REVIEW ARTICLES  THE REPRODUCTIVE SYSTEM
Guest Editors: Freeman L. M., Bombardieri E. 

The Quarterly Journal of Nuclear Medicine 2002 June;46(2):88-104

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Circulating tumor markers and nuclear medicine imaging modalities: breast, prostate and ovarian cancer

Ugrinska A., Bombardieri E., Stokkel M. P. M., Crippa F., Pauwels E. K. J.

Department of Radiology Division of Nuclear Medicine Leiden University Medical Centre, Leiden, The Netherlands * Division of Nuclear Medicine Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy

Clinical oncol­o­gists ­have ­always ­shown ­great inter­est in cir­cu­lat­ing ­tumor mark­ers. There are sev­er­al mark­ers ­that in the clin­i­cal rou­tine are a sig­nal of par­tic­u­lar ­tumor ­types; ­some of ­them are strict­ly tis­sue-spe­cif­ic ­such as pros­tat­ic spe­cif­ic anti­gen (PSA) for pros­tat­ic can­cer, AFP and HCG for ­germ ­cell ­tumors of the tes­tis and ­ovary, oth­ers ­such as CA 15.3, CA125, CEA or cyto­ker­a­tins are ­less spe­cif­ic ­since ­their ele­va­tions can be ­found in dif­fer­ent varie­ties of can­cers ­even if ­they are pref­e­ren­tial­ly asso­ciat­ed to a cer­tain ­tumor ­type, ­thus are con­sid­ered mark­ers for ­breast, ovar­ian can­cer and ­colon aden­o­car­cin­o­ma. The ­most use­ful clin­i­cal appli­ca­tions of ­these param­e­ters is ­their deter­mi­na­tion dur­ing the fol­low-up of the treat­ed ­patients, in ­order to ­detect the ­tumor recur­rence ear­ly, and ­also to eval­u­ate the evo­lu­tion of the dis­ease by mon­i­tor­ing the treat­ment respons­es. During fol­low-up, increas­ing lev­els of ­tumor mark­ers can be ­observed ­even sev­er­al ­months ­before the clin­i­cal dem­on­stra­tion of can­cer recur­rence. The asso­ci­a­tion of ­tumor mark­er ­tests ­with imag­ing modal­ities can ­lead to sev­er­al advan­tag­es: the ­first is to con­firm the diag­no­sis of relaps­es, pos­sibly ­before the appear­ence of the relat­ed clin­i­cal symp­toms due to ­tumor ­growth; the sec­ond is to local­ize the ­sites of ­lesions, ­while ­tumor mark­ers pro­vide ­only a gen­er­al indi­ca­tion of the exis­tence of metas­ta­ses; the ­third is to ­make pos­sible a cor­rect ­whole ­body restag­ing. In the assess­ment of can­cer ­response ­tumor mark­ers are ­often ­very reli­able and ­their chang­es are fast­er ­than the mor­pho­log­i­cal ­ones. Among all the imag­ing modal­ities, nucle­ar med­i­cine ­plays an impor­tant ­role in detect­ing recur­renc­es and met­a­stat­ic local­iza­tions as it is ­able to inves­ti­gate func­tion­al rath­er ­than mor­pho­log­i­cal ­aspects of ­tumors, and pro­vide dif­fer­ent infor­ma­tion in com­par­i­son to mor­pho­log­ic imag­ing. In addi­tion, the scin­ti­graph­ic tech­niques ­offer the pos­sibil­ity to eval­u­ate treat­ment respons­es, con­firm­ing or not the infor­ma­tion from bio­chem­i­cal chang­es. This ­review ­aims to ­show ­some exam­ples (­breast, pros­tate and ovar­ian can­cer) in ­which the com­bi­na­tion of nucle­ar med­i­cine imag­ing modal­ities and ­tumor mark­er ­tests is pro­posed for clin­i­cal prac­tice. The advan­tag­es and ­some crit­i­cal ­aspects are dis­cussed on the ­basis of the clin­i­cal find­ings and the ­most impor­tant clin­i­cal indi­ca­tions are ­described.