| Ch 5 | Page 4 / 8 | |
| Tumour markers | Variations according to staging | |
The level of a tumour marker generally reflect the tumour mass : its level is generally more often elevated during advanced diseases than during localised tumours and it increases with the evolution of cancer.
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Variation in percentage of breast cancer patients having a CEA increased according to breast cancer stage. |
This same observation can be made for colon adenocarcinoma.
L'élévation très importante de l'ACE est en rapport avec le stade des cancers coliques : un taux bas fait présager une évolution locale, un taux élevé fait craindre la présence de métastases ganglionnaires voire d'une métastase hépatique.
CEA levels are relatively low for localised adenocarcinoma, higher for node metastases and strongly elevated for liver metastases.
Evolution of CEA according to stage
in colon carcinoma |
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| Dukes classification | A |
B |
C |
D |
| CEA levels | 9,0±7,0 |
15,0 ± 30,4 |
28,6 ± 52,0 |
478,2 ± 917,8 |
However, these levels of CEA does not permit to differentiate clearly enough the stages to have a real influence for the therapeutic decision (except maybe for very elevated levels).
On the contrary, the elevation of PSA is very important during the discussion of the treatment of apparently localised prostate cancers.
An elevated value of PSA let fear a tumour spread outside prostate. Above 30 ng/ml, it is improbable that the cancer is limited to the prostate.
Studying the pathologic reports of more than 800 prostate cancer patients treated by radical prostatectomy Partin combining stage, PSA level, Histological grading (Gleason see classification chapter) was able to define nomograms predicting the tumour limits of prostatectomy.
The two following tables indicate the proportion of patients without extra-glandular evolution in the Partin study : this outside evolution may be
| Gleason score |
Stage T1a |
Stage T1b |
Stage T1c |
Stage T2a |
Stage T2b |
Stage T2c |
Stage T3a |
| 2-4 |
84% |
70% |
83% |
71% |
61% |
66% |
43% |
| 5 |
72% |
53% |
71% |
55% |
43% |
49% |
27% |
| 6 |
67% |
47% |
67% |
51% |
38% |
43% |
23% |
| 7 |
49% |
29% |
49% |
33% |
22% |
25% |
11% |
| 8-10 |
35% |
18% |
37% |
23% |
14% |
15% |
6% |
| PSA between 4 and 10 ng / ml |
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| Gleason score |
Stage T1a |
Stage T1b |
Stage T1c |
Stage T2a |
Stage T2b |
Stage T2c |
Stage T3a |
| 2-4 |
76% |
58% |
75% |
60% |
48% |
53% |
- |
| 5 |
61% |
40% |
60% |
43% |
32% |
36% |
18% |
| 6 |
- |
33% |
55% |
38% |
26% |
31% |
14% |
| 7 |
33% |
17% |
35% |
22% |
13% |
15% |
6% |
| 8-10 |
- |
9% |
23% |
14% |
7% |
8% |
3% |
| PSA between 10 and 20ng / ml |
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There is a clear worsening of the tumour invasion between these two table relating to the increase of PSA levels. Further worsening is observed for PSA value above 20 ng/ml and on the contrary better results for PSA value below 4 ng/ml.
Thus the urological surgeon should operate in full knowledge of what will be the situation during the operation (if there is more than 30-40% chances of extra-prostate invasion, radical prostatectomy should be re-considered).
The same can apply for radiotherapy: the volume should be adapted to the potential diffusion of the cancer.
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