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Colon
Cancer DNA Screen
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Colon (colorectal)
cancer, often called the "silent killer" ranks as the second leading cause of
cancer death
in the United States.
Colon cancer
affects both men and women about equally and kills more people annually than either breast cancer or prostate
cancer.
Too few people taking an
active role in monitoring their own health to prevent this disease
because of neglect, lack of awareness, lack of media attention,
embarrassment and the "yuck" factor.
No one has to
die from colon cancer.
With over a 90 percent cure rate caught early enough, colon cancer is
preventable and treatable.
Early
detection through screening is the key.
The
Best Test Is the One That Gets Used
- Only 37% of colorectal cancers are
detected at an early stage, when most treatable.1
- At least 60% of the 80 million
Americans over the age of 50 have never been screened.2
- 30,000 lives could be saved annually
if colorectal cancers were detected at an early stage.3
Colon cancer deaths could be nearly eliminated if most people
learn the
basics, talk to their family and physicians about it, and take
action to prevent it. Unfortunately, as recent government surveys and
studies show, less than 40% of people who should be screened have been
screened. Respondents age 50 and over to a recent survey said only 51% of
their doctors discussed colon cancer screening with them.
Prevention of colon cancer and other digestive disorders starts with
you.
It requires that you take an active role in your own health. That
means know the basics:
- the early warning signs and
symptoms of colon cancer
- whether you have a family history of
cancer requiring earlier screening measures than the average population,
- the different screening methods available, and
- the best
screening tests to use.
It also requires that you engage in:
Healthy eating habits and lifestyle
can be useful prevention measures, but scientific evidence clearly
weighs in favor of a regular regimen of screening as the best and most
reliable form of colon cancer prevention. The goal of screening is to
detect and remove pre-cancerous polyps - the source of nearly all colon
cancers. A simple screening regimen, regularly used, can literally mean
the difference between life or death.
Although colon cancer can strike with
no warning signs, one of the most frequent and commonly the only early
warning sign is blood in stool from bleeding polyps. Too often this
sign is either not noticed because the blood is not visible to the human
eye or not acted upon.
A healthy, normal individual does not bleed internally. If you do
bleed internally, resulting in either occult (hidden) or visible traces of
blood in stool, this can be a sign of colon cancer or other digestive
health problem that requires immediate medical attention.
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Prostate-Specific Antigen (PSA) |
The PSA test is a blood test
that is used to screen for the presence of prostate cancer.
Prostate specific antigen is a protein found in the fluid
portion of blood, called serum. PSA is specific to the prostate.
No other human tissue or body part can make it. PSA levels can
be measured in an individual's serum. With this information,
doctors are able to screen for prostate cancer. PSA is only
present in men. PSA is present in all normal prostate tissue.
The normal prostate cell holds onto most of the PSA. Very little
leaks into the bloodstream. The small amount that leaks out is
what is measured by the blood test. Prostate cancer cells
actually have less PSA in each cell. However, the cancer cell
tends to leak more PSA into the bloodstream. Knowing this fact,
experts developed a range of expected values in patients with a
normal prostate gland. The PSA value should be less than 4.0.
This number reflects the belief that most men, roughly 95%, with
normal prostate glands have a PSA value of 4.0 or less. (See
below for age-specific normal values.) Almost any condition that
affects the prostate can make the PSA rise.
The American Cancer Society and the American Urological
Association recommend that men over age 50 have a yearly PSA.
They should also have a rectal examination of the prostate.
High-risk groups should begin screening at age 40 to 45. Men
with a family history of the disease and African Americans fall
into this category
When
evaluating PSA results, the doctor must also take into account
the results of the rectal exam, the patient's age, previous PSA
results, and prostatic size. For example, findings on a rectal
exam must be looked into even if the PSA result is normal.
Recent studies have suggested that the 4.0 level may be too high
for younger men and too low for older men. Many researchers now
use the following levels rather than the 4.0 used in the past.
