Biochemistry

Biochemistry is the application of chemistry to the study of biological processes at the cellular and molecular levels. Biochemistry has become the foundation for understanding all biological processes. It provides explanations for the causes of many diseases and has found its place in the diagnosis and treatment of cancer.

• Head and Neck Oncology:
  Ferritin, lipid-associated sialic acid (LSA), carcinoembryonic antigen (CEA) and TPA (Tissue Polypeptide Specific Antigen)appear to be sensitive markers for the prognosis of head and neck cancers.
• Paediatric Oncology & Haematology: NA
• Esophageal Cancer
• Tumour Markers: CEA and CA 19-9 are significantly increased in the patients with oesophageal cancer
• Liver enzymes: You may also have a blood test to check your liver function because oesophageal cancer can spread to the liver.
• Stomach Cancers
• Liver function tests may be performed to assess the function of your liver, to which stomach cancer can spread.
• Tumour Markers: Markers CEA (carcinoembryonic antigen) and CA 19-9 (cancer antigen) are sometimes raised in stomach cancer as well as other cancers.
• Liver Cancer: Blood tests are done to check for abnormalities in liver function; these include an assay of Alanine transaminase (ALT). ALT is an enzyme found in the liver that helps convert proteins into energy for the liver cells. When the liver is damaged, ALT is released into the bloodstream, and levels increase.
• Aspartate transaminase (AST). AST is an enzyme that helps metabolise amino acids. Like ALT, AST is normally present in blood at low levels. An increase in AST levels may indicate liver damage, disease or muscle damage.
• Alkaline phosphatase (ALP). ALP is an enzyme found in the liver and bone and is important for breaking down proteins. Higher-than-normal levels of ALP may indicate liver damage or diseases, such as a blocked bile duct, or certain bone diseases.
• Albumin and total protein. Albumin is one of several proteins made in the liver. Your body needs these proteins to fight infections and perform other functions. Lower-than-normal levels of albumin and total protein may indicate liver damage or disease.
• Bilirubin. Bilirubin is a substance produced during the normal breakdown of red blood cells. Bilirubin passes through the liver and is excreted in the stool. Elevated levels of bilirubin (jaundice) might indicate liver damage or disease or certain types of anaemia.
• Gamma-glutamyltransferase (GGT). GGT is an enzyme in the blood. Higher-than-normal levels may indicate liver or bile duct damage.
• Tumour Markers – Serum AFP:
  AFP stands for alpha-fetoprotein. It is a protein made in the liver of a developing baby. Healthy adults should have very low levels of AFP. High levels of AFP can be a sign of liver cancer and can help diagnose cancer when used with other tests. The test may also be used to help monitor the effectiveness of cancer treatment and to see if cancer has returned after you’ve finished treatment.
• Bladder Cancer
• Urinalysis:This is a simple lab test to check for blood and other substances in a sample of urine.
• Urine cytology:
  For this test, a sample of urine is looked at with a microscope to see if there are any cancer or precancer cells in it. Cytology is also done on any bladder washings taken during a cystoscopy (see below). Cytology can help find some cancers, but it isn’t perfect. Not finding cancer on this test doesn’t always mean you are cancer free.
• Urine culture:
  If you’re having urinary symptoms, this test may be done to see if an infection (rather than cancer) is the cause. Urinary tract infections and Bladder Cancers can cause the same symptoms. For a urine culture, a sample of urine is put into a dish in the lab to allow any bacteria that are present to grow. It can take time for the bacteria to grow, so it may take a few days to get the results of this test.
• Biochemistry: The blood test is used primarily to make sure your kidneys are functioning normally. Serum blood urea nitrogen, and creatinine levels should be obtained for all patients in whom Bladder Cancer is suspected. If metastatic disease is suspected, a complete blood count and complete metabolic panel, including alkaline phosphatase level and assessment of liver function, are appropriate.
• Glomerular filtration rate (eGFR): A reduced estimated glomerular filtration rate (eGFR) was found to be associated with a significantly increased risk for renal and urothelial cancer
• Kidney Cancer
• Urine cytology:
  Renal cell cancer will have blood in their urine. If the patient has transitional cell carcinoma (in the renal pelvis, the ureter, or the bladder), sometimes a special test of the urine sample (called urine cytology) will show actual cancer cells in the urine.
• Complete blood count (CBC):
  This is a test that measures the number of different cells in the blood. This test result is often abnormal in people with Kidney Cancer .
