Biochemical Markers in the Follow-up of Medullary Thyroid Cancer

Abstract

Medullary thyroid cancer (MTC) shares biochemical features with other neuroendocrine tumors but the particular characteristics are largely unexplored. We investigated the biochemical neuroendocrine profile of MTC and whether specific markers could be useful in follow-up. In addition to the standard tumor marker calcitonin, plasma carcino-embryonic antigen (CEA), plasma catecholamines, (platelet) serotonin, chromogranin A, tryptase, and urinary markers of catecholamine, histamine, and serotonin metabolism were prospectively determined in 46 patients with histologically proven MTC. Patients were divided according to the stage of disease: group 1, no evidence; group 2, stable disease (SD); and group 3, progressive disease (PD). Plasma dopamine was increased in the majority of the patients with SD and PD; however it did not correlate with extent of disease. Elevated plasma platelet levels of serotonin were only present in patients with multiple endocrine neoplasia 2 with SD or PD but did not differ between those groups. Histamine metabolites were elevated in 20% of patients with SD and PD. In addition to plasma calcitonin, only CEA and chromogranin A could differentiate between stable and progressive MTC. MTCs are capable of synthesizing catecholamines, serotonin, and histamine metabolites underscoring that MTCs have metabolic characteristics in common with other neuroendocrine tumors. Thus far, clinical usefulness and relevance seems limited. The most useful markers in the follow-up of MTC are plasma calcitonin and CEA.

Medullary thyroid carcinoma: the influence of policy changing in clinical characteristics and disease progression

“…This illustrates the importance of applying scientific knowledge in patient care, which may have significant effects on the outcome of malignant disease. Similar results have been reported in other studies (4,10,19). In an older study, Modigliani et al (5) reported biochemical cure in 37.6% in sporadic cases, which is lower compared with the remission rate in our groups before 2001 (41.5%) and after 2001 (61.2%).…”

“…The stage of the disease and the tumor extent at presentation are significant predictors of life expectancy, thus early diagnosis is important for the outcome of the disease (4). Furthermore, the postoperative calcitonin (CT) levels as well as the calcitonin and carcinoembryonic antigen (CEA) doubling time have been proposed as predictive factors for the outcome and the progression rate of the disease (5,6,7,8,9,10).…”

FDG PET/CT Negative Medullary Thyroid Carcinoma Patient with Elevated CEA Level: Case Report and Review of Literature

“…31 As it is in our case; there are some false positivity reasons related to CEA but this is the first report showing a false positivity in the literature as far as we know.…”

The Prognostic Value of 2-Deoxy-2-[18F]Fluoro-d-Glucose Positron Emission Tomography in Patients With Suspected Residual or Recurrent Medullary Thyroid Carcinoma

“…C cells are derived from the neuronal crest and are part of the amino precursor uptake and decarboxylation system [1][2][3]. C cells secrete a number of compounds, including the polypeptide hormone calcitonin and carcinoembryonic antigen (CEA) [1][2][3].…”