However, more time is needed to assure that these levels are
more accurate.
|
AGE |
NORMAL RANGE |
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40 to 50 |
0 to 2.5 |
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50 to 60 |
0 to 3.5 |
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60 to 70, |
0 to 4.5 |
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70 to 80 |
0 to 6.5 |
If the rectal exam is
normal then the following recommendations are suggested: PSA of
4 or less. If the PSA level has been measured for the first time
and is less than 4, repeat testing is recommended on a yearly
basis. (This number may be dependent on age. See above for
normal values). PSA between 4 and 10.
If the PSA level is greater than 4 but less than 10, a
diagnostic ultrasound of the prostate is recommended. If the
ultrasound shows no suspicious areas, the prostate can be
monitored through regular testing and exams.
Another option is to take random biopsies from various parts of
the prostate. If observation alone is used, the PSA should be
repeated in 4 to 6 months and no later than a year. If the
ultrasound shows a suspicious area, then biopsy of the area
needs to be performed. This can be done at the time of the
ultrasound. The patient will need to take antibiotics ahead of
time. PSA greater than 10. If the
PSA is greater than 10, diagnostic ultrasound of the prostate
with biopsies is the recommended course. If the ultrasound shows
no suspicious areas, then random biopsies of the prostate are
taken. If the ultrasound shows suspicious areas, then biopsies
of the areas along with random biopsies need to be done. If
previous PSA values are available, test results will be
evaluated differently. The PSA level almost always rises if
cancer is growing. Any PSA level that is rising is suspicious.
However, a high PSA level may not mean that cancer is present.
For example, a male with a stable PSA of 8 over a three-year
period (8,8,8) is probably at less risk than a male with a PSA
of 2, 4, and 6 over the same time frame. This is because the
second patient's rising levels suggest growth. This makes it
suspicious for cancer. If the first patient had a negative
biopsy when the first high PSA value occurred, there may be no
need to repeat the biopsies. If the PSA level jumped to 10 or 15
for no apparent reason, then repeat ultrasound and biopsies
would be called for. Recent studies suggest that either a 20%
rise or a measurable rise of 0.75 in PSA in one year should
prompt a closer look. Ultrasound and biopsy may be needed.
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Prostate-Specific Antigen (PSA),
Complexed |
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Other PSA tests
that measure just the free or complexed portion are also
available.
The relative proportions of free and complexed PSA are thought
to be different in prostate cancer when compared with other
prostatic diseases. Men with cancer are thought to have a
smaller proportion of free PSA and more complexed PSA than men
with other benign prostatic diseases such as benign prostatic
hyperplasia (BPH) or prostatitis, which can also lead to
abnormal total PSA test results.
Free or complexed PSA tests are provided by some laboratories
usually in addition to the total PSA test. They have often been
used as reflex tests following a raised total PSA test result.
The results are then expressed as the percentage of free PSA
compared with the total amount of PSA detected. Any results
below a cut-off are thought to be suggestive of prostate cancer.
These free or complexed PSA tests are designed to be used when
the total PSA test result is marginally raised, and not in cases
where the total PSA test result is very high and suggestive of
advanced prostate cancer.
The introduction of free PSA (fPSA) testing has introduced a
greater level of specificity in identifying early prostate
cancer. In 1998, the FDA approved fPSA testing as a diagnostic
aid for men with total PSA values between 4.0-10.0 ng/mL. This
has often been the diagnostic gray zone for total PSA testing
and fPSA may aid in the stratification. In general, “At
any percent free PSA level, one could be a lot more reassured in
the man with the small prostate…if somebody has a really low
percent free PSA, 10 or 12, no matter how big or how small their
prostate is, then you worry. And if a patient has a really high
free PSA, say 30%, no matter how big or small his prostate is,
you can feel reassured.” (William Catalona, M.D.,
Urologist at Barnes Hosptial, Washington University, St. Louis)
But fPSA levels between 10-25% are another gray zone as the
table illustrates. Additional testing on the horizon includes
complexed PSA and human glandular kallikrein (hK2) to fPSA
ratio.