• Biochemistry tests: High levels of liver enzymes are sometimes found. High blood calcium levels may be found, which might lead to more imaging tests. Blood chemistry tests also measure kidney function, which is especially important if certain imaging tests or if surgery is planned.
• Breast Cancer
• Tumour Markers
  cancer antigen 15-3 (CA 15-3), cancer antigen 27.29 (CA 27.29), and carcinoembryonic antigen (CEA) — have been used to help monitor metastatic Breast Cancer (advanced disease),
• Lung Cancer
• Tumour markers: Carcinoembryonic antigen (CEA) represents a heterogeneous group of glycoproteins with common antigenic determinants. CEA is produced by the secretory cells of the normal adult gastrointestinal tract, and clearance is accomplished primarily in the liver. The highest concentrations of the marker are found in patients with liver metastases from carcinoma of the colon. CEA assays are useful in Lung Cancer clinical management,
• Chromogranin A: is a protein released from neuroendocrine cells that have been demonstrated in the serum of patients with Lung Cancer
• Adrenocorticotropic hormone: small cell carcinoma of the lung (SCLC), which originated from neuroendocrine tissue, can develop into paraneoplastic endocrine syndromes, such as Cushing syndrome, because of inappropriate secretion of ectopic adrenocorticotropic hormone (ACTH).
• Insulin-like growth factor 1 (IGF1): high levels of circulating insulin-like growth factor 1 (IGF1), the main ligand for IGF1R, increase the risk of developing lung malignancy in the future.
• Brain Tumours
• Neuron-specific enolase (NSE): high serum levels of NSE were noticed in the patients with neuroblastomas and malignant gliomas, etc.
• Colorectal Cancer
• Tumour Markers – Carcino Embryonic Antigen (CEA):
  The most common tumour marker for Colorectal Cancer is a carcinoembryonic antigen (CEA). Blood tests for this tumour marker can sometimes suggest someone might have Colorectal Cancer , but they can’t be used alone to screen for or diagnose cancer. High levels of CEA may indicate that cancer has spread to other parts of the body. In addition, other medical conditions can cause CEA to increase. A CEA test is most often used to monitor Colorectal Cancer in people who are already receiving treatment. It is not useful as a screening test.
• Testicular Cancer: There are three important tumour markers for Testicular Cancer:
• Alpha-fetoprotein:
  AFP is a protein secreted by the foetal yolk sac, liver and gastrointestinal tract and appears in high levels in the blood of the foetus. AFP can be secreted by NSGCT that contains embryonal carcinoma, yolk sac tumour or teratoma. By definition, seminoma or choriocarcinoma do not secrete AFP. Therefore any patient with an elevated AFP must have a non-seminomatous component of testis cancer.
• Human Chorionic Gonadotropin (HCG):
  HCG is a glycoprotein produced by the placenta to maintain the corpus luteum during pregnancy. HCG can be elevated in a number of other malignancies, including cancers of the liver, lung, pancreas and stomach. In germ cell tumours of the testis, including both seminomas and NSGCT, cancerous cells can transform into syncytiotrophoblasts (a normal component of the placenta) and secrete HCG. Levels greater than 5,000 IU are usually indicative of NSGCT, and in NSGCT, higher levels of HCG are associated with a worse prognosis. However, HCG-producing seminomas (approximately 15 per cent of seminomas) have the same prognosis as seminomas that do not produce HCG.
• Lactate Dehydrogenase (LDH):
  LDH is a cellular enzyme found in every tissue in the body. The highest concentrations of LDH in normal tissue are found in muscle (including skeletal, cardiac and smooth muscle), liver and brain. LDH is less specific for testis cancer than HCG or AFP. However, elevated LDH levels are correlated to high tumour burden in seminoma and recurrence in NSGCT.
• Prostate Cancer
• Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein in your arm and analysed for PSA, a substance that’s naturally produced by your prostate gland. A higher-than-normal level of PSA found may indicate prostate infection, inflammation, enlargement or cancer.
• Penile Cancer
• Blood test: A routine assessment of renal function tests, electrolytes and liver function tests will be suggested by the clinician to help in the treatment assessment and follow-up.
• Skin Cancer: Doctors often test blood for levels of a substance called lactate dehydrogenase (LDH) before treatment. If the melanoma has spread to distant parts of the body, a high LDH level is used for staging and effectiveness of treatment.
• Bone Cancer: People with osteosarcoma or Ewing sarcoma may have higher alkaline phosphatase and lactate dehydrogenase levels in the blood. However, it is important to note that high levels do not always mean cancer.