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INTRODUCCIN
El marcador tumoral (MT) incluye un amplio espectro de molculas, con caractersticas muy variables, producidas o inducidas
por la clula neoplsica que reflejan su crecimiento y/o actividad
y que permiten conocer la presencia, la evolucin o la respuesta
teraputica de un tumor maligno (1-4). Esta definicin no indica que
los MTs sean especficos del cncer, ya que la mayora de ellos son
sintetizados y liberados tambin por las clulas normales, por ello se
detectan en sangre y es necesario establecer valores de referencia. Las
diversas patologas benignas que afectan a los tejidos productores
de los MTs, tambin pueden provocar los incrementos sricos de
estos MTs, dando lugar a falsos positivos. La valoracin diferencial
entre la causa de incremento de un MT, benigna o maligna, es un
problema frecuente en la prctica asistencial.
RECOMENDACIONES
La inespecificidad de los MTs plantea el importante problema de
discriminar ante una elevacin, el origen benigno o maligno de la
misma. Hay 4 criterios (Criterios de Barcelona) que sern de ayuda
para distinguir y valorar correctamente los resultados de los MTs (1):
1) Los niveles sricos del MT. Los niveles sricos de la mayora
de los MTs, que se observan en ausencia de una neoplasia, suelen
ser moderados. Cuanto mayores sean las concentraciones de un
MT detectadas en un paciente, mayores son las probabilidades de
tratarse de un tumor maligno. Por ejemplo, niveles de CEA inferiores a 20-25 ng/mL pueden detectarse en numerosas enfermedades
benignas, pero niveles superiores a dicho valor indican con elevada
probabilidad la existencia de una patologa maligna. El nivel sugestivo de la presencia de una neoplasia vara segn el MT, si bien en
general, cuando supera los valores y patologas benignas incluidas en
incrementos importantes, sugiere con elevada probabilidad cncer.
2) Descartar la patologa benigna. Ante un incremento de un
MT hay que descartar la existencia de determinadas patologas
benignas que puedan incrementarlo, variables segn el MT y que
podran asociarse a dos grandes grupos: las alteraciones de los tejidos productores o en su catabolismo (Tabla I). La mayora de los
MTs son catabolizados a nivel heptico y excretados por va renal.
Las alteraciones de estos rganos producirn un menor catabolismo
y/o eliminacin e indirectamente provocarn su acumulacin y
valores superiores al lmite de referencia. La mayora de los MTs
CONCLUSIONES
Los falsos positivos en la interpretacin de los resultados de los MTs
es una causa frecuente de problemas, interpretaciones inadecuadas,
ansiedad, nerviosismo y realizacin de pruebas o consultas mdicas
innecesarias. El conocimiento de las causas de dichos falsos positivos
y una metodologa adecuada en la interpretacin de los resultados permite obviar la mayora de los problemas en las diferentes situaciones.
AFP
(6, 9, 15-32)
b 2 M (42-48)
Caracteristicas
Glicoprotena con
gran homologa a
la albmina
Fraccin de
la Hormona
gonadotrofina
corinica humana
Cadena ligera de
los antgenos de
histocompatibilidad
tipo I
Valores de
referencia*
<10 ng/mL
(adultos)
Leves
Enfermedades
autoinmunes
Falsos positivos
Moderados
Enfermedades
hepatobiliares
Importantes
Embarazo,
neonatos.
Hepatopatas de
diversa ndole
(< 100 ng/mL),
tirosinemia
hereditaria
Ataxiatelangiectasia
Indicaciones
Carcinoma
hepatocelular
y tumores
germinales de
testculo (no
seminomas) u
ovario. Cancer
gstrico
<2 U/mL
Enfermedades
autoinmunes.
