What is a Tumor Marker?
A tumor marker is simply a protein produced by cancer cells or another substance produced by other cells of the body in response to cancer. Though they are NOT always produced and therefore cannot always be used as a viable marker, if they show “out-of-range”, they can be helpful to determine treatment parameters. Positive tumor markers may provide information about a cancer, such as how aggressive it is, whether it can be treated with a targeted therapy, or whether it is responding to current treatment.
The nice thing about tumor markers is that they are measured with a blood test. This gives the patient, if they are present, a non-invasive way to track their care. Many people are hesitant to continue with CT and PET scans due to the radiation exposure of continued use. MRI scans with a contrast dye pose similar risks. A cancer marker test is a simple and inexpensive blood test that you usually MUST REQUEST from your doctor.
Here are some common cancer markers to request:
- Alpha Fetoprotein – Normal range: Adults: < 15 ng/ml. more common in Liver cancer and certain types of ovarian and testicular cancers but my show positive in other cancers as well.
- CA 15-3 (Cancer Antigen 15-3) – The reference range of serum CA 15-3 is less than 30 U/mL. Cancer antigen 15-3 (CA 15-3) is used to monitor response to breast cancer treatment and disease recurrence.
- CA 19-9 (Cancer Antigen 19-9) – Normal results are less than 37 U/mL. A high amount of CA 19-9 is most often caused by pancreatic cancer. But it can also be caused by breast cancer and other types of cancer. And it can also be elevated by infections in your liver, gallbladder, and pancreas.
- CA 27-29 (Cancer antigen 27-29) – The reference range of serum CA 27-29 is less than 38 U/mL. This is usually used to predict early recurrence of disease in women with treated carcinoma of the breast.
- CA-125 (Cancer Antigen-125) – Normal range: 0 – 35 U/mL. This is useful for monitoring for ovarian cancer, liver and colon cancers by measuring an antigen to epithelial neoplasms circulating in blood serum. It may also be elevated in liver cirrhosis, uterine fibroids, and endometriosis.
- Calcitonin – A normal value is less than 10 pg/mL. Elevated levels of this thyroid hormone occasionally occur with small cell lung cancer.
- CEA (Carcinoembryonic Antigen) – A normal result is less than 2.5 nanograms per milliliter for non-smokers and up to 5 nanograms per milliliter for smokers. The most frequent cancer which causes an increased CEA is cancer of the colon and rectum. Others include cancers of the pancreas, stomach, breast, lung, and medullary carcinoma of the thyroid and ovarian cancer. High levels of CEA do not always mean you have cancer. These other conditions can also increase levels: Breast cysts, Chronic obstructive pulmonary disease, infections such as cholecystitis and diverticulitis, inflammatory bowel disease, Liver disease, lung problems, and pancreatitis.
- Human Chorionic Gonadotropin (hCG) – A test less than 5 mIU/mL is considered normal. HCG is a nonspecific marker for pancreatic, pituitary, and placental tumors; elevated levels may be present in pancreatic cancer. Of course, it will also be elevated in pregnancy.
- LDH (Lactic Dehydrogenase) – Normal levels of LDH in the blood can vary depending on the lab, but usually range between 140 units per liter (U/L) to 280 U/L for adults and tend to be higher for children and teens. The lactate dehydrogenase (LDH) test looks for signs of damage to the body’s tissues and therefore is a common test to help rule out a heart attack. LDH is an enzyme found in almost every cell of your body, including your blood, muscles, brain, kidneys, and pancreas.
- Prostate Specific Antigen (PSA) – There is no specific normal or abnormal level of PSA in the blood, and levels may vary over time in the same man. In the past, most doctors considered PSA levels of 4.0 ng/mL and lower as normal. It is best to use this test to monitor care as it rises and falls.
