Cancer Biomarker Roles

Cancer biomarkers can play a role in screening the general population, or differential diagnosis in symptomatic patients, and clinical staging of cancer. Additionally, these markers can be used to estimate tumor volume, to evaluate response to treatment, to assess disease recurrence through monitoring, or as prognostic indicators of disease progression. Regardless of the type of cancer biomarker or profile, the use of a cancer biomarker must be associated with proven improvements in patient outcomes. A caveat concerning currently used tumor markers is that, generally, they suffer from low diagnostic specificity and sensitivity. Only a few cancer biomarkers have entered routine use.

Questions that can be answered by cancer biomarkers
(Cancer biomarker roles) Questions that can be answered by cancer biomarkers
Current roles of cancer biomarkers and their limitations
Role
Current usefulness Comments
Population screening
Limited A screening test should have very high sensitivity and exceptional specificity, to avoid too many false positives in populations with a low cancer prevalence. The test must demonstrate a benefit in terms of clinical outcome. Current biomarkers suffer from too low diagnostic sensitivity and specificity to serve as screening markers. Except for PSA, current tumor markers are more frequently elevated at late stages of disease.
Diagnosis
Limited Current biomarkers suffer from too low diagnostic sensitivity and specificity to serve as diagnostic markers.
Prognosis
Limited Most cancer markers have some prognostic value. Specific therapeutic interventions cannot be determined because the accuracy of prediction of current markers is rather poor.
Prediction of therapeutic response
High Very few markers have predictive power (exceptions include steroid hormone receptors and HER2 amplification for breast cancer), but the information they provide aids therapy selection.
Tumor staging
Limited Besides AFP and HCG, the accuracy of the markers in determining tumor stage is poor.
Detecting early tumor recurrence
Controversial Lead time is short and does not considerably affect outcome. Clinical relapses could occur without biomarker elevation. Biomarker elevation can be nonspecific.
Monitoring effectiveness of cancer therapy
High Current biomarkers provide information on therapeutic response (effective or noneffective) that is readily interpretable and more economical than imaging modalities.
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