A tumor marker is a substance present in or produced by a tumor or by the tumor’s host in response to the tumor’s presence that can be used to differentiate a tumor from normal tissue or to determine the presence of a tumor based on measurement in the blood or secretions.

1. PREPARED BY:
Dr. Monali Prajapati
MDS
Oral Medicine and Radiology

2. HISTORY
• 2000 YEARS AGO- The first known attempt to find
markers for malignancy was made and is described in
an Egyptian papyrus, where breast cancer was
distinguished from mastitis.
• 1846- first tumor marker in modern medicine was
identified by Bence-Jones, who detected a heat
precipitate in samples of acidified urine from patients
suffering from "Mollities osseum".
• 1965- Gold et al.,isolated a glycoprotein molecule from
specimens of human colonic cancer and thus discovered
the first "tumor antigen," later identified as carcino-
embryonic antigen (CEA).
Indian J Med Paediatr Oncol. 2009 Jan-Mar; 30(1): 1–8.

3. • The first modern tumor marker used to detect
cancer was Human Chorionic Gonadotropin (HCG)
the substance doctors look for in pregnancy tests.
• Women who have ended a pregnancy but still have
an enlarged uterus are tested for HCG.
• A high level of HCG in the blood may be a sign of a
cancer of the placenta called Gestational
Trophoblastic Disease (GTD). This cancer continues
to produce HCG.
Journal of Orofacial Sciences Vol. 4 • Issue 2 • December 2012

4. Tumor markers…..
A tumor marker is a substance present in or produced by a
tumor or by the tumor’s host in response to the tumor’s
presence that can be used to differentiate a tumor from
normal tissue or to determine the presence of a tumor based
on measurement in the blood or secretions.
Tumor markers can also be defined as “specific, novel or
structurally altered cellular macromolecules or temporarily
spatially or quantitatively altered normal molecules that are
associated with malignant (and in some cases benign)
neoplastic cells.
Another group of investigators have defined tumor markers
as “cellular products that are abnormally elaborated by
malignancies that can be detected in various body fluids and
on the surface of cancer cells.”
Journal of Indian Academy of Oral Medicine and Radiology, July-September 2010;22(3):147-150

5. Tumor markers….
• A tumor marker is a substance present in or
produced by a tumor (benign or malignant)
or by the tumor’s host in response to the
tumor’s presence that can be used to
differentiate a tumor from normal tissue or to
determine the presence of a tumor based on
measurement in the blood or secretions and
that can be detected in various body fluids and
on the surface of cancer cells.

6. Tumor marker
Tumor specific
marker
specific for a
single individual
tumor
Tumor
associated
marker
Found with
different tumors
of the same tissue
type

7. Classified according to site…
• BIOCHEMICAL /SEROLOGICAL MARKERS:
Markers which can be detected in the blood or
body fluids of patients harbouring an underlying
malignancy are thus called as Serological markers. There
are a large number of tumour markers present in the
blood circulation.
• HISTOCHEMICAL /TISSUE MARKERS:
Markers which can be detected in the tissue by
immunological tests are called Histochemical markers.
Journal of Advanced Medical and Dental Sciences Research |Vol. 3|Issue 5| November
(Supplement) 2015

8. ACCORDING TO CLINICAL
IMPLICATIONS
94 Indian Journal of Oral Sciences ? Vol. 6 ? Issue 3 ? Sep-Dec 2015

9. Diagnostic markers…
• Overexpression of some molecular markers can be utilized
as a potential tool in diagnosis.
• Some of the tissue-specific markers are :
• Epithelial marker- cytokeratin
• sarcomas -vimentin,
• rhabdomyosarcomas -desmin
• nervous tissue tumors – NSE (Neuron specific enolase),
neurofilament
• gliomas -glial fibrillar acid protein
• Myogenic sarcoma- myogenin and MyoD1
• Desmin and myogenin are positive in about 90% of the
rhabdomyosarcomas of head and neck.