Consumo de
marihuana
Insuficiencia renal
Gestacin
Tumores
trofoblsticos
y neoplasias
germinales de
testculo (no
seminomas)y
ovario
2,3 mg/L
Hepatopatas
crnicas, lesiones
cerebrales,
infecciones
Enfermedades
autoinmunes
Insuficiencia renal
Mieloma, linfomas
CA 15.3 (MCA,
CA 549, B27-29)
(6, 9, 14, 17, 18,
49-58)
Mucinas
identificadas
por distintos
anticuerpos
monoclonales
frente al mismo
eptopo
CA 19.9
(6-9, 13, 15, 17,
18, 58-74)
Glicolpido
que incluye el
determinante del
grupo sanguneo
Lewis a
<35 U/mL
<37 U/mL
CA 125
(6-9, 15, 17, 18,
74-95)
Mucina
identificada
por anticuerpos
monoclonales
<35 U/mL
Calcitonina
Hormona
protica (3,6
Kd) sintetizada
por las clulas
parafoliculares del
tiroides
Varones
<15 pg/mL
Mujeres
<7 pg/mL
CEA
(6-9, 13-15,
17-18,49-51, 82,
95-104)
Cromogranina A
(105-146)
Familia de
glicoprotenas
Glicoprotena
cida de 49 Kd,
perteneciente a las
graninas, presente
en los grnulos
cromafines
de las clulas
neuroendocrinas
<5 ng/mL
<100 ng/mL
Fragmento de la
citoqueratina 19
<3,3 ng/mL
HER-2/neu (6,
151-156)
Porcin externa de
la Oncoprotena
HER-2/neu
< 15 U/mL
Tratamiento con
factor estimulante
de colonias de
granulocitos.
Espordicos
en patologa
infecciosa
pulmnar,
enfermedades
autoinmunes,
quistes ovricos (<
100 U/mL)
Insuficiencia renal,
hepatopatas < 100
U/mL
Anemias
megaloblsticas
(dficit Vit B12)
Carcinomas de
mama y ovario.
Incrementos en
NCICP y linfomas
Patologa benigna
pulmnar
Patologa
gastrointestinal,
endometriosis,
quistes ovricos,
hepatopatas,
insuficiencia renal
(< 400 U/mL)
Pancreatitis,
Colestasis,(<1.000
U/mL)
quistes mucinosos
o bronquiectasias
(<500 U/mL)
Neoplasias
digestivas, en
especial pncreas,
carcinomas
mucinosos e
indiferenciados de
ovario
Hepatopatas,
insuficiencia renal
(< 300 U/mL).
Gestacin (lquido
amnitico).
Retenciones
lquidas: derrames
serosos, en
especial con
infecciones o
tumores (<1.000
U/mL)
Carcinomas
ovricos,
pulmnares y de
endometrio
Pico ovulatorio,
menstruacin,
infecciones
pulmnares, EPOC
(< 100 U/mL).
Sndrome
nefrtico,
patologa
ginecolgica:
quistes, miomas
endometriosis (<
200 U/mL)
Cncer medular
tiroides. Cncer de
pulmn, Sndrome
Zollinger-Ellison
5% fumadores
, mltiples
patologas
benignas
(< 15 ng/mL),
Mltiples
patologas,
agudas y crnicas.
Hipertensin
Mltiples
patologas agudas
o crnicas,
derrames (< 7ng/
mL)
Insuficiencia
renal, patologa
ginecolgica o
mamaria (<20 ng/
mL)
Neoplasias
epiteliales,
especialmente
digestivas,
medular tiroides,
mama, pulmn
Hepatopatas,
insuficiencia renal,
colitis ulcerosa,
Crohn
(< 25 ng/mL)
Neumonias,
sepsis, procesos
agudos (<500 ng/
mL). Cardiopatas
(miocardiopatas,
Insuficiencia
cardaca),
gastritis atrfica,
gastritis crnicas.
Adenomas
hipofisarios,
hiperparatiroidismo
primario
Patologa cutnea
sistmica (pnfigo,
psoriasis)
hepatopatas (< 15
ng/mL)
Hepatopatas (< 30
ng/mL)
Insuficiencia renal.
