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8/17/2019 Patologi Klinis Tumor Marker
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!"#"$%&'(() +",()-( ,.#/$
!" $%"&'% ()&* +,-.
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PENGERTIAN
0(1(# %',%1(2 1(#( 3 "#$%& $'&()& (,(. +",()-(,.#/$ (-(1(2 '.4',()'% 5()6 -%2('%1&() /1"2 '"1&()&"$ (,(. '"1 7%)(& 5()6 -(+(, -%-","&'% -(1(#-($(2 (,(. 8(%$() ,.4.2 1(%) '"4(6(% $"'+/)' ,"$2(-(+
(-()5( &"6()('()9
0(1(# +"$&"#4()6() '"1()7.,)5( +")6"$,%()+",()-( ,.#/$ %)% #")8(&.+ +.1( 4"$4(6(% '.4',()'%
#/1"&.1"$ 5()6 ,"$-(+(, +(-( +"$#.&(() '"1 #(.+.)%),$('"1.1"$ 5()6 -%&")(1 '"4(6(% *+%$'&()&(),'-'.'-/
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0(+(, -%4"-(&() 3:9 +",()-( 6()(' '"$/1/6%& ;"&',$('"1.1"$<
=9 +",()-( 6()(' '"1.1"$
>9 +",()-( 6()(' #/1"&.1"$9
!"#4(2('() -%'%)% -%4(,('% +(-( +",()-( 6()('
'"1.1"$9
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Penggolongan Petanda Tumor berdasarkan
Jenisnya
• (*/&01* 2*3241/%5 3 #%'(1)5( ?($8%)/"#4$5/)%8(),%6") ;?@A
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• :2")2* 3 J?KB &(1'%,/)%)B A?IJ
•
;+1"2/2*&*< &))=*2052>=5&* 3 O6KB O6AB O6PBO60B O60B &(++( -() 1(#4-( 1%62, 82(%)'
• +/1"2&' "1?1,/2"7 3 @',$/6") -() +$/6"',"$/$"8"+,/$' ;@Q -() !Q
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Persyaratan petanda tumor
yang ideal:
• 71*7&/&4 ;+"&(B -(+(, #")-","&'% &()&"$ 5()6
&"8%1
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• J%)66( '((, %)% 4"1.# (-( +",()-( ,.#/$ 5()6
#"#").2% +"$'5($(,() ,"$'"4., ;'")'%,%R%,(':SSTB '+"'%D%'%,(' :SST
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Manfaat Petanda Tumor
• !"#"$%&'(() +",()-( ,.#/$ #"$.+(&()4(6%() -($% +")(,(1(&'()(() &()&"$9
• !"#"$%&'(() +",()-( ,.#/$ ,%-(& -(+(,-%+(&(% .),.& '&$ %) %)6 +(-( +('%")('%#+,/#(,%'B &"8.(1% +(-( &"1/#+/& $%'%&/
,%)66%B #%'(1)5( AE! +(-( +")-"$%,( '%$/'%'2(,%B !HA +(-( 1(&%= .'%( 1"4%2 -($% FS ,(2.)-")6() (-")/#( +$/',(,"
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B%*4%%/ =/%)% C
• P")%1(% "D"&,%R%,(' ,"$(+%
• P"#(),(. +"$7(1()() +")5(&%,
P%'(1)5( +(-( +('%") +('8( /+"$('% ,.#/$&/1/$"&,(1 +")6.&.$() ?@A #"$.+(&() 8($(#/)%,/$%)6 5()6 1"4%2 '")'%,%D -($%+(-( ")-/'&/+%B
?I '8() (,(.+.) .1,$('/)/6$(D%9
• V),.& %-"),%D%&('% (-()5( #",(',('%' (,(. #")%1(%&"&(#4.2() '"4"1.# 6"7(1( &1%)%& #()%D"',9
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• O-"),%D%&('% $"'%-.(1 ,.#/$
•
U(-($ +",()-( ,.#/$ 5()6 ,%-(& #").$.)'"8($( (-"&.(, '","1(2 /+"$('% #").)7.&&()
&"#.)6&%)() +")6()6&(,() ,.#/$ 5()6 ,%-(&
&/#+1%, (,(. (-()5( ,.#/$ 5()6 #.1,%+"19
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• 0","&'% -%)% ,.#/$C,.#/$ ,"$,"),.
