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Novel Biomarkers for Cholangiocarcinoma

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Biliary Tract and Gallbladder Cancer

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

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Abstract

The development of cholangiocarcinoma is an uncommon event apart from countries where liver fluke is prevalent. It most commonly occurs as a consequence of chronic inflammation and, therefore, markers of the onset of malignant change need to distinguish between the process of chronic inflammation and neoplastic transformation. Access to samples of tumour is difficult because of its small size but biomarkers have been recognised in plasma, bile and brushings of strictures. The most available biomarkers are derived from the mucus produced by biliary epithelium, where although carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA) are frequently relied on for advanced cases where their sensitivity and specificity is about 90 % and 98 %, the diagnostic accuracy is much poorer in early disease. Other mucoproteins have similar results but these markers do not distinguish between other forms of GI cancer. Markers of genetic alterations associated with neoplasia, such as aneuploidy and mutations of P53, have been shown to improve the cytological assessment of brushing samples from biliary strictures. Future understanding of the neoplastic mechanism through gene sequencing promises to give a more accurate picture. Proteomic analysis of serum has demonstrated the presence of some interesting proteins with m/z of 4462 and 11535, which add to the diagnostic value of CA19-9 and CEA to diagnose cholangiocarcinoma from patients with other benign diseases and from healthy volunteers. Leucin- rich alpha-2-glycoprotein, LRG1 is an interesting protein identified by the MALDI technique which has been shown to be concentrated in cholangiocarcinoma tissue and in the serum of these patients. When a serum protein panel combines this novel biomarker with CA19-9 and with the inflammatory marker IL-6 the ROC AUC was 0.98. A multiplexmeasure of biomarkers will be required to bring these novel findings into clinical practice.

“Novel” indicates a new kind of nature: strange; previously unknown.

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Authors and Affiliations

  1. Department of Surgery, University of Sydney, Sydney, NSW, Australia

    Ross C. Smith

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  1. Ross C. Smith
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Correspondence to Ross C. Smith .

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  1. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland, USA

    Joseph M. Herman

  2. Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA

    Timothy M. Pawlik

  3. Department of Radiation Oncology, Oregon Health and Science University, Portland, Oregon, USA

    Charles R. Thomas, Jr.

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Smith, R.C. (2014). Novel Biomarkers for Cholangiocarcinoma. In: Herman, J., Pawlik, T., Thomas, Jr., C. (eds) Biliary Tract and Gallbladder Cancer. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-40558-7_5

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  • DOI: https://doi.org/10.1007/978-3-642-40558-7_5

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