Here is a more complete list, in alphabetical order, from the National Cancer Institute:
ALK gene rearrangements and over-expression
Cancer types: Non-small cell lung cancer and anaplastic large cell lymphoma
What’s analyzed: Tumor
How used: To help determine treatment and prognosis
Alpha-fetoprotein (AFP)
Cancer types: Liver cancer and germ cell tumors
What’s analyzed: Blood
How used: To help diagnose liver cancer and follow response to treatment; to assess stage, prognosis, and response to treatment of germ cell tumors
B-cell immunoglobulin gene rearrangement
Cancer type: B-cell lymphoma
What’s analyzed: Blood, bone marrow, or tumor tissue
How used: To help in diagnosis, to evaluate effectiveness of treatment, and to check for recurrence
Beta-2-microglobulin (B2M)
Cancer types: Multiple myeloma, chronic lymphocytic leukemia, and some lymphomas
What’s analyzed: Blood, urine, or cerebrospinal fluid
How used: To determine prognosis and follow response to treatment
Beta-human chorionic gonadotropin (Beta-hCG)
Cancer types: Choriocarcinoma and germ cell tumors
What’s analyzed: Urine or blood
How used: To assess stage, prognosis, and response to treatment
Bladder Tumor Antigen (BTA)
Cancer types: Bladder cancer and cancer of the kidney or ureter
What’s analyzed: Urine
How used: As surveillance with cytology and cystoscopy of patients already known to have bladder cancer
BRCA1 and BRCA2 gene mutations
Cancer types: Ovarian and breast cancers
What’s analyzed: Blood and/or tumor
How used: To determine whether treatment with a particular type of targeted therapy is appropriate. This is NOT technically a tumor marker test.
BCR-ABL fusion gene (Philadelphia chromosome)
Cancer types: Chronic myeloid leukemia, acute lymphoblastic leukemia, and acute myelogenous leukemia
What’s analyzed: Blood or bone marrow
How used: To confirm diagnosis, predict response to targeted therapy, determine whether treatment with a particular type of targeted therapy is appropriate, and monitor disease status
BRAF V600 mutations
Cancer types: Cutaneous melanoma, Erdheim-Chester disease, colorectal cancer, and non-small cell lung cancer
What’s analyzed: Tumor
How used: To select patients who are most likely to benefit from treatment with certain targeted therapies
C-kit/CD117
Cancer types: Gastrointestinal stromal tumor, mucosal melanoma, acute myeloid leukemia, and mast cell disease
What’s analyzed: Tumor, blood, or bone marrow
How used: To help in diagnosing and determining treatment
CA15-3/CA27.29
Cancer type: Breast cancer
What’s analyzed: Blood
How used: To assess whether treatment is working or if the cancer has recurred
CA19-9
Cancer types: Pancreatic, gallbladder, bile duct, and gastric cancers
What’s analyzed: Blood
How used: To assess whether treatment is working
CA-125
Cancer type: Ovarian cancer
What’s analyzed: Blood
How used: To help in diagnosis, assessment of response to treatment, and evaluation of recurrence
CA 27.29
Cancer type: Breast cancer
What’s analyzed: Blood
How used: To detect metastasis or recurrence
Calcitonin
Cancer type: Medullary thyroid cancer
What’s analyzed: Blood
How used: To aid in diagnosis, check whether treatment is working, and assess recurrence
Carcinoembryonic antigen (CEA)
Cancer types: Colorectal cancer and some other cancers
What’s analyzed: Blood
How used: To keep track of how well cancer treatments are working and check if cancer has come back or spread
CD20
Cancer type: Non-Hodgkin lymphoma
What’s analyzed: Blood
How used: To determine whether treatment with a targeted therapy is appropriate
CD22
Cancer types: Hairy cell leukemia and B-cell neoplasms
What’s analyzed: Blood and bone marrow
How used: To help in diagnosis
CD25
Cancer type: Non-Hodgkin (T-cell) lymphoma
What’s analyzed: Blood
How used: To determine whether treatment with a targeted therapy is appropriate
CD30
Cancer types: Mycosis fungoides and peripheral T-cell lymphoma
What’s analyzed: Tumor
How used: To determine whether treatment with a targeted therapy is appropriate
CD33
Cancer type: Acute myeloid leukemia
What’s analyzed: Blood
How used: To determine whether treatment with a targeted therapy is appropriate
Chromogranin A (CgA)
Cancer type: Neuroendocrine tumors