Probability of Prostate Cancer Based Upon Test Results (Modified
from Hybridech, Inc.)
|
Standard PSA |
Probability of cancer |
Percent free PSA |
Probability of cancer |
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0-2 ng/mL |
1% |
0-10% |
56% |
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2-4 ng/mL |
15% |
10-15% |
28% |
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4-10 ng/mL |
25% |
15-20% |
20% |
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>10 ng/mL |
>50% |
20-25% |
16% |
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>25% |
8%
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Prostate-Specific Antigen (PSA),
Free/Total Ratio |
PSA represents a major
indicator for the diagnosis and management of prostate cancer.
However, within the range of 4-10 ng/mL, in which 75% of men do
not have cancer, the PSA lacks specificity. At this range, 4 men
require a biopsy to identify 1 man with cancer.
Stenman et al studied this problem and reported in 1991 that men
with prostate cancer had more complexed prostate-specific
antigen (cPSA) than fPSA, in contrast to men with BPH. After the
development of an immunoassay, investigators demonstrated that
the ratio of free-to-total prostate-specific antigen (f/tPSA)
was lower in men with prostate cancer.
In the PSA range of 4-10, total prostate-specific antigen (tPSA)
segregates adequately between men with or without cancer. The f/tPSA
is more discriminatory.
A 7-institution study investigated 63 men with BPH, 30 men with
prostate cancer (prostate size >40 cm3), and 20 men with small
prostates. All of the PSA levels were 4-10 ng/mL. The median f/tPSA
proportion was 0.188 (in BPH), 0.159 (in prostate cancer
[prostate size >40 cm3]), and 0.092 (in small prostates).
This implies that prostate size is an important variable in
selecting a cutoff value for fPSA. For men whose prostates are
smaller than 40 cm3, a percent fPSA of 0.137 or lower is used to
detect 90% of the cancers, and 76% of the negative biopsy
findings can be eliminated. For men with prostates larger than
40 cm3, a cutoff of 0.205 allows detection of 90% of the
cancers, and 38% of the negative biopsy findings can be
eliminated. If the patient has a normal-sized prostate on DRE, a
value of 0.234 is necessary to detect 90% of the cancers,
sparing 31.3% of the patients an unnecessary biopsy.
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Prostate-Specific Antigen (PSA),
Ultra sensitive |
| Ultra sensitive
prostate specific antigen (PSA) assays allow a lower
limit of detection (less than 0.01 ng/ml) than standard
PSA assays
This
test is intended for use as an aid in the management of
patients following surgical or medical treatment for
prostate cancer. The use of PSA as an aid in the
management of prostate cancer patients after treatment
has been well documented.1 The frequency of cancer
recurrence correlates with the degree of cancer
progression at the time of treatment.2 It has been
estimated that cancer relapse following radical
prostatectomy occurs in 3% to 11% of patients where the
tumor is confined to the prostate. Fifteen percent to
40% of patients with tumors extending beyond the
prostatic capsule will have cancer recurrence and to 30%
to 66% for patients with positive surgical margins or
invasion of seminal vesicles will experience relapse.
Biochemical recurrence, defined as increasing PSA levels
after treatment, can be observed much earlier than
clinical signs of tumor recurrence.3,4 Persistent
elevation of PSA following treatment or an increase in a
post-treatment PSA level has been found to be indicative
of recurrent or residual disease.5,6,7,8,9,10,11 The
lead time for the detection of cancer may be increased
by months, or even years, through the use of
ultrasensitive PSA.12,13 The ultrasensitive PSA test has
a functional sensitivity of 0.01 ng/mL, which is an
order of magnitude greater than that of other
conventional assays (0.1 ng/mL).
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C E A |
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Colorectal, pancreas, lung, breast,
stomach, thyroid, female genital cancers.
