Dossier: Ovarian and prostate cancersSerum tumor markers in the management of ovarian, endometrial and cervical cancer
Introduction
From a clinical point of view, the term of tumor marker is applied to all substances produced and released either by tumor cells or by host cells and whose presence may be detected in the serum or other biological fluids, behaving as an indicator of the presence of the tumor [1]. The ideal tumor marker should have a high sensitivity (SE) and a high specificity (SP), in order to discriminate cancer patients from healthy subjects or patients with benign conditions, and should be secreted into the circulation in concentrations proportional to tumor burden and activity. Even if very few currently used tumor markers can be considered ideal, some tumor-associated antigens mainly identified with the monoclonal antibody technology may represent useful biochemical tools for the management of patients with gynecological malignancies, and particularly of those with ovarian carcinoma.
The aim of this paper is to review literature data about the clinical relevance of tumor marker assay in the management of patients with ovarian, endometrial and cervical cancer (Table 1).
Section snippets
CA 125 and ovarian carcinoma diagnosis
CA 125 is an antigenic epitope on a high-molecular-weight glycoprotein expressed in coelomic epithelium during embryonic development and recognized by a monoclonal antibody developed against a human ovarian carcinoma cell line [2], [3]. In adult tissues, traces of CA 125 can be detected in fallopian tube, endometrium, and endocervix; moreover, reactive mesothelial cells of the adult peritoneum in areas of inflammation and adhesions have also been found to stain positive for this antigen at
CA 125
Elevation of serum CA 125 has been detected in a number of physiological and pathological conditions associated with endometrial proliferation, including menstrual cycle, pregnancy, endometriosis, and endometrial carcinoma [3]. In detail, raised CA 125 levels (>35 U/ml) have been reported in 11–33.9% of patients with this malignancy [104], [105], [106], [107], [108]. Ginath et al. [108] found that 21.4% of 28 patients with endometrioid endometrial carcinoma had elevated serum CA 125, whereas
SCC
SCC antigen, a subfraction of the glycoprotein TA-4 isolated from squamous cell cervical cancer tissues, is the most commonly used serum marker for cervical cancer [127], [132], [133], [134], [135], [136], [137], [138], [139], [140], [141]. Elevated antigen levels have been found in 27–87.7% of patients with SCC of the cervix, and the different positivity rates among the authors reflect the differences in the selected cut-off value for the antigen (ranging from 1.9 to 2.8 ng/ml) and in patient
Conclusions
In gynecological oncology ideal tumor markers, such as αFP and βHCG, have been detected only for the rare nondysgerminomatous ovarian germ cell tumors, whereas for the common ovarian, endometrial and cervical carcinoma, there are available some tumor-associated antigens, such as CA 125 and SCC, that can help the clinicians in the management of these tumors. The future for tumor marker research is represented by the emerging technologies of transcriptional profiling and proteomics [166], [167].
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