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 This is an original JCO publication from 2006. Please visit the JCO website to access the full article.


Recommendations for the Use of Tumor Markers in Gastrointestinal Cancer


 

 Authors

Gershon Y. Locker, Stanley Hamilton, Jules Harris, John M. Jessup, Nancy Kemeny, John S. Macdonald, Mark R. Somerfield, Daniel F. Hayes and Robert C. Bast Jr

SUMMARY OF RECOMMENDATIONS

 

 

Specific MarkersRecommendations for the Use of Tumor Markers in Gastrointestinal Cancer
1. CEA as a marker for colorectal cancer1a. Screening: CEA is not recommended as a screening test for colorectal cancer.
1b. Staging/Treatment Planning: CEA may be ordered preoperatively in patients with colorectal carcinoma if it would assist in staging and surgical treatment planning. Although elevated preoperative CEA (> 5 mg/mL) may correlate with poorer prognosis, data are insufficient to support the use of CEA to determine whether to treat a patient with adjuvant therapy.
1c. Postoperative: Postoperative serum CEA testing should be performed every 3 mo in patients with stage II or III disease for at least 3 yr after diagnosis, if the patient is a candidate for surgery or systemic therapy. An elevated CEA, if confirmed by retesting, warrants further evaluation for metastatic disease, but by itself does not justify systemic therapy for presumed metastatic disease.1 Because chemotherapy may falsely elevate CEA levels, waiting until chemotherapy is finished to initiate surveillance is advised.
1d. Monitoring Response to Therapy: CEA is the marker of choice for monitoring metastatic colorectal cancer during systemic therapy. CEA should be measured at the start of treatment for metastatic disease and every 1-3 mo during active treatment. Persistently rising values above baseline should prompt restaging but suggest progressive disease even in the absence of corroborating radiographs. Caution should be used when interpreting a rising CEA level during the first 4-6 wk of a new therapy, since spurious early rises may occur especially after oxaliplatin.2,3
2. CA 19-9 as a marker for colon cancer2. Present data are insufficient to recommend CA 19-9 for screening, diagnosis, staging, surveillance, or monitoring treatment of patients with colorectal cancer.
3. DNA ploidy or flow cytometric proliferation analysis as a marker for colon cancer3. Neither flow cytometrically derived DNA ploidy (DNA index) nor DNA flow cytometric proliferation analysis (% S phase) should be used to determine prognosis of early-stage colorectal cancer.
4. p53 as a marker for colorectal cancer4. Present data are insufficient to recommend the use of p53 expression or mutation for screening, diagnosis, staging, surveillance, or monitoring treatment of patients with colorectal cancer.
5. ras as a marker for colorectal cancer5. Present data are insufficient to recommend the use of the ras oncogene for screening, diagnosis, staging, surveillance, or monitoring treatment of patients with colorectal cancer.
6. TS, DPD, and TP as markers in colorectal cancer (Note: This topic is new to the guideline.)6a. Screening: TS, DPD, and TP are tissue markers that have been used to predict response to treatment of established carcinomas and thus are not useful for screening.
6b. Prognosis: None of the three markers—TS, DPD, or TP—are recommended for use to determine the prognosis of colorectal carcinoma.
6c. Predicting Response to Therapy: There is insufficient evidence to recommend use of TS, DPD, or TP as predictors of response to therapy.
6d. Monitoring Response to Therapy: There is insufficient evidence to recommend use of TS, DPD, or TP for monitoring response to therapy.
7. MSI/hMSH2 or hMLH1as markers in colorectal cancer (Note: This topic is new to the guideline.)7. MSI ascertained by PCR is not recommended at this time to determine the prognosis of operable colorectal cancer nor to predict the effectiveness of FU adjuvant chemotherapy.
8. 18q/DCC as markers for colorectal cancer (Note: This topic is new to the guideline.)8. Assaying for LOH on the long arm of chromosome 18 (18q) or DCC protein determination by immunohistochemistry should not be used to determine the prognosis of operable colorectal cancer, nor to predict response to therapy.
9. CA 19-9 as a marker for pancreatic cancer (Note: This topic is new to the guideline.)9a. Screening: CA 19-9 is not recommended for use as a screening test for pancreatic cancer.
9b. Operability: The use of CA 19-9 testing alone is not recommended for use in determining operability or the results of operability in pancreatic cancer.
9c. Evidence of Recurrence: CA 19-9 determinations by themselves cannot provide definitive evidence of disease recurrence without seeking confirmation with imaging studies for clinical findings and/or biopsy.
9d. Monitoring Response to Therapy: Present data are insufficient to recommend the routine use of serum CA 19-9 rules alone for monitoring response to treatment. However, CA 19-9 can be measured at the start of treatment for locally advanced metastatic disease and every 1-3 mo during active treatment. If there is an elevation in serial CA 19-9 determinations, this may be an indication of progressive disease and confirmation with other studies should be sought.
  • Abbreviations: CEA, carcinoembroynic antigen; mo, months; yr, years; wk, weeks; TS, thymidine synthase; DPD, dihydropyrimidine dehydrogenase; TP, thymidine phosphorylase; MSI, microsatellite instability; PCR, polymerase chain reaction; FU, fluorouracil; LOH, loss of heterozygosity.

 

 

 

 

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