What’s analyzed: Blood
How used: To help in diagnosis, assessment of treatment response, and evaluation of recurrence
Chromosome 17p deletion
Cancer type: Chronic lymphocytic leukemia
What’s analyzed: Blood
How used: To determine whether treatment with a certain targeted therapy is appropriate
Chromosomes 3, 7, 17, and 9p21
Cancer type: Bladder cancer
What’s analyzed: Urine
How used: To help in monitoring for tumor recurrence
Circulating tumor cells of epithelial origin (CELLSEARCH®)
Cancer types: Metastatic breast, prostate, and colorectal cancers
What’s analyzed: Blood
How used: To inform clinical decision making, and to assess prognosis
Cytokeratin fragment 21-1
Cancer type: Lung cancer
What’s analyzed: Blood
How used: To help in monitoring for recurrence
Des-gamma-carboxy prothrombin (DCP)
Cancer type: Hepatocellular carcinoma
What’s analyzed: Blood
How used: To monitor the effectiveness of treatment and to detect recurrence
DPD gene mutation
Cancer types: Breast, colorectal, gastric, and pancreatic cancers
What’s analyzed: Blood
How used: To predict the risk of a toxic reaction to 5-fluorouracil therapy
EGFR gene mutation
Cancer type: Non-small cell lung cancer
What’s analyzed: Tumor
How used: To help determine treatment and prognosis
Estrogen receptor (ER)/progesterone receptor (PR)
Cancer type: Breast cancer
What’s analyzed: Tumor
How used: To determine whether treatment with hormone therapy and some targeted therapies is appropriate
FGFR2 and FGFR3 gene mutations
Cancer type: Bladder cancer
What’s analyzed: Tumor
How used: To determine whether treatment with a certain targeted therapy is appropriate
Fibrin/fibrinogen
Cancer type: Bladder cancer
What’s analyzed: Urine
How used: To monitor progression and response to treatment
FLT3 gene mutations
Cancer type: Acute myeloid leukemia
What’s analyzed: Blood
How used: To determine whether treatment with certain targeted therapies is appropriate
Gastrin
Cancer type: Gastrin-producing tumor (gastrinoma)
What’s analyzed: Blood
How used: To help in diagnosis, to monitor the effectiveness of treatment, and to detect recurrence
HE4
Cancer type: Ovarian cancer
What’s analyzed: Blood
How used: To plan cancer treatment, assess disease progression, and monitor for recurrence
HER2/neu gene amplification or protein overexpression
Cancer types: Breast, ovarian, bladder, pancreatic, and stomach cancers
What’s analyzed: Tumor
How used: To determine whether treatment with certain targeted therapies is appropriate
5-HIAA
Cancer type: Carcinoid tumors
What’s analyzed: Urine
How used: To help in diagnosis and to monitor disease
IDH1 and IDH2 gene mutations
Cancer type: Acute myeloid leukemia
What’s analyzed: Bone marrow and blood
How used: To determine whether treatment with certain targeted therapies is appropriate
Immunoglobulins
Cancer types: Multiple myeloma and Waldenström macroglobulinemia
What’s analyzed: Blood and urine
How used: To help diagnose disease, assess response to treatment, and look for recurrence
JAK2 gene mutation
Cancer type: Certain types of leukemia
What’s analyzed: Blood and bone marrow
How used: To help in diagnosis
KRAS gene mutation
Cancer types: Colorectal cancer and non-small cell lung cancer
What’s analyzed: Tumor
How used: To determine whether treatment with a particular type of targeted therapy is appropriate
Lactate dehydrogenase
Cancer types: Germ cell tumors, lymphoma, leukemia, melanoma, and neuroblastoma
What’s analyzed: Blood
How used: To assess stage, prognosis, and response to treatment
Microsatellite instability (MSI) and/or mismatch repair deficient (dMMR)
Cancer types: Colorectal cancer and other solid tumors
What’s analyzed: Tumor
How used: To guide treatment and to identify those at high risk of certain cancer-predisposing syndromes
Neuron-specific enolase (NSE)
Cancer types: Small cell lung cancer and neuroblastoma
What’s analyzed: Blood
How used: To help in diagnosis and to assess response to treatment
Nuclear matrix protein 22
Cancer type: Bladder cancer
What’s analyzed: Urine
How used: To monitor response to treatment
PCA3 mRNA
Cancer type: Prostate cancer
What’s analyzed: Urine (collected after digital rectal exam)
How used: To determine need for repeat biopsy after negative biopsy
