurrence of tumor, which can reach more than 80%, often earlier than clinical, pathological and X-ray examination. A large number of clinical practices have confirmed that CEA concentration before or after treatment can clearly predict the state, survival time and surgical indications of tumors. The lower the preoperative CEA concentration, the earlier the disease stage, the less the possibility of tumor metastasis and recurrence, and the longer its survival time. On the contrary, the higher the preoperative CEA concentration, the later the stage of the disease, the difficulty in resection and the poor prognosis. The continuous determination of carcinoembryonic antigen is helpful to observe the curative effect of surgical resection of malignant tumor. CEA returned to normal 6 weeks after operation. If there is residual or micrometastasis after operation, it can be reduced, but it will not return to normal; Those who cannot be removed and receive palliative surgery generally show a continuous increase. The detection of CEA concentration can also reflect the curative effect of radiotherapy and chemotherapy. Its curative effect is not necessarily proportional to the tumor volume, as long as the CEA concentration can decrease with the treatment, it is effective; If the concentration does not change or even increase after treatment, the treatment plan must be changed. CEA detection can also be used for long-term follow-up to monitor the recurrence and metastasis of patients who have recovered CEA by surgery or other methods. The following schemes are usually adopted: once in the sixth week after operation; Once a month within three years after operation; Once a year in March for 3-5 years; Once every five to seven years; Once a year after seven years. If it is found to be elevated, it will be measured again two weeks later. Both elevations indicate recurrence and metastasis. Normal reference value: 0 ~ 5 ng/ml 3. Cancer antigen125 (ca125 ca125) is the first choice for ovarian cancer and endometrial cancer. If the positive limit is 65U/ml, the accuracy of stage III-IV cancer can reach 100%. Up to now, CA 125 is the most important index for early diagnosis, curative effect observation, prognosis judgment and monitoring recurrence and metastasis of ovarian cancer. The combination of CA 125 determination and pelvic examination can improve the specificity of detection. The diagnostic coincidence rate of tubal cancer, endometrial cancer, cervical cancer, breast cancer and mesothelial cancer is also very high, and the positive rate of benign lesions is only 2%. The increase of CA 125 level is a signal of female genital tumor recurrence. Dynamic observation of serum CA 125 concentration is helpful for prognosis evaluation and treatment control of ovarian cancer. After treatment, the content of CA 125 can be significantly reduced. If it can't return to the normal range, we should consider the possibility of tumor residue. The serum CA 125 concentration of 95% patients with residual tumor is greater than 35U/ml. When ovarian cancer recurs, the CA 125 will increase several months before the clinical diagnosis, and the serum CA 125 of patients with ovarian cancer metastasis is significantly higher than the normal reference value. The increase of CA 125 can also be seen in ascites caused by various malignant tumors. The increase of CA 125 can also be seen in many gynecological benign diseases, such as ovarian cyst, endometriosis, cervicitis, hysteromyoma, gastrointestinal cancer, cirrhosis and hepatitis. Normal reference value: 0. 1 ~ 35 u/ml. 4. Cancer antigen15-3 (Ca15-3) Ca15-3 is the most important specific marker of breast cancer. 30%-50% of breast cancer patients have significantly increased CA 15-3, and the change of its content is closely related to the therapeutic effect, which is the best index for breast cancer patients to diagnose and monitor postoperative recurrence and observe the therapeutic effect. The dynamic determination of CA 15-3 is helpful for the early detection of recurrence in patients with stage ⅱ and ⅲ breast cancer after treatment. When CA 15-3 is greater than 100U/ml, it can be considered as a metastatic lesion. Serum CA 15-3 in patients with lung cancer, gastrointestinal cancer, ovarian cancer and cervical cancer can also increase, which should be differentiated, especially to exclude the increase caused by partial pregnancy. Normal reference value: 0. 1 ~ 25 u/ml 5. Cancer antigen19-9 (ca19-9) ca19-9 is a related marker of pancreatic cancer, gastric cancer, colorectal cancer and gallbladder cancer. A large number of studies have proved that CA 19-9. 