In case
of cancer, higher rates will be reported in the following carcinomas:
pancreas (65-90% of the cases with very high rates);
lungs (52-77%);
breast (50%);
stomach;
thyroid (high rates);
and female genital cancers (25-40%). |
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Colon Cancer |
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Colon
Cancer Screen
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Colon (colorectal)
cancer, often called the "silent killer" ranks as the second leading cause of
cancer death
in the United States.
Colon cancer
affects both men and women about equally and kills more people annually than either breast cancer or prostate
cancer.
Too few people taking an
active role in monitoring their own health to prevent this disease
because of neglect, lack of awareness, lack of media attention,
embarrassment and the "yuck" factor.
No one has to
die from colon cancer.
With over a 90 percent cure rate caught early enough, colon cancer is
preventable and treatable.
Early
detection through screening is the key.
The
Best Test Is the One That Gets Used
- Only 37% of colorectal cancers are
detected at an early stage, when most treatable.1
- At least 60% of the 80 million
Americans over the age of 50 have never been screened.2
- 30,000 lives could be saved annually
if colorectal cancers were detected at an early stage.3
Colon cancer deaths could be nearly eliminated if most people
learn the
basics, talk to their family and physicians about it, and take
action to prevent it. Unfortunately, as recent government surveys and
studies show, less than 40% of people who should be screened have been
screened. Respondents age 50 and over to a recent survey said only 51% of
their doctors discussed colon cancer screening with them.
Prevention of colon cancer and other digestive disorders starts with
you. It requires that you take an active role in your own health. That
means know the basics: 1) the early warning signs and
symptoms of colon cancer, 2) whether you have a family history of
cancer requiring earlier screening measures than the average population,
3) the different screening methods available, and 4) the best
screening tests to use. It also requires that you engage in: 1) a
regular regimen of screening, and 2) an educated and active dialog with
your health care provider so they can provide the best available
preventative care.
Healthy eating habits and lifestyle
can be useful prevention measures, but scientific evidence clearly
weighs in favor of a regular regimen of screening as the best and most
reliable form of colon cancer prevention. The goal of screening is to
detect and remove pre-cancerous polyps - the source of nearly all colon
cancers. A simple screening regimen, regularly used, can literally mean
the difference between life or death.
Although colon cancer can strike with
no warning signs, one of the most frequent and commonly the only early
warning sign is blood in stool from bleeding polyps. Too often this
sign is either not noticed because the blood is not visible to the human
eye or not acted upon.
A healthy, normal individual does not bleed internally. If you do
bleed internally, resulting in either occult (hidden) or visible traces of
blood in stool, this can be a sign of colon cancer or other digestive
health problem that requires immediate medical attention.
go back
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Breast Cancer Antigen (CA15-3) |
Cancer antigen 15-3 (CA
15-3) is a normal product of breast cells; it is produced by a gene that
is often over expressed (i.e., the body makes too many copies) in
cancerous breast tumors, leading to an increased production of CA 15-3
and the related Cancer antigen 27.29. CA 15-3 does not cause cancer;
rather, it is a protein that is shed by the tumor cells, making it
useful as a tumor marker to follow the course of the cancer.
CA 15-3 is elevated in about 30% of women with localized breast cancer
and in about 75% of those with invasive breast cancer (cancer that has
metastasized or spread to other organs). CA 15-3 also may be elevated in
healthy people and in individuals with other cancers, conditions, or
diseases, such as colorectal cancer, lung cancer, cirrhosis, hepatitis,
and benign breast disease.
CA 15-3 can only be used as a marker if the cancer is producing elevated
amounts of it; however, since only a small percent of women with
localized breast cancer have increased CA 15-3, it may still be able to
be used later as a marker.
CA 15-3 sometimes also is used to give a doctor additional information
about where the cancer may have spread (such as into the bones or the
liver) and a general sense of how much cancer may be present .