10. Prognostic/ predictive markers
• The clinical course of a tumor is predicted by prognostic
markers whereas the response to a specific treatment is
assessed by predictive markers.
• Markers under various categories such as markers of
angiogenesis, metastasis, tumor suppressor genes and
oncogenes have also been validated as prognostic factors.
• As, inactivation of p53 tumor suppressor gene resulting in
suppression of apoptosis serves as a negative prognostic
marker; whereas Bcl-2, another anti-apoptotic protein is
associated with favorable prognosis

11. Therapeutic marker..
• Over the past decade, new anticancer agents have been
developed which target the factors associated with
apoptosis, increased proliferation rate and angiogenesis in
the tumor mass.
• Besides this, antibodies conjugated with drugs, radionuclides
and toxins are being developed as an alternative to
conventional chemotherapy
• Some studies have shown response by targeting viral
antigens on cancer cells with radiolabeled antibodies
• The Chicken anemia virus derived protein apoptin, is known
to induce apoptosis in primary oral squamous cell carcinoma
(OSCC) cells in immunocompetent mice models, indicating
that it can be a potential therapeutic agent for treatment of
head and neck squamous cell carcinoma

13. Prognostic/ predictive markers
The clinical course of a tumor is predicted by
prognostic markers whereas the response to a
specific treatment is assessed by predictive markers
Markers under various categories such as markers of
angiogenesis, metastasis, tumor suppressor genes
and oncogenes have also been validated as
prognostic factors.
As, inactivation of p53 tumor suppressor gene
resulting in suppression of apoptosis serves as a
negative prognostic marker; whereas Bcl-2, another
anti-apoptotic protein is associated with favorable
prognosis

14. Huber (1994) categorized tumor markers as:
I. MARKERS IN EXTRACELLULAR COMPARTMENT
a. Serum markers
b. Urinary markers- Bence Johns protein, VMA
c. Salivary markers- cytokeratin, HPV, copper
d. Other extracellular markers
i. Enteric fluid(gastric, pancreatic)
ii. Third space(pleural fluid, ascites)
iii. Cerebrospinal fluid
II. CELLULAR MARKERS DEMONSTRABLE
IMMUNOHISTOCHEMICALLY
a. Peptides
b. Intermediate filaments
c. Antigens d. Receptors
III. CYTOGENETIC MARKERS
IV. MOLECULAR MARKERS (DETECTION

15. • Epithelial
• Mesenchymal
• Prognostic
• Biochemical
• hormonal

16. 1. Epithelial markers
• Cytokeratins (CK)
• Epithelial membrane antigen (EMA)
• Oncofetal antigens
• Alpha-fetoprotein (AFP)
• Carcinoembryonic antigen (CEA)
• Desmoplakin
Journal of Orofacial Sciences Vol. 4 • Issue 2 • December 2012

17. 2. Mesenchymal markers
• Muscle antigens
• Desmin
• Actin
• Myoglobin
• Myosin
• Vascular antigen
• CD 34
• CD 31
• Neural antigens
• S 100
• Neuron specific enolase (NSE)
• Glial fibrillary acidic protein (GFAP)
• Synaptophysin
• Nerve growth factor receptor

18. • LYMPHOID MARKERS:
• CD3, CD15, CD20, CD30, CD45, CD68, CD79a, anaplastic
lymphoma kinase -1, and TdT

19. 3. Prognostic markers
• Cell adhesion molecules
• Cadherins
• Integrins
• Selectins
• Proliferation markers
• PCNA
• Ki67
• AgNORs

20. 4. Biochemical markers
• Enzymes and isoenzymes
• Prostatic acid phosphatase (PAP)
• Prostate Specific Antigen (PSA)
• Placental Alkaline Phosphatase (PALP)
• Lysozyme
• Protein
• Ferritin
• Glycoprotein
• Beta protein
• Immuno globulins
5. Hormone
• Estrogen receptor (ER)
• Progesterone receptor (PR)

21. 6. SALIVARY GLAND MARKERS:
• Epithelial markers – Cytokeratins
• Myoepithelial cell markers – Actin, myosin
• Serum acinar cell markers – Salivary amylase
• Myoepithelial cells + acinar cells – S100 protein

22. Classification by Küstner et al. in 2004
• TUMOR GROWTH MARKERS
1. Epithelial growth factor (EGF)
2. Cyclins
3. Nuclear cell proliferation antigens
4. Agryophilic nucleolar organizer region
5. S-phase kinase-interacting protein 2
6. Heat shock proteins 27 and 70 7.
7. Telomerase.

23. • MARKERS OF TUMOR SUPPRESSION AND ANTI-
TUMOR RESPONSE
1. Retinoblastoma protein (pRb)
2. Cyclin dependant kinase inhibitors
3. p53
4. bax
5. Fas/FasL.
Angiogenesis markers
1. Vascular endothelial growth factor/receptor
2. Platelet-derived endothelial cell growth factor
3. Fibroblast growth factor.

24. • MARKERS OF TUMOR INVASION AND METASTATIC POTENTIAL