P%'9 +")6.&.$() AE! .),.& -","&'% -%)%&($'%)/#( 2"+(,/'"1.1"$ +$%#"$ +(-( +('%")'%$/'%' 2"+(,%'B !HA .),.& -","&'% &($'%)/#(+$/',(," +(-( +('%") -")6() (-")/#(+$/',(,"9
• P")"),.&() +$/6)/'%' +(-( ,.#/$C,.#/$
,"$,"),.B #%'(1)5( +(-( #%"1/#( #.1,%+"1-%#()( +$/6)/'%' (&() #")"),.&() +"#%1%2(),"$(+%9
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Faktor-faktor yang mempengaruhi
konsentrasi petanda tumor
D*A&A2 • !$/-.&'%B "&'&$"'%B &(,(4/1%'#" -() '.+1(% -($(2 &"
,.#/$9
• K(6(1 6%)7(1B 6()66.() D.)6'% 2(,% ,"$.,(#( &/1"',('%'-(+(, #")%)6&(,&() &(-($ +",()-( ,.#/$9
• O(,$/6")%&9
!HA )%1(%)5( #")%)6&(, '","1(2 ,%)-(&()C,%)-(&()
'"+"$,% -%6%,(1 $"8,(1 "W(#%)(,%/) ;0Q@
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D* E&/"2
• !"#%'(2() '"$.#9
!").)-(() 1"4%2 -($% YS #")%, -(+(, #")%)6&(,&()&(-($ LH@
• J"#/1%'%' -() %&,"$.'9
U(-($ LH@ #")%)6&(, +(-( '"$.# 5()6 2"#/1%'%'9
U(-($ !HA #")%)6&(, +(-( '"$.# 5()6 %&,"$%&• U/),(& '(#+"1 -")6() &.1%, 3 #")%)6&(,&() &(-($
H?? ;HZ.(#/.' 8"11 8($8%)/#( (),%6")<
• U/),(#%)('% '(#+"1 -")6() '(1%R( ,"$.,(#(
#")%)6&(,&() H??B ?A :GCGB '"-%&%, ?@A• O),"$(&'% /4(, 3 !HA (&() #")%)6&(, +(1'. (&%4(,
&/)'"),$('% ,%)66% +.$%)B %)-/1"B ()(1/6 6.()%-%)";#%'(1)5( %'/'/$4%- -%)%,$(,"
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Waktu pemeriksaan petanda tumor
• H"4"1.# ,"$(+% +"$,(#( ;/+"$('%B &"#/,"$(+%B ,"$(+% 2/$#/)(,(. $(-%/,"$(+%<
• H","1(2 /+"$('%
0%()7.$&() =C:S 2($% '","1(2 ,"$(+%B'",%(+ > 4.1() '"1(#( =
,(2.) +"$,(#(B '"1()7.,)5( ,%(+ Y 4.1() '"1(#( > ,(2.)4"$%&.,)5(9 !",()-( ,.#/$ 7.6( +"$1. -%+"$%&'( 4%1( (&()-%1(&.&() +"$.4(2() ,"$(+%9
• [%1( (-( -.6(() &"&(#4.2() (,(. #",(',('%'
• H((, +")"),.() &"#4(1% ',(-%.# +")5(&%, ;&)."',+-,<
• =C\#%)66. '","1(2 +")%)6&(,() 4"$#(&)( +",()-( ,.#/$
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Cara pemeriksaan petanda tumor
•
!",()-( ,.#/$ "&',$('"1.1"$ -%6.)(&() '"$.# • !"#"$%&'(() -(+(, -%1(&.&() -")6() 8($( 3
Q(-%/%##.)/(''(5 ;QOA
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Interpretasi Hasil - 1
• H"4(6%() +",()-( 6()(' '"$/1/6%& 7.6( -%+$/-.&'%'"1 7%)(& 3 '"1(%) )%1(% $.7.&() +"$1. '.(,. 0)1+.+%-
2'3#) 5()6 -(+(, #"#4"-(&() &()&"$ -($% 1"'%
7%)(&9
• 4)1+.+%- 2'3#) 5()6 /+,%#(1 -%+%1%2 -")6()
#")66.)(&() &.$R( Q]? ; $"8"%R"$ /+"$(,%)6
82($(8,"$%',%8
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Interpretasi Hasil - 2
• !"-/#() -(1(# +"#(),(.() &%)",%& +",()-(6()(' 3
&(-($ 2($.' ,.$.) 4%1( ,"$7(-% $"6$"'%
#")%)6&(, 4%1( &()&"$ #")7(-% +$/6$"'%D -()#")",(+ +(-( &"(-(() ',(4%19
• P('( +($.2 #('%)6= +",()-( ,.#/$ !
