What are the markers for cervical cancer?

From the Guidelines

Cervical cancer screening primarily relies on Pap smears and HPV testing as key markers, with HPV DNA testing focusing on high-risk strains, particularly HPV 16 and 18, which cause approximately 70% of cervical cancers, as identified in the most recent study 1. The markers for cervical cancer can be broadly categorized into screening tests and tumor markers. For routine screening, women aged 21-29 should have Pap smears every 3 years, while those 30-65 should undergo co-testing with both Pap smear and HPV testing every 5 years, or Pap smear alone every 3 years, as recommended by various guidelines, including those from the American Cancer Society 1.

• Specific molecular markers include p16/Ki-67 dual staining, which identifies cells with active HPV infection showing abnormal cell cycle regulation.
• HPV DNA testing focuses on high-risk strains (particularly HPV 16 and 18) that cause approximately 70% of cervical cancers, as supported by studies such as 1.
• For diagnosed cervical cancer, squamous cell carcinoma antigen (SCC-Ag) and carcinoembryonic antigen (CEA) serve as tumor markers to monitor treatment response and detect recurrence.
• Additionally, CA-125 may be elevated in advanced disease, as noted in various studies, including 1. These markers work by detecting cellular changes, viral presence, or proteins produced by cancer cells, allowing for early detection and monitoring of cervical cancer progression.
• The use of HPV vaccines, which protect against HPV strains 16,18,31,33,45,52, and 58, is expected to continue to drive down cervical cancer incidence in the future, as discussed in 1.
• The role of HPV testing in cervical cancer screening is supported by studies such as 1, which demonstrate its effectiveness in detecting high-grade cervical intraepithelial neoplasia (CIN2+).

From the Research

Markers for Cervical Cancer

• Squamous cell carcinoma antigen (SCC Ag) is a commonly used tumor marker in cervical cancer, as indicated by studies 2, 3, 4, 5, 6.
• SCC Ag can be used to detect residual disease, early local recurrence, or distant metastasis in locally advanced cervical cancer, even before clinical symptoms appear 2.
• Elevated levels of SCC Ag are associated with recurrence of cervical cancer, and dynamic monitoring of SCC Ag levels can contribute to early diagnosis of tumor recurrence 4.
• Other imaging modalities, such as 18F-FDG PET/CT, can be used in conjunction with SCC Ag to detect recurrence and metastasis in cervical cancer 5, 6.
• The combination of SCC Ag and 18F-FDG PET/CT can provide complementary information and improve the accuracy of diagnosis in suspected recurrence of cervical squamous cell cancer 6.

Characteristics of SCC Ag

• SCC Ag is a sub-fraction of the tumor antigen TA-4, and its levels are closely related to clinical stages and tumor size in cervical cancer 2, 4.
• The positive expression rate of SCC Ag before treatment is closely related to clinical stages and tumor size, but not to pathological grade and lymphatic metastasis 4.
• The level of SCC Ag can be used to predict recurrence and metastasis in cervical cancer, with higher levels indicating a higher risk of recurrence and metastasis 4, 5, 6.

Clinical Applications of SCC Ag

• SCC Ag can be used as a reference indicator of biological behavior of cervical cancer, to monitor treatment response, and as a prognostic marker, especially in node-positive disease 2.
• The use of SCC Ag in conjunction with 18F-FDG PET/CT can improve the detection of recurrence and metastasis in cervical cancer, and provide complementary information for diagnosis and treatment 5, 6.
• The clinical value of SCC Ag and 18F-FDG PET/CT can be assessed based on patient-based sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for the detection of tumor recurrence or malignancy 6.