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226 SECtIoN II Pathology ` PATHOLOGY—neOPLASIA Pathology ` PATHOLOGY—neOPLASIA

Oncogenic microbes
Microbe Associated cancer
EBV Burkitt lymphoma, Hodgkin lymphoma,
nasopharyngeal carcinoma, 1° CNS
lymphoma (in immunocompromised patients)
HBV, HCV Hepatocellular carcinoma
HHV-8 Kaposi sarcoma
HPV Cervical and penile/anal carcinoma (types 16,
18), head and neck cancer
H pylori Gastric adenocarcinoma and MALT lymphoma
HTLV-1 Adult T-cell Leukemia/Lymphoma
Liver fluke (Clonorchis sinensis) Cholangiocarcinoma
Schistosoma haematobium Squamous cell bladder cancer

Serum tumor markers Tumor markers should not be used as the 1° tool for cancer diagnosis or screening. They may be
used to monitor tumor recurrence and response to therapy, but definitive diagnosis is made via
biopsy. Some can be associated with non-neoplastic conditions.
MArKer IMPOrTAnT ASSOCIATIOnS nOTeS
Alkaline phosphatase Metastases to bone or liver, Paget disease of Exclude hepatic origin by checking LFTs and
bone, seminoma (placental ALP). GGT levels.
α-fetoprotein Hepatocellular carcinoma, Endodermal sinus Normally made by fetus. Transiently elevated in
(yolk sac) tumor, Mixed germ cell tumor, pregnancy. High levels associated with neural
Ataxia-telangiectasia, Neural tube defects. tube and abdominal wall defects, low levels
(HE-MAN is the alpha male!) associated with Down syndrome.
hCG Hydatidiform moles and Choriocarcinomas Produced by syncytiotrophoblasts of the
(Gestational trophoblastic disease), testicular placenta.
cancer, mixed germ cell tumor.
CA 15-3/CA 27-29 Breast cancer.
CA 19-9 Pancreatic adenocarcinoma.
CA 125 Ovarian cancer.
Calcitonin Medullary thyroid carcinoma (alone and in
MEN2A, MEN2B).
CEA Colorectal and pancreatic cancers. Carcinoembryonic antigen. Very nonspecific.
Minor associations: gastric, breast, and
medullary thyroid carcinomas.
Chromogranin Neuroendocrine tumors.
LDH Testicular germ cell tumors, ovarian Can be used as an indicator of tumor burden.
dysgerminoma, other cancers.
Neuron-specific Neuroendocrine tumors (eg, small cell lung
enolase cancer, carcinoid tumor, neuroblastoma)

PSA Prostate cancer. Prostate-specific antigen. Also elevated in BPH
and prostatitis. Questionable risk/benefit for
screening. Marker for recurrence after treatment.

FAS1_2019_04-Pathol.indd 226 11/7/19 4:02 PM