In general, the higher the CA 15-3 level the more advanced the breast
cancer and the larger the tumor burden (amount of tumor present). The
level tends to increase as the cancer grows. In metastatic breast
cancer, the highest levels of CA 15-3 often are seen when the cancer has
spread to the bones and/or the liver.
Mild to moderate elevations of CA 15-3 also are seen in a variety of
conditions, including liver and pancreatic cancer, cirrhosis, and benign
breast disorders as well as in a certain percentage of apparently
healthy individuals. The CA 15-3 elevations seen in these non-cancerous
conditions tend to be stable over time.
Negative CA 15-3 levels do not ensure that a patient does not have
cancer. It may be too soon in the disease for elevated levels to be
detected. In addition, 25% to 30% of individuals with advanced breast
cancer have tumors that do not shed CA 15-3.
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Ovarian Cancer CA 125 |
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CA 125 is produced by a
variety of cells, but particularly by ovarian cancer cells. Studies have
shown that many women with ovarian cancer have elevated CA 125 levels.
CA 125 is used primarily in the management of treatment for ovarian
cancer.
In women with ovarian cancer being
treated with chemotherapy, a falling CA 125 level generally indicates
that the cancer is responding to treatment. Increasing CA 125 levels
during or after treatment, on the other hand, may suggest that the
cancer is not responding to therapy or that some cancer cells remain in
the body. Doctors may also use CA 125 levels to monitor patients for
recurrence of ovarian cancer.
Not all women with elevated CA 125
levels have ovarian cancer. CA 125 levels may also be elevated by
cancers of the uterus, cervix, pancreas, liver, colon, breast, lung, and
digestive tract. Non cancerous conditions that can cause elevated CA 125
levels include endometriosis, pelvic inflammatory disease, peritonitis,
pancreatitis, liver disease, and any condition that inflames the pleura
(the tissue that surrounds the lungs and lines the chest cavity).
Menstruation and pregnancy can also cause an increase in CA 125.
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Pancreatic - Gastrointestinal - Colorectal
Cancer (CA-19 & CEA) |
Initially found in
colorectal cancer patients, CA 19-9 has also been identified in patients
with pancreatic, stomach, and bile duct cancer. Researchers have
discovered that, in those who have pancreatic cancer, higher levels of
CA 19-9 tend to be associated with more advanced disease. Noncancerous
conditions that may elevate CA 19-9 levels include gallstones,
pancreatitis, cirrhosis of the liver, and cholecystitis
CA 19-9, as a tumor marker, is helpful in post-therapeutic monitoring to
determine the success of therapy or the development of recurrence when
used serially. CA 19-9 has been reported as positive in 70% to 80% of
pancreatic carcinomas, 50% to 60% of gastric cancers, 60% of
hepatobiliary cancer, 30% of colorectal cancer, and few lung, breast or
prostate cancers. Serum levels may differentiate pancreatic cancer from
pancreatitis. The test may also be positive in patients with non-neoplastic
disease, particularly inflammatory disease of the bowel, cirrhosis, and
autoimmune conditions including rheumatoid arthritis (33%), systemic
lupus erythematosus (32%), and scleroderma (33%).
CEA levels are elevated in smokers;
patients with inflammation including infections, inflammatory bowel
disease, and pancreatitis; some patients with hypothyroidism; cirrhosis;
and in some patients with noncolorectal neoplasms especially gastric,
pancreatic, breast, and ovarian. CEA is not a screening test for occult
cancer. Many negatives occur in patients with early carcinoma. Negative
in some patients with even metastatic colorectal and other neoplasms: a
minority of such patients do not have high CEA levels. Hepatotoxicity of
antineoplastic drugs, as well as tumor cell necrosis or membrane damage
may permit escape of CEA into the circulation and cause CEA increase;
simultaneous evaluation of liver-related tests has been advocated for
the former. Radiation therapy may also induce a transient rise in CEA.
Benign diseases usually do not cause CEA levels >5-10 ng/mL.
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