Increasing numbers of commercial assays for the established tumour markers are available which are capable of excellent analytical performance. Whilst all these assays are useful as research tools, their clinical value is more limited and should be appreciated before any decision is taken to offer a tumour marker assay service.
Calcitonin (medullary carcinoma of thyroid), alphafetoprotein (hepatoma) and human chorionic gonadotrophin (choriocarcinoma) are the only tumour markers that can be used for screening for malignancy in high risk populations.
Hormones, paraproteins, alphafetoprotein, human chorionic gonadotrophin and prostate specific antigen are valuable in establishing the diagnosis of certain tumour types.
Alphafetoprotein and human chorionic gonadotrophin concentrations at the time of diagnosis are of value in predicting prognosis in specific tumour types.
Although their sensitivity for a particular tumour type may be poor, most tumour markers can be used for monitoring the therapy and follow-up of selected marker positive patients.
Optimal clinical results of the management of patients with malignancy are usually obtained by specialist centres, and laboratory tumour marker services should be established so that they are appropriate to local oncology specialities.
GalenRSGambinoSR. Beyond Normality: the Predictive Value and Efficiency of Medical Diagnoses.New York: Wiley, 1975; 13.
5.
TashjianAH. Howland BG, Kelvin KEW, Hill CS. Immunoassay of human calcitonin: Clinical measurement, relation to serum calcium and studies in patients with medullary carcinoma. N Engl J Med1970; 280: 890–5.
6.
GrazeKSpillerIRTashjianAH. Natural history of familiar medullary thyroid carcinoma. Effect of a programme for early diagnosis. N Engl J Med1978; 299: 980–5.
External qualaity assessment schemes in clinical chemistry. Directory of schemes available in the UK. 4th issue. London: Department of Health and Social Services1989.
9.
NomuraMImaiMJsudaSNakamuierTMiyakawaYMagumiM. A pitfall in two-site sandwich, “one step” immunoassay with monoclonal antibodies for the determination of human alpha-fetoprotein. J Immunol Methods1982; 56: 13–17.
10.
StevensonJDChapmanRSPerryBLogueFC. Evaluation and clinical application of a two-site immunoradiometric assay for alpha-1-foetoprotein using readily available reagents. Ann Clin Biochem1987; 24: 411–18.
11.
BockJLFurgiveleJWenzB. False positive immunometric assays caused by anti-immunoglobulin antibodies: A case report. Clin Chim Acta1985; 147: 241–6.
HobbsJR. Paraproteins. Proc Roy Soc Med1969; 62: 773–9.
15.
MRC Working Party on Leukaemia in Adults. Report on the second myelomatosis trial after five years of follow up. Br J Cancer1980; 42: 813–22.
16.
WhicherJTCalvinJRickesPWarrenC. The laboratory investigation of paraproteinemia. Ann Clin Biochem1987; 24: 119–31.
17.
GoldPFreedmanSO. Demonstration of tumour-specific antigens in human colonic carcinomata by immunological tolerance and adsorption techniques. J Exp Med1965; 121: 439–62.
18.
FletcherRH. Carcinoembryonic antigen. Ann Int Med1986; 104: 66–73.
19.
WarnesTWSmithA. Tumour markers in diagnosis and management. Bailliere's Clin Gastroenterol1987; 1: 63–89.
20.
ThomsonDMPKrupeyJFreedmanSOGoldP. The radioimmunoassay of circulating carcinoembryonic antigen of the human digestive system. Proc Soc Nat Acad Sci1969; 64: 616–7.
21.
CooperMJMackieCRSkinnerDBMoosaAR. A reappraisal of the value of carcinoembryonic antigen in the management of patients with various neoplasms. Brit J Surg1979; 66: 120–3.
GoldenbergDM. Carcinoembryonic antigen: Its role as a marker in the management of cancer: A National Institute of Health Consensus Development Conference. Ann Int Med1981; 94: 407–9.
24.
DallekMVanAckeenHKlapdorR. Primary diagnosis and follow-up of colorectal and stomach cancer with the tumour associated antigens CEA, CA19–9 and CA125. In: GretenHKapdoorR, Eds. New Tumour Associated Antigens: Two Years Clinical Experience with Monoclonal Antibodies.Stuttgart: Georg Thieme Verlag, 1986; 35–42.
25.
BegentRHJ. The value of carcinoembryonic antigen measurement in clinical practice. Ann Clin Biochem1984; 21: 231–8.
26.
BergstrandCGCzarB. Demonstration of new protein fraction in serum from human fetus. Scand J Clin Lab Invest1956; 8: 174–80.
27.
MorinagaTSakaiMWegmannTGTamaokiT. Primary structures of human alpha-fetoprotein and its mRNA. Proc Nat Acad Sci1983; 80: 4604–8.
28.
JonesMSpraggS. Analysis of fetal peptides in human amniotic fluid and in fetal fluids and tissues by two dimensional electrophoresis. Electrophoresis1983; 4: 291–7.
29.
GarrettPEKurtzSR. Clinical utility of oncofetal proteins and hormones as tumour markers. Med Clin North Am1986; 70: 1295–306.
30.
VinceJDMcManusTJFerguson-SmithMARatcliffeJG. A semi-automated, serum alpha-foetoprotein radioimmunoassay for prenatal spina bifida screening. Br J Obstet Gynaecol1975; 82: 718–27.
31.
CuckleHSWaldNJLindcbourneRH. Maternal serum alpha-foetoprotein measurement; a screening test for Down's syndrome. Lancet1984; i: 926–9.
32.
SethJHanningIBaconRRAHunterWM. Quality of performance of assays for maternal serum alphafetoprotein in the United Kingdom: Evidence from the UK external quality assessment scheme 1980–87. Ann Clin Biochem1988; 25: 310–18.
33.
WaldmannTAMcIntyrcKR. The use of radioimmunoassay for alphafetoprotein in the diagnosis of malignancy. Cancer1974; 34: 1510–15.
34.
JavadpourNSoaresT. False positive and false negative alphafetoprotein and human chorionic gonadotrophin assays in testicular cancer: A double blind study. Cancer1981; 48: 2279–81.
35.
SellS.Alpha-fetoprotein. In: SellS, ed. Cancer Markers: Diagnostic and Development Significance.Clifton, New Jersey: Humana Press1980; 295–314.
36.
JavadpourN. The role of biologic tumour markers in testicular cancer. Cancer1980; 45: 1755–60.
37.
MRC Working Party on Testicular Tumours. Prognostic factors in advanced non-seminomatous germ-cell testicular tumours: Results of a multicentre study. Lancet1985; i: 8–11.
38.
Norgaard-PedersenBSchultzHPArendsJ. Markers in testicular germ cell tumours: Five year experience from the DATECA Study 1976–1980. Acta Radiol Oncol1984; 23: 287–94.
39.
NewlandsESBegentRHJRustinGJSParkerDBagshaweKD. Further advances in the management of malignant teratomas of the testis and other sites. Lancet1983; i: 948–51.
40.
RustinGJS. Tumour markers in germ cell tumours. Br Med J1986; 292: 713–14.
41.
BagshaweKDSearleFWassM. Human chorionic gonadotrophin. In: GrayCHJamesVHT, Eds. Hormones in Blood.3rd Edition. London: Academic Press1979; 364–411.
42.
ThomasCMGSegersMFGHouxPCW. Comparisons of the analytical characteristics and clinical usefulness in tumour monitoring of fifteen hCG (–β) immunoassay kits. Ann Clin Biochem1985; 22: 236–46.
43.
AndersenHJMarusakA. Value of B-subunit of human chorionic gonadotrophin pregnancy-specific Bi-glycoprotein and alpha-fetoprotein and in pre-operative evaluation of patients with a pelvic mass. Am J Obstet Gynecol1984; 149: 694–5.
44.
De BustrosABaylinSB. Hormone production by tumours: Biological and clinical aspects. Clin Endocrinol Metab1985; 14: 221–56.
45.
BoslGJGellerNLCirrincioneC. Multivariate analysis of prognostic variables in patients with metastatic testicular cancer. Cancer Res1983; 43: 3403–7.
BagshaweKD. Recent observations related to the chemotherapy and immunology of gestational choriocarcinoma. Adv Cancer Res1973; 18: 231–63.
48.
PontesJE. Biological markers in prostate cancer. J Urol1983; 130: 1037–47.
49.
GutmanEBSproulEEGutmanAB. Significance of increased phosphatase activity of bone at the site of osteoblastic metastases secondary to carcinoma of the prostate gland. Am J Cancer1936; 28: 485–95.
50.
FishmanWHLernerFA. A method for estimating serum acid phosphatases of prostatic origin. J Biochem1953; 200: 89–97.
51.
RoyAVBrowerMEHaydenJE. Sodium thymolphthalein monophosphate: A new acid phosphatase substrate with greater specificity for the prostatic enzyme in serum. Clin Chem1971; 17: 1093–102.
52.
FotiAGCooperJFHerschmanHMalvaezRR. Detection of prostatic cancer by solid-phase radioimmunoassay of serum prostatic acid phosphatase. N Engl J Med1977; 297: 1357–61.
53.
GriffithsJRippeDFPanfiliPR. Comparison of enzyme-linked immunosorbent assay and radioimmunoassay for prostate-specific acid phosphatase in prostatic disease. Clin Chem1982; 28: 183–6.
54.
LeeCLChuTNWajsmanLZSlackNHMurphyGP. Value of a new fluorescent immunoassay for human prostate acid phosphatase in prostate cancer. Urology1980; 15: 338–41.
55.
BruceAWMahanDEMoralesAClarkAFBelvilleWE. An objective look at acid phosphatase determinations: A comparison of biochemical and immunological methods. Br J Urol1979; 51: 213–17.
56.
WangMCValenzuelaLAMurphyGPChuTM. Purification of a human prostate specific antigen. Invest Urol1979; 17: 159–63.
57.
PapsideroLDWangMCValenzuelaLAMurphyGPChuTM. A prostate antigen in sera of prostatic cancer patients. Cancer Res1980; 40: 2428–32.
58.
NadhiMTabeiSZCastroA. Prostatic-specific antigen: An immunohistologic marker for prostatic neoplasms. Cancer1981; 48: 1229–32.
59.
MyrtleJFKlimleyPGIvorLPBruniJF. Clinical Utility of Prostate Specific Antigen in the Management of Prostate Cancer.Hybritech Incorporated1986; 1–6.
60.
ChanDWBruzekDJOesterlingJERockRCWalshPC. Prostate-specific antigen as a marker for prostatic cancer: A monoclonal and a polyclonal immunoassay compared. Clin Chem1987; 33: 1916–20.
61.
KuriyamaMWangMCLeeC. Multiple marker evaluation in human prostate cancer with the use of tissue-specific antigens. J Natl Cancer Inst1982; 68: 99–104.
62.
ErcoleCJLangePHMathisenMChiouRKVessellaRL. Prostate specific antigen and prostatic acid phosphatase in the monitoring and staging of patients with prostatic cancer. J Urol1987; 138: 1181–4.
63.
LiedtkeRJBatjerJD. Measurement of prostate-specific antigen by radioimmunoassay. Clin Chem1984; 30: 649–52.
64.
AhmannFRSchifmanRB. Prospective comparison between serum monoclonal prostate-specific antigen and acid phosphatase measurements in metastatic prostatic cancer. J Urol1987; 137: 431–4.
65.
SchwartzMK. Can prostate-specific antigen be used in screening In: LangePH, ed. Tumour Markers In Prostate Cancer.New York: Excerpta Medica1986; 47–51.
66.
EmtageLALewisPWBlackledgeGRP. Serum PSA in the follow-up of prostatic cancer treated with hormone therapy; comparison with acid and alkaline phosphatase. Ann Clin Biochem1988; 25 (Suppl): 151–52s.
