CLINICAL-APPLICATIONS OF SERUM AND TISSUE MARKERS IN MALIGNANT DISEASE - BREAST-CANCER AS THE PARADIGM

Within the past few years, the measurement of serum and tissue markers , especially the latter, has assumed a more significant role influenci ng clinical decisions about treatment and follow-up of patients with m alignant disease. Breast cancer is a useful paradigm to illustrate the types and importance of these various markers. Tissue markers, includ ing nuclear grade, steroid hormone receptors, DNA index, ploidy, expre ssion of oncogenes or tumor-suppressor genes, epidermal growth factors , cathepsin D, proliferating cell nuclear antigen (PCNA), Ki-67, p32, and others, may influence choices of initial treatment as well as adju vant chemotherapy and (or) hormone administration. The serial measurem ent of serum markers, those currently available and those on the horiz on, for example, may offer a way to monitor patients at risk for recur rent cancer. Although the current role of these markers may be controv ersial, as information about them is collected and refined, in the fut ure perhaps a panel of such studies could be incorporated into forthco ming clinical staging systems for carcinoma of the breast and other ma lignancies to define both treatment and outcome.