Academic journal article Iranian Journal of Public Health

Combined Evaluation of AFP, CA15-3, CA125, CA19-9, and CEA Tumor Markers in Patients with Hepatitis B and C

Academic journal article Iranian Journal of Public Health

Combined Evaluation of AFP, CA15-3, CA125, CA19-9, and CEA Tumor Markers in Patients with Hepatitis B and C

Article excerpt

Introduction

Hepatitis B is a liver infection caused by hepatitis B virus (HBV). People can catch hepatitis B through contact with body fluid, blood, and sex-ual intercourse. Hepatitis B may have no symptoms or feelings of sickness for a period. Symptoms include low fever, yellow skin, dark urine etc. (1, 2). If people do not know they are affected, they may spread the virus to other people. From 100 people who get hepatitis B, 1 person dies from this virus. They may also suffer from liver cancer and cirrhosis (3).

Prevalence of this disease in Middle East countries like Iran is in medium range, was 1.7% and 5% in Fars and Sistan-Balochastan provinces, respectively (4, 5). The prevalence of hepatitis B in Gonbad Kavoos City area was 4.5% (6). In city of Shiraz, the prevalence rate was rather low (1.07%); however, the highest prevalence was reported in Tuserkan City (8.96%) (7, 8). Worldwide HCV infection rate is around 3%, which correspond to 170 million people (1).

Infection with HBV or HCV leads to formation of immune complex by virus antigen and antibody in the glomerular basement membrane resulting in production of membranous glomerulonephritis and membrane proliferation. In extreme cases, severity of hepatic disease will surpass the symptoms of hepatic complication. Mixed Cryo- globulinemia, due to production of antibody with particular physical properties leading to precipitation in low temperature was reported in hepatitis B and currently in HCV (9). These infections are highly prevalent in prison population. Preventive measures may significantly reduce the rate of infection and infectivity (10).

Tumor markers are biomolecules that share the structure of proteins and hormones found in abnormal blood, urine and tissue of patients with all kinds of cancer. Measurement of a tumor marker in most cases is limited to the diagnosis, since most tumor markers do not act specifically and will increase in number within the patients without cancer. In most cancers, the levels of several tumor markers increase; therefore, identification of their concentration has diagnostic value. They have less than 100% sensitivity; therefore, no tumor marker is specific to an organ or to a specific cancer (9). Tumor markers can be used for one of five purposes; 1) screening for the presence of cancer, 2) monitoring the course of cancer in patients, 3) diagnosis of cancer or of a specific type of cancer, 4) determining the prognosis in patients, 5) determining stage of cancer. High levels of tumor markers in cancer patients can be used to help determine the extent at which the cancer has spread to other tissues and organ (11).

a-fetoprotein: AFP is a 70,000 Da glycoprotein consisting of 591 amino acids and 0.04 carbohydrate residues, encoded by a gene on chromosome 4q11-q13. It is normally produced during gestation by the fetal liver and yolk sac. AFP can be elevated in other neoplasm, including pancreatic cancer (23%), gastric cancer (20%), colorectal cancer (5%) and bronchial cancer (7%). The sensitivity of AFP for liver cancer is about 60%. An AFP level greater than 500 ng/ml is very suggestive of liver cancer (12-14).

CA15-3: Considered as the biomarker of breast cancer. It has a glycoprotein structure. An increased CA15-3 level is indicative of lung, ovarian, liver, or stomach cancer (12-14).

CA125: Is a modified antigen with Mullerian fetus cells. This antigen has a semi-mucin glycoprotein structure and is considered as a major marker in ovary non-mucin tumors and endometriosis (12, 13).

CA19-9: Is considered as a marker of pancreatic cancer, hepatocellular carcinoma, colon and rectum cancers. Identification of its levels helps in identification and prognosis of pancreatic, stomach, colorectal cancer (13, 14).

CEA: Is a glycoprotein that is not specific for a particular organ. It is widely used for diagnosis, follow-up, and prognosis of adenocarcinoma, especially for colorectal cancer (15). …

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