Cancer biomarkers: Clinical aspects & laboratory determination

This book is a part of the ‘Clinical Aspects and Laboratory Determination of Biomarkers’ series and focuses on cancer biomarkers. The field of cancer diagnosis and its management have seen tremendous progress over the past few decades. The availability of less invasive biomarkers and increased awareness about the benefits of early cancer detection has also led to the establishment of various cancer screening protocols. This has resulted in the timely detection and effective management of various cancers leading to improved survival rates. However, there is still an unmet need for newer biomarkers for further strengthening the accurate cancer detection and post-therapy monitoring.

This book reviews cancer biomarkers useful in the detection, disease management and prediction of complications as well as follow up of various cancers. The book attempts to cover the principles, technical considerations, limitations, clinical context and the latest evidence about the clinical usage of various cancer biomarkers. This is a multi-author book written by the subject experts in the respective areas of consideration and covers both paediatric and adult cancers and solid as well as haematological malignancies.

The book has been divided into 13 chapters. The first chapter outlines the traditional and non-traditional laboratory tests used in cancer diagnosis and gives an overview of different methodologies used for tumour marker measurement. The second chapter focuses on laboratory testing and biochemical cancer marker application in common childhood malignancies. The third chapter highlights the challenges with common laboratory tests in adult cancer patients. These challenges include various pre-analytical issues such as pseudohyperkalemia in leukaemia patients, analytical issues, post-analytical issues, interferences by inflammation and cancer therapy.

The fourth chapter is dedicated to the role of thyroglobulin in the management of thyroid cancer and the various methodologies used for thyroglobulin measurements, use of liquid chromatography, tandem mass spectrometry-based assays and the challenges involved. The fifth chapter deals with the role of prostate-specific antigen (PSA) as a tumour marker in the diagnosis, monitoring and detection of the recurrence of the disease.

The sixth chapter is about the detection of monoclonal gammopathies and the role of M-protein in disease diagnosis and monitoring. This chapter details the current methods such as protein electrophoresis, immunofixation and free light-chain assay and the role of newer technologies such as shifting assay and mass spectrometry to distinguish monoclonal antibody drugs from disease-related M-protein.

The seventh chapter explores the potential role and challenges of liquid biopsy as a cancer biomarker. The scope of liquid biopsy includes the analysis of circulating tumour cells, as well as circulating tumour DNA to predict the prognosis and monitor the treatment response.

The eighth chapter covers the implications and limitations of biomarkers in the chimeric antigen receptor T-cell therapy in B-lymphoid malignancy and also proposes future approach in research and implementation of biomarkers in the case of CAR (chimeric antigen receptor) T-cell recipients. The ninth chapter details the role of cerebrospinal fluid circulating tumour cells for diagnosis, response evaluation and molecular profiling of leptomeningeal metastasis from solid tumours.

The clinical relevance of salivary diagnostics gained attention during the COVID-19 pandemic due to the easy, non-invasive access to the diagnostic sample. The tenth chapter deals with the role of saliva as a matrix for the measurement of various cancer biomarkers and its limitations as a sample. Saliva contains biomarkers of clinical relevance, and thus, salivary ‘omics’ offers new opportunities.

New emerging technologies in cancer detection have been covered in chapter 11. These emerging technologies are likely to impact the laboratory medicine practice for cancer diagnosis in the next 5-10 yr and include the use of microfluidics, magnetic sensors and point-of-care mass spectrometry and the role of artificial intelligence.

Chapter 12 discusses the origin of oncometabolites such as 1DH1 and IDH2 and their role as cancer biomarkers. Chapter 13 reviews the clinical use, current status and future prospects of established serum cancer biomarkers such as PSA and CA-125.

The highlight of the book is that the latest areas such as the role of liquid biopsy, CAR T-cell therapy as well as emerging technologies in cancer detection such as the role of proteomics, metabolomics, oncometabolites and artificial intelligence have also been given due consideration.

At places, the authors have also included diagrams, tables and pictures related to various assays for better clarity. The readers will get an excellent overview of the cancer biomarkers being used in the current clinical practice. However, the readers are advised to also refer to the latest specific disease-related management guidelines and go through the suggested references for further details.

Overall this book is a comprehensive manual on cancer biomarkers and will be useful for trainee students, research scholars and practicing clinical oncologists (medical oncologists, surgical oncologists and paediatric oncologists) as well as pathologists and laboratory medicine practitioners, for a better understanding of the various cancer biomarkers.