85%-95% of patients with pancreatic cancer are positive, and the determination of CA 19-9 is helpful for differential diagnosis and disease monitoring of pancreatic cancer. When CA 19-9 is less than 1000U/ml, it has certain surgical significance. After tumor resection, the concentration of CA 19-9 will decrease, and if it increases again, it may indicate recurrence. The diagnosis of pancreatic cancer metastasis also has a high positive rate. When the serum CA 19-9 level is higher than 10000 U/mL, almost all of them have peripheral metastasis. The positive rate of gastric cancer, colorectal cancer, gallbladder cancer, cholangiocarcinoma and liver cancer will also be high. If CEA and AFP are detected at the same time, the positive detection rate can be further improved (combined detection of CA72-4 and CEA is recommended for gastric cancer). In many benign and inflammatory diseases of gastrointestinal tract and liver, such as pancreatitis, mild cholestasis and jaundice, the concentration of CA 19-9 can also increase, but it is often transient, and its concentration is mostly lower than 120U/ml, so it must be differentiated. Normal reference value: 0. 1 ~ 27 U/mL 6. Cancer antigen 72-4(CA72-4) CA72-4 is one of the best tumor markers for the diagnosis of gastric cancer at present, with high specificity for gastric cancer, and its sensitivity can reach 28-80%. If combined with CA 19-9 and CEA, it can monitor more than 70%. The level of CA72-4 has obvious correlation with the stages of gastric cancer, and it generally rises in stages III-IV of gastric cancer. For patients with metastatic gastric cancer, the positive rate of CA72-4 is much higher than that of patients without metastasis. The level of CA72-4 can quickly drop to normal after operation. In 70% recurrent cases, the concentration of CA72-4 increased first. Compared with other markers, the main advantage of CA72-4 is its high specificity in differential diagnosis of benign diseases, and the detection rate is only 0.7% in many patients with gastric benign diseases. CA72-4 also has different detection rates for other gastrointestinal cancers, breast cancer, lung cancer and ovarian cancer. The combined detection of CA72-4 and CA 125 is a marker for the diagnosis of primary and recurrent ovarian tumors, and its specificity is 100%. Normal reference value: 0. 1 ~ 7 u/ml 7. Cancer antigen 242(CA242) CA242 is a new tumor-associated antigen, and its content increases when tumors occur in digestive tract. It has high sensitivity and specificity for pancreatic cancer and colorectal cancer, with positive detection rates of 86% and 62% respectively, and also has certain positive detection rates for lung cancer and breast cancer. It can be used for differential diagnosis and prognosis of pancreatic cancer and benign hepatobiliary diseases, and can also be used for preoperative prognosis and recurrence differentiation of patients with colorectal cancer. The combined detection of CEA and CA242 can improve the sensitivity, which can be increased by 40-70% for colon cancer and 47-62% for rectal cancer. CEA has no correlation with CA242 and has independent diagnostic value. They are complementary. Normal reference value: 0 ~ 17u/m 8. Cancer antigen 50(CA50) n CA50 is a marker of pancreas and colorectal cancer, and it is also the most commonly used carbohydrate antigen tumor marker, because it exists widely in pancreas, gallbladder, liver, stomach, colorectal cancer, bladder and uterus, and its tumor recognition spectrum is wider than that of CA 19-9. CA50 can be detected in all kinds of malignant tumors with different positive rates. The positive rates of pancreatic cancer and gallbladder cancer rank first, accounting for 94.4%. Others are liver cancer (88%), ovarian cancer and uterine cancer (88%) and malignant pleural effusion (80%). It can be used for the early diagnosis of pancreatic cancer, gallbladder cancer and other tumors, and also has high value for the diagnosis of liver cancer, gastric cancer, colorectal cancer and ovarian tumors. It is worth pointing out that CA50 is positive in 80% of AFP-negative hepatocellular carcinoma, and it is also correct as an indicator of whether surgical treatment is complete or not. In addition, CA50 has a high positive detection rate for malignant pleural effusion, but there is no positive report for benign pleural effusion, so the detection of CA50 also has important application value in differentiating benign from malignant pleural effusion. It is reported that compared with normal people, the concentration of CA50 in gastric juice of patients with atrophic gastritis has changed significantly. It is generally believed that atrophic gastritis is a high incidence period before cancer, so CA50 can