Clinical use of tumor markers based on outcome analysis

Abstract

In ovarian cancer, the tumor marker CA 125 is best used to monitor patients for recurrent disease postoophorectomy. Elevated concentrations of CA 125 indicate a recurrence, but a negative value does not rule out recurrent disease, and a follow-up operation still is recommended. Carcinoembryonic antigen (CEA) lacks the specificity and sensitivity to be used as a screening test. CA 19-9 can be used before surgery to assess the resectability of a pancreatic tumor. β-human chorionic gonadotropin (β- hCG) is a nearly perfect tumor marker for the assessment of trophoblastic disease, and a high concentration indicates the presence of a choriocarcinoma or an invasive mole. In nonseminomatous germ cell tumors of the testes, assays for β-hCG and α-fetoprotein (AFP) are useful for assessing patients postorchiectomy for the presence of a recurrence. Although tumor markers are not 100% sensitive and specific, with appropriate choice of cutoff values, they can be used to manage patients and thus affect patient outcome.