#"#+"$2%,.)6&() 4"$(+( 1(#( &(-($ '.(,.+",()-( ,.#/$ (&() #").$.) '","1(2 ,"$(+% 5()6
4"$2('%19
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Tabel 1. BEBERAPA PETANDA TUMOR UTAMA (2,3,4)
Petanda tumorNilai
RujukanIndikasi utama
Peningkatan tidak
Spesifik/Indikasi lain/ kombinasi
dgn petanda lain
CEA < 3 ng/ml Kolorectal, gaster, tiroid,
Esofagus, payudara, bronkhuspankreas, paru
Meningkat : merokok ( 7-10ng/mL) , alkohol
AFP < 15 ng/ml Hati, tumor sel germinal Peny. Hati & empedu, kelainan Janin,
kehamilan .
PSA
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-+(
•
P/)%,/$%)6 +"$7(1()() +")5(&%, ^ $"'+/)' ,"$(+% ?(+$/',(,
• !HA 3 %&,'- .5).+6+1 ,(+% ,%-(& "#$%& .5).+6+( 7
&($")( #")%)6&(, 7.6( +(-( 8
7 J%+"$,/+% +$/',(,B O)D1(#('% +$/',(,
C I%)-(&() 3 0Q@B '%',/'&/+%B ")-/'&/+%B 4%/+'%
+$/',(,B &(,","$%'('% .$%)
0")'%,(' !HA ;!HA0< 3 !HA -($(2 -%4(6% R/1.#"+$/',(, 5()6 -%.&.$ -($% IQVH ;,$()'$"8,(1
.1,$('/)/6$(+25 <
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• U"1"#(2() !HA ,%-(& -(+(, #"#4"-(&() &"1(%)() 7%)(&-")6() ?( +$/',(,B ,"$.,(#( +(-( +")-"$%,( -")6() )%1(% !HA
+(-( ,&)9 '&)' ; _C>S )6X#M :/ ?.,/DD O)-/)9 _ )6X#M9• O)-%&('% 4%/+'% 3 !HA ,/,(1 ` >S (,(. !HA0 ` S9=S
E$"" !HA
> 4"),.& !HA 8 4"4(' -() ,"$%&(, &" (1D(:C(),%&%#/,$%+'%)
-() &" (1D(#(&$/61/4.1%)9
!")%)6&(,() !HA ,/,(1 -%'"$,(% +").$.)() E$"" !HA
#")6%)-%&('% &() '.(,. &"6()('()
L%1(% E$"" !HA a :FT!
+"1.()6 &"6()('() 1"4%2 4"'($
Q('%/ E$"" !HA ,2-+ ,/,(1 !HA!