PML/RARα fusion gene
Cancer type: Acute promyelocytic leukemia (APL)
What’s analyzed: Blood and bone marrow
How used: To diagnose APL, to predict response to all-trans-retinoic acid or arsenic trioxide therapy, to assess effectiveness of therapy, to monitor minimal residual disease, and to predict early relapse
Prostatic Acid Phosphatase (PAP)
Cancer type: Metastatic prostate cancer
What’s analyzed: Blood
How used: To help in diagnosing poorly differentiated carcinomas
Programmed death ligand 1 (PD-L1)
Cancer types: Non-small cell lung cancer, liver cancer, stomach cancer, gastroesophageal junction cancer, classical Hodgkin lymphoma, and other aggressive lymphoma subtypes
What’s analyzed: Tumor
How used: To determine whether treatment with a particular type of targeted therapy is appropriate
Prostate-specific antigen (PSA)
Cancer type: Prostate cancer
What’s analyzed: Blood
How used: To help in diagnosis, to assess response to treatment, and to look for recurrence
ROS1 gene rearrangement
Cancer type: Non-small cell lung cancer
What’s analyzed: Tumor
How used: To determine whether treatment with a particular type of targeted therapy is appropriate
Soluble mesothelin-related peptides (SMRP)
Cancer type: Mesothelioma
What’s analyzed: Blood
How used: To monitor progression or recurrence
Somatostatin receptor
Cancer type: Neuroendocrine tumors affecting the pancreas or gastrointestinal tract (GEP-NETs)
What’s analyzed: Tumor (by diagnostic imaging)
How used: To determine whether treatment with a particular type of targeted therapy is appropriate
T-cell receptor gene rearrangement
Cancer type: T-cell lymphoma
What’s analyzed: Bone marrow, tissue, body fluid, blood
How used: To help in diagnosis; sometimes to detect and evaluate residual disease
Thiopurine S-methyltransferase (TPMT) enzyme activity or TPMT genetic test
Cancer type: Acute lymphoblastic leukemia
What’s analyzed: Blood and buccal (cheek) swab
How used: To predict the risk of severe bone marrow toxicity (myelosuppression) with thiopurine treatment
Thyroglobulin
Cancer type: Thyroid cancer
What’s analyzed: Blood
How used: To evaluate response to treatment and to look for recurrence
UGT1A1*28 variant homozygosity
Cancer type: Colorectal cancer
What’s analyzed: Blood and buccal (cheek) swab
How used: To predict toxicity from irinotecan therapy
Urine catecholamines: VMA and HVA
Cancer type: Neuroblastoma
What’s analyzed: Urine
How used: To help in diagnosis
Urokinase plasminogen activator (uPA) and plasminogen activator inhibitor (PAI-1)
Cancer type: Breast cancer
What’s analyzed: Tumor
How used: To determine aggressiveness of cancer and guide treatment
FoundationOne® CDx (F1CDx) genomic test
Cancer type: Any solid tumor
What’s analyzed: Tumor
How used: As a companion diagnostic test to determine whether treatment with a particular type of targeted therapy is appropriate
5-Protein signature (OVA1®)
Cancer type: Ovarian cancer
What’s analyzed: Blood
How used: To pre-operatively assess pelvic mass for suspected ovarian cancer
17-Gene signature (Oncotype DX GPS test®)
Cancer type: Prostate cancer
What’s analyzed: Tumor
How used: To predict the aggressiveness of prostate cancer and to help manage treatment
21-Gene signature (Oncotype DX®)
Cancer type: Breast cancer
What’s analyzed: Tumor
How used: To evaluate risk of distant recurrence and to help plan treatment
46-Gene signature (Prolaris®)
Cancer type: Prostate cancer
What’s analyzed: Tumor
How used: To predict the aggressiveness of prostate cancer and to help manage treatment
70-Gene signature (Mammaprint®)
Cancer type: Breast cancer
What’s analyzed: Tumor
How used: To evaluate risk of recurrence
NOTE: All of the above statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
Dr. Conners graduated with his doctorate from Northwestern Health Sciences University in 1986. He holds AMA Fellowships in Regenerative & Functional Medicine and Integrative Cancer Therapy.
He is the author of numerous books including, Stop Fighting Cancer and Start Treating the Cause, Cancer Can’t Kill You if You’re Already Dead, Help, My Body is Killing Me, Chronic Lyme, 3 Phases of Lyme, 23 Steps to Freedom, and many more you can download for FREE on our books page.