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Tumour Markers

  1. AFP:
    1. Hepatocellular carcinoma (not much in fibrolamellar hepatic CA)
    2. Germ cell tumors (Yolk cell tumour, teratoma, embryonal cell carcinoma)
    3. CA stomach
    4. CA pancreas
  2. HCG:
    1. Germ cell tumors (seminoma, choriocarcinoma, teratoma, embryonal cell carcinoma)
    2. Gestational trophoblastic disease
  3. CEA:
    1. Adenocarcinomas of –
      1. Colon
      2. Rectum
      3. Stomach
      4. Pancreas
      5. Ovary
      6. Breast
      7. Lung
    2. Non-malignant conditions:
      1. Alcoholic cirrhosis
      2. Hepatitis
      3. Inflammatory bowl disease
      4. Smokers
Calcitonin : Medullary CA thyroid
CA – 125 : Ovarian CA
Catecholamines : Pheochromocytoma
Prostatic Acid phosphatase : CA prostate
PSA : CA prostate
Intermediate filament markers: Q
Cytokeratin - Carcinomas, Mestheliomas
Desmin - Muscle tumors e.g. Rhabdomyosarcoma
(Note that Desmosome is a marker of carcinoma)
Neurofilaments - Neural tumors
Viamentin - Mesenchymal tumours
  1. Underlying internal malignancy is shown by:
    1. Acanthosis nigricans
    2. Erythema – gyratum – repens
    3. Annular erythema
    4. Necrolytic migratory erythema
Hormone production by tumors:
GH - Large cell CA lung
ACTH - small cell CA lung, RCC, Adrenal CA
PTH - Squamous cell CA lung
Erythropoitin - Cerebellar hemangioblastoma
Renal cell CA

Hepatocellular CA
Small cell carcinoma lung produces following hormones:
  1. GHRH (leading to acromegaly)
  2. ADH (causing hyponatremia of SIADH)
  3. ACTH (causing hypokalemia)
  4. CRH (corticotrophin releasing hormone)
  5. GRP (Bombesin like Gastrin releasing peptide)
  6. HPL (Human placental lectogen)
  7. VIP (Causing watery diarrhea: WDHA Syndrome)
  8. Gastrin
  9. Calcitonin
  10. Somatstonin
  11. ANP
  1. Remember, small cell CA does not secrete GH or Gn RH and does not cause hypoglycaemiaQ.
Malignancies associated with smokingQ
  1. GIT
  2. Pancreas
  3. Larynx
  4. Lung
  5. Kidney
  6. Cervix
Note that liver malignancy is not associated with smoking. 
  1. Adjuvant chemotherapy = chemotherapy administered after surgery.
  2. Neo-adjuvent chemotherapy = chemotherapy administered before surgery e.g. in breast esophagus, lung.
  1. Malignancies curable by CT:
    1. AML, ALL
    2. Hodgkin’s & Non-Hodgkin’s Lymphoma
    3. Wilm’s tumour
    4. Ewing’s sarcoma
    5. Gestational trophoblastic carcinoma
    6. Hepatocellular carcinoma
    7. CT has not been shown to prolong life but chemoembolization via hepatic artery may be palliative.
    8. Hepatic metastases may also be treated by direct hepatic artery infusion of 5-FU.
  2. T cell proliferation inhibitors
    1. Cycloporine and Tacrolimus – act by blocking transcription of m-RNA for IL-2.
    2. Rapamycin (Sirolimur) – acts by preventing response to IL-2.

Endocrinal Drugs Used in Malignancies

fluoxymesterone - ca breast

flutamide & cyproterone
ethiny1 estradiol - ca breast
diethylestilbesterol (des) - ca prostate

tamoxifen - ca breast

Gnrh analogues:
burerelin - ca breast - ca prostate

Aromatase inhibitors:
aminoglutethimide - ca breast - ca prostate

Somatostatin analogues:
octreotide - carcinoid tumours - vipoma
Mechanisms of actions of some endocrinal drugs q
Selected FDA-Approved Targeted Therapies
Generic Name Target Initial Indication
Trastuzumab HER2 Breast cancer
Imatinib c-kit, bcr-abl, PDGFR CML, GIST
Cetuximab EGFR Colorectal cancer
Bevacizumab VEGF Colorectal cancer, lung cancer
Erlotinib EGFR Non–small cell lung cancer
Sorafenib Raf, PDGF, VEGFR, c-kit RCC
Sunitinib VEGFR PDGFR c-kit, Flt-3, RET GIST, RCC
Dasatinib bcr-abl, src family, c-kit, EPHA2,PDGFR- CML
Lapatinib EGFR and HER2 Breast cancer
Temsirolimus mTOR RCC
  1. Premalignant Conditions
    1. Actinic Keratosis
    2. Bowen’s Disease
    3. Leukoplakia
    4. Keratoacanthoma
    5. Erythroplaqia of querat
    6. Cutaneous horns
    7. Solar Keratosis (Senile Keratosis)

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