Markers??

[Meg]

I just finished chemo 7/9 for stage I invasive ductal. What is the deal with markers? Lots of people out in the world keep asking me about them...should I know this and if so why hasn't my onc told me?

[Joe]

Meg,
Markers are just one of the many tools that an Oncologist uses to determine if your cancer is arrested or spreading. A good analogy is your family doctor taking your temperature. An elevated temperature or elevated tumor marker, means nothing by itself, but may warrant further testing of the individual. Also markers are not consistent between individuals. For example, my wife Christine's CEA marker was only slightly elevated when at the same time she was dx'ed as stage IV. Others may have highly elevated markers and still have no detectable cancer. Markers also vary from day to day and may also be affected by diet

The following is taken from a link explaining Tumor Markers on our Tests and Treatments Page

While specific details relating to the most frequently used markers are listed, we feel that it is important to make some general points about these tests.

1.No serum marker in current use is specific for malignancy.
2.Generally, serum marker levels are rarely elevated in patients with early malignancy. High levels are usually found only when patients have advanced disease.
3.No cancer marker has absolute organ specificity. PSA however, appears to be relatively specific for prostate tissue.
4.Apart from possibly HCG in choriocarcinoma, no marker is elevated in 100% of patients with a particular malignancy.
5.Requesting of multiple markers (such as CEA and the CA series of antigens) in an attempt to identify an unknown primary cancer is rarely of use.
6.Reference ranges for cancer markers are not well defined and are used only for guidance. Please note that a level below the reference range does not exclude malignancy while concentrations above the reference range does not necessary mean the presence of cancer. Changes in levels over time are likely to be more clinically useful than absolute levels at one point in time.
7.As many tumour markers lack agreed International Reference Preparations, different assay kits may give different results for the same sera. This situation applies particularly for PSA.
8.Laboratories carrying out tumour marker assays should state the assay used on their report form.


Warmest Regards
Joe

[lauren]

Some oncologists do not check tumor markers in early stage patients, relying insteady upon physical examinations and interviewing the patient (ie., for reporting of symptoms). My oncologist does not routinely check markers. For this I am grateful.

[Lisa]

Love the "temperature" analogy, Joe.

[Meg]

Thank you all (again) for helping me muddle through. I've been asked several times by well meaning people what my prognosis is and I don't really no what to say. People need you to have a concrete answer. I don't feel that I do.

[chere farr]

Thank you for your great question about markers..."what's the deal on markers?" I understand that language and Joe's reply so useful to me at this time "3.No cancer marker has absolute organ specificity. PSA however, appears to be relatively specific for prostate tissue.
4.Apart from possibly HCG in choriocarcinoma, no marker is elevated in 100% of patients with a particular malignancy.
5.Requesting of multiple markers (such as CEA and the CA series of antigens) in an attempt to identify an unknown primary cancer is rarely of use.
6.Reference ranges for cancer markers are not well defined and are used only for guidance. Please note that a level below the reference range does not exclude malignancy while concentrations above the reference range does not necessary mean the presence of cancer. Changes in levels over time are likely to be more clinically useful than absolute levels at one point in time.
7.As many tumour markers lack agreed International Reference Preparations, different assay kits may give different results for the same sera. This situation applies particularly for PSA.
8.Laboratories carrying out tumour marker assays should state the assay used on their report form"

i'm comforted reading this excellent response from joe which is very articulate...again language i can understand.

i am almost 3 year survivor who was on the third arm of herceptin trial. The CA 27.29 marker was not being used in beginning but CA25 was and in my case still is. To my understanding, the CA 27.29 was approved by FDA right about the same time as Herceptin was approved in September 2002.

i think the normal range for CA 27.29 is 0?-38 I AM ONLY A LAY PERSON and with what little information i was able to gleen about the marker range for CA27.29 i took this to my doctor who explained much of what joe was stating as my CA 27.29 had increased from 26 to 30 to 31 to 36 in a year and a half still considered within "normal" limit. but this stand alone test reveled little yet when compared with a routine series of tests including mammo/ultra cat and bone scan the CA25 other lab followups and compared with previous scans and mammo, followup, etc.,...i feel my doctor is on top of it and using the most of the best that can be gotten.

the elevated marker increase was presented to me in a relaxed and loving way so that i didn't suffer a "scare" of reoccurance but this information was given to me so that discussions of my diet and daily routine could be reviewed by him as well in my followup visits. ideally it would be great if all tests measure up with a big guarantee!

as human beings being human with our improved standards in quality of care from research and medical practice, etc... all the advancement in every area that contributes to furthering our awareness and being reminded of the greater picture i am ever so grateful to be a part.

i could never have possibly made it alone and thank God for this support and for every fraction of advancement made which contributes to the greater equasion and i view these markers as little helpers in our daily endeavors together. that's the deal.

[janelle]

My onc does not use markers, they are too unreliable and cause undo worry and fears. Some people use them, but I don't.

[joy]

Hey guys, Hope everyone is hangin' in! At the risk of sounding like a "marker zealot" i wanted to share a study that i received in my BCN newsletter yesterday. If I weren't such a techno weenie i'd post it in the "articles of interest". i will just give the highlight. this was published recently by ASCO, "How can CEA and CA 15-3 be used for estimation of the clinical status and effectiveness of therapy during metastatic breast cancer?"
Background: Tumor markers like CEA and CA 15-3 are often used in follow up care of bc, but mainly due to a lack of knowledge, experience but also confidence-the actual situation is more to observe kinetics than to react on these results. Therefore we try to validate the significance of CEA and CA 15-3 in the course of metastatic disease.

101 MBC pts. All using systemic tx of various kinds totalling 223 courses of tx and CEA and CA 15-3 checked every 3-4 weeks.

Results: Meanwhile we evaluated CEA and CA15-3 at 1st dx of mets and at every further moment of progression/new mets. At 1st metastatic disease CEA was in 53% above the 95th percentile of healthy individuals. and CA 15-3 in 74% (19% CEA and CA 15-3 negative) with enhancing percentage of senitivity with increasing numbers of further events 'progressive disease (PD)' (PD CEA 52%/CA 15-369%, 3rd PD 65%/80%, 4th PD 74%/93%), decreasing number of false negatives (3% 4th PD) and a general shift of the value levels of CEA (ng/ml)/ CA 15-3 (U/ml) with the number of events, e.g. the medians 1st PD CEA 2.7/Ca 15-3 43.4; 2nd PD 2.6/46.2; 3rd PD 5.3/78.5, 4th PD 8.8/92.5). Okay, so...

Conclusion: Our results show a clear correlation between CEA/CA 15-3 and the number of events as well as effectiveness of therapy.

Anyway I found it interesting and worth sharing.

LOVE, LOVE, LOVE joy