"%7&2 $FG -+( !")"1%,%() 3 $('%/ EXI !HA a +(-( +('%") -")6() ?( +$/',(,-%4()-%)6&() -")6() +('%") +$/',(, ,%-(& 6()('9
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Tabel 2. INDIKASI PENGUKURAN PETANDA TUMOR (3)
PETANDA
TUMOR
SKRINING DIAGNOSIS PEMANTAUAN PROGNOSIS
CEA KelompokRisiko tinggi
C-cellcarcinoma
Kolon, payudara, paru, C-cell ca
Kolon
AFP Risiko tinggi Hepatoma, germcells
Hepatoma, germ cell Germ cell
CA 19-9 Pankreas Pankreas, duktus biliarisCA 72-4 Lambung, ovarium
CA 125 Ovarium
CA 15-3 Payudara
NSE Paru (smallcells)
Small cell, neuroblastoma
SCC Kanker serviks, kanker THT,esofagus
CYFRA 21-1 Paru (non small cell),kandung kemih
HCG Risiko tinggi Germ cell
trophoblastictumor
Germ cell trophoblstic tumor Germ cell
trophoblastictumor
PSA Laki-laki usia>50 tahun
Prostat Prostat
TPA Kandung kemih
Calsitonin Risiko tinggi C-cell C-cell C-cell
Beta-2 -
microglobulin
Mieloma multipel
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-1/%*'% /=)2" ,%'% H% ,%"= ;.+-(,"<
• L"6($( %)-.',$% 3 ?( +($. +(1%)6 4()5(& ,"$ 0X ^ +")5"4(4.,(#( &"#(,%() (&%4(, &()&"$
• H.$R%R(1 3 C ,%+" 2%',/1/6%' ^ ',(-%.# ,.#/$
• H.4 ,%+" 3
:9 H#(11 8"11 1.)6 8()8"$ ;H?M?<Q(+%- 6$/b,2B (6$"'%DB '")'%,%D &"#/,"$(+%
-() $(-%/,"$(+%
=9 L/) H#(11 ?"11 M.)6 ?()8"$ ;LH?M? ,%+" ;(-")/8(B 'Z.(#/.' 8"11 8(B 1($6" 8"11' 1.)6
8(
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-1/%*'% /=)2" ,%"= =/%)% I%*0 71"&*0
'&0=*%3%* )1*'=3=*0 '&%0*27&7
I%6( +",()-( .,(#( 3
• LH?M? 3 H??B ?cEQA =:C:B ?@A
• H?M? 3 !$/KQ! ;!$/6(',$%) Q"1"('%)6 +"+,%-"
C LH@ #")%)6&(, +(-( &"6()('() 1(%) 3 +()&$"('B 6(',"$
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H2*/2J 3%7=7 3
• d()%,(B >e ,2)B +"$/&/&9 U1%)%' 3 ('#(9 P('.& QH &($")(+")%)6&(,() +",()-( ,.#/$ +(-( 8"& $.,%)9
P($&"$ J('%1 L%1(% L/$#(1
• H?? >> )6X#M a =• !$/KQ! _ +6X#M aFS
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• ?cEQA =:C: :9= )6X#M a>9>
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• ?A :=F >e> VX#M a >F
• ?A :GCG :>F VX#M a >e
• U$"(,%)%) : #6X-M a :9>
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0OAKL]HOH 3 LH?M? ; HZ.(#/.' 1.)6 8()8"$<
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• !",()-( H?M? ;!$/KQ! ^ LH@< 3 )"6(,%D +- LH?M?
• !",()-( 56 '"$%)6 #")%)6&(, +- 1.)6 ?( 3
f ?@A ^ ?A :=F 3 +- LH?M? ;(-")/ ?(<
f H?? 3 +(-( 'Z.(#/.' ,.#/$'
f ?A :=F ^ ?A :GCG ,%)66%! #").)7()6 1.)6
?(
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[%/#($&"$ ?( /R($%.#
O)'%-") 8.&.+ $")-(2 ; \FX:SS9SSS b()%,(#")/+(.'" < B #/$,(1%,(' 8.&.+ ,%)66% ; eFT
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:=)%* 1,&'&'I)&7 ;:8< K
• K1%&/+$/,"%) -")6() [P :: g&0(
• @&'+$"'% J@\ +- ?( /R($%.# ,%)66%B '"-()6 +-
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#")%)6&(, +- +")59 7%)(& 6%)"&/1/6%'• U/#4 ?A :=F -() J@\ 3 '")'%,%D%,(' +(1%)6
,%)66% -%4()-%)6 &/#4 -6) #($&"$ 1(%)
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