Tumour markers in diagnosis and management

Area of Science:

• Oncology
• Biochemistry
• Medical Diagnostics

Background:

• Hepatocellular carcinoma (HCC) is biologically heterogeneous, with various tumor markers identified.
• Alpha-fetoprotein (AFP) was discovered by Abelev 20 years ago and remains a key marker for HCC.
• Tumor markers, predominantly glycoproteins, can resemble placental or fetal liver proteins.

Purpose of the Study:

• To evaluate the diagnostic and monitoring value of various tumor markers for primary liver cancer (PLC).
• To highlight the importance of a multiple-marker approach due to tumor heterogeneity.
• To assess the potential for improved survival rates through early detection using tumor markers.

Main Methods:

• Analysis of diagnostic performance of AFP and its isoforms (Con A reactive, fucosylated).
• Evaluation of additional markers like vitamin B12 binding protein, neurotensin, HCC-associated GGTP, and H-ALP.
• Review of studies utilizing screening and multiple-marker strategies for HCC detection.

Main Results:

• AFP is the most sensitive and specific marker for HCC diagnosis and monitoring.
• A multiple-marker approach, including vitamin B12 binding protein and neurotensin, can detect most fibrolamellar HCC variants.
• Screening high-risk groups with multiple markers identifies 90% of clinically diagnosed HCCs, enabling early detection and improved survival.
• Other markers show diagnostic value in AFP-negative cases, but their role in monitoring disease progression needs further establishment.

Conclusions:

• AFP remains the primary marker for HCC diagnosis and monitoring.
• A comprehensive multiple-marker strategy is crucial for effectively diagnosing and managing diverse forms of primary liver cancer.
• Emerging roles for tumor markers in imaging and drug targeting suggest future advancements in liver cancer treatment.