Tratamiento con
inhibidores bomba
protones. Gastritis
atrfica
Tumores
neuroendocrinos
(carcinoides,
feocromocitomas,
neuroblastomas,
ganglioneuromas).
Incrementos
moderados en
otras neoplasias
Cirrosis heptica,
insuficiencia renal
(<20 ng/mL)
Neoplasias
epiteliales,
Mesotelioma,
algunos linfomas y
sarcomas
Cncer de
mama. Discretos
incrementos en
prstata, pulmn
HE4 (157-161)
Proteasa
epididimal
5 HIAA (133-141,
162-167)
Metabolito de la
serotonina
MIA (168-169)
Melanoma
inhibitory activity
<11 U/mL
Dmero
(Gamma,Gamma)
de la enolasa
< 25ng/mL
Isoenzima
termoestable de la
fosfatasa alcalina
Propptido
liberador de la
Gastrina
<50 pg/mL
Glicoprotena con
actividad proteasa
(Kalicrena 3)
Subfraccin
glicoproteca
del antgeno T 4
(serin-proteasa)
S-100 (175-178,
223-231)
Protena acdica
nuclear dimrica
(BB) fijadora de
calcio
Glicoprotena
identificada
por anticuerpos
monoclonales
(B72.3, cc49)
Hepatopatas (<
200 pmol/L)
Insuficiencia renal
Factores
alimenticios:
caf, alcohol,
pia, frutos secos,
pltanos
Hepatopatas,
insuficiencia renal
Hepatopatas,
neumopatas
Insuficiencia renal
Tumores
carcinoides,
feocromocitoma
Hemorragias
cerebrales
Isquemia cerebral,
Hemlisis
Fumadores
Melanoma
maligno
Carcinoma
microctico de
pulmn, tumor
carcinoide,
neuroblastomas,
tumor de Wilms.
Seminoma
testicular,
carcinoma de
ovario
Carcinoma
microctico de
pulmn, tumor
carcinoide,
neuroblastomas,
tumor de Wilms.
Insuficiencia renal
(< 350 pg/mL)
Hiperplasia
prosttica
(especialmente con
retencin),
Prostatitis aguda
Cncer de prstata
<2,5 ng/mL
5-10 %
enfemedades
pulmnares o
hepticas
(< 4
ng/mL)
Insuficiencia renal,
pnfigo, psoriasis,
eczemas
Carcinoma
escamoso
Hepatopata,
patologa
autoinmune.
Insuficiencia
renal, Lesiones
cerebrales con
necrosis
Melanoma
maligno
<6 U/mL
Discreto
incremento en
procesos agudos,
EPOC.
Tratamientos
con AINES,
corticoides u
omeprazol
Carcinoma
digestivo, ovrico
y pulmonar
< 4 ng/mL
Patologas crnicas
(<80 pg/mL)
Ovario,
Adenocarcinomas
de endometrio,
pulmn
Manipulacin
prosttica
Tiroglobulina
(237-240)
Hormona
glicoproteca
sintetizada por las
clulas foliculares
del tiroides
< 60 ng/mL
(<1 ng/mL en
tiroidectoma)
Gestante (ltimo
trimestre),
tiroiditis subaguda,
adenoma txico
tiroideo, sndrome
de Goitier
Fragmentos de la
citoqueratina 8,
18 y 19
< 75 U/mL
Moderados
incrementos en
procesos agudos
Fragmentos de la
citoqueratina 18
< 75 U/mL
Discretos
incrementos en
procesos agudos
Neoplasia folicular
y papilar de
tiroides
Hepatopata,
Insuficiencia renal,
enfermedades
infecciosas
Hepatopata ,
insuficiencia renal,
enfermedades
infecciosas
Neoplasias
epiteliales
Neoplasias
epiteliales
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