The Ideal Biomarker for Cancer

The ideal biomarker for cancer would have applications in determining predisposition, early detection, assessment of prognosis, and drug response. It would be an additional advantage if the biomarker could also serve as a target for drug development. Desirable characteristics of molecular biomarkers for cancer are shown in Table 13.1.

No one test meets all these requirements but these should be kept in mind for selection of diagnostic tests. There is an urgent need for cancer biomarkers with more accurate diagnostic capability, particularly for early stage cancer.

Biomarkers and Hallmarks of Cancer

The hallmarks of cancer comprise 8 biological capabilities acquired during the multistep development of human tumors and constitute an organizing principle for rationalizing the complexities of neoplastic disease (Hanahan and Weinberg 2011):

  • 1. Sustaining proliferative signaling
  • 2. Evading growth suppressors
  • 3. Resisting cell death
  • 4. Enabling replicative immortality
  • 5. Inducing angiogenesis
  • 6. Activating invasion and metastasis
  • 7. Reprogramming energy metabolism (emerging)
  • 8. Escaping immune destruction (emerging)

Underlying these hallmarks are genome instability, which generates the genetic diversity that expedites their acquisition, and inflammation, which fosters multiple hallmark functions. In addition to cancer cells, tumors exhibit another dimension of complexity: they contain a repertoire of recruited, ostensibly normal cells that contribute to the acquisition of hallmark traits by creating the “tumor microenvironment.” These hallmarks should be taken into consideration for detection of biomarkers as guide to diagnosis and treatment of cancer.

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