be used as one of the indicators of precancerous diagnosis. In pancreatitis, colitis and pneumonia, CA50 will also increase, but it will decrease with the elimination of inflammation. N normal reference value: 0 ~ 20 u/ml 9. Non-small cell lung cancer-associated antigen (cyfra21-1) n cyfra21-kloc-0/is the most valuable serum tumor marker of non-small cell lung cancer, especially suitable for early diagnosis, curative effect observation and prognosis monitoring of patients with squamous cell carcinoma. CYFRA 2 1- 1 can also be used to monitor the course of rhabdomyoinvasive bladder cancer, especially to predict the recurrence of bladder cancer. If the tumor treatment effect is good, the level of CYFRA 2 1- 1 will soon decrease or return to normal level. In the course of disease development, the changes of CYFRA 2 1- 1 are often earlier than the clinical symptoms and imaging examination. N CYFRA 2 1- 1 has good specificity in differentiating benign lung diseases (pneumonia, tuberculosis, chronic bronchitis, bronchial asthma and emphysema). N Normal reference value: 0. 10 ~ 4 ng/ml 10. The antigen NSE associated with small cell lung cancer is considered as the first choice for monitoring small cell lung cancer, and 60-80% of patients with small cell lung cancer have increased NSE. In the remission stage, 80-96% of patients have normal NSE content, such as increased NSE, suggesting recurrence. Within 24-72 hours after the first round of chemotherapy in patients with small cell lung cancer, NSE temporarily increased due to the decomposition of tumor cells. Therefore, NSE is an effective marker to monitor the curative effect and course of small cell lung cancer, and can provide valuable prognostic information. N NSE can also be used as a marker of neuroblastoma, which has high clinical application value for early diagnosis of this disease. The urine NSE level of neuroblastoma patients also increased to some extent, and the serum NSE level decreased to normal after treatment. The determination of serum NSE level has important reference value for the curative effect monitoring and recurrence prediction of neuroblastoma, and its significance is greater than the determination of catecholamine metabolites in urine. N is also of great significance in the diagnosis of brain tumors such as amine precursor uptake decarboxylation cell tumor and seminoma. N Normal reference value: 0 ~16 ng/ml11. Squamous cell carcinoma antigen (SCC) n Squamous cell carcinoma antigen (SCC) is a tumor marker with good specificity and is the earliest diagnosis of squamous cell carcinoma. SCC inhibits apoptosis in normal squamous epithelial cells and participates in the differentiation of squamous epithelium, and participates in tumor growth in tumor cells, which is helpful for the diagnosis and monitoring of all squamous epithelial cancers, such as cervical cancer, lung cancer (non-small cell lung cancer), head and neck cancer, esophageal cancer, nasopharyngeal cancer, vulvar squamous cell cancer and so on. The serum SCC of these tumor patients increased, and its concentration increased with the aggravation of disease stages. It is clinically used to monitor the curative effect, recurrence, metastasis and evaluate the prognosis of these tumors. N has high diagnostic value for cervical cancer: the sensitivity to primary cervical squamous cell carcinoma is 44%-69%; The sensitivity of recurrent cancer was 67%- 100%, and the specificity was 90%-96%. Its serological level is related to the development, invasion and metastasis of tumor. The concentration of SCC decreased significantly after radical operation of cervical cancer. Recurrence can be suggested as early as possible, and the increase of SCC concentration in 50% patients is 2-5 months before clinical diagnosis of recurrence, which can be used as an independent risk factor. N Auxiliary diagnosis of lung squamous cell carcinoma: The positive rate of lung squamous cell carcinoma is 46.5%, and its level is related to the degree of tumor progression. Combined detection of CA 125, CYFRA2 1- 1 and CEA can improve the diagnostic sensitivity of lung cancer patients. N prediction of esophageal squamous cell carcinoma and nasopharyngeal carcinoma: the positive rate increases with the development of the disease, and the sensitivity to advanced patients can reach 73%. Combined detection of CYFRA2 1- 1 and SCC can improve the sensitivity of detection. The positive rate of stage ⅲ head and neck cancer was 40%, and it increased to 60% in stage ⅳ. Diagnosis and monitoring of other squamous cell carcinoma: head and neck cancer, vulvar cancer, bladder cancer, anal canal cancer, skin cancer, etc. Normal reference value: