Standard and potential tumor markers in patients with cervical cancer

Abstract

The determination of tumor markers in gynecological oncology has been useful for many years. Previously known tumor markers are used mainly when predicting and monitoring the disease. The routinely determined tumor markers in the serum of patients with squamous cell carcinoma of the cervix are: antigen SCCAg and CYFRA 21.1, and for patients with adenocarcinoma CA 125 and CEA. The concentration of SCCAg before treatment is useful for the determination of the clinical stage, as well as for the prediction of the disease. The decrease in the concentration of SCCAg in serum after surgery proves radical activity. Values of SCCAg in patients with squamous cell carcinoma after treatment, have a greater positive predictive value for the detection of a recurrence or of distant metastase. The complementary determination of CYFRA 21.1 with SCCAg increases diagnostic sensitivity, which is essential for patients in low stages of the disease. In adenocarcinoma, the tumor marker of the greatest sensitivity is CA 125. Its concentrations increase along with clinical stage, correlating with pelvic and para-aortic lymph node status. Moreover, the concentrations of CA 125 in serum are independent predictors for disease-free survival. The diagnostic sensitivity of CA 125 in adenocarcinoma is greater in comparison to CEA. During the past several years it has appeared that potentially, cytokines can be clinically useful markers. In patients with cervical cancer of significant interest is the determination of the concentrations between vascular endothelial growth factor (VEGF) and its soluble receptors: VEGFR1 (sFLT1) and VEGFR2, interleukin 6 (IL-6) and soluble receptors of the tumor necrosis factors: STNF RI, sTNF RII. In patients with cervical cancer, the concentrations of VEGF increase with the clinical stage and the tumor size. They may be clinically useful when monitoring the disease, as well as evaluating both the disease-free survival and overall survival. The concentrations of receptors VEGFR1 and VEGFR2 may play the role of a prognostic factor. On the basis of the literature review collected over the past several years, it appears that the determination of e.g., YKL-40, gamma glutamyltransferase (GGT), leptin, matrix metalloproteinase 9 (MMP-9) or HER2 receptor in patients with cervical cancer may also have a clinical application to create an opportunity to improve diagnosis and thus the effectiveness in treatment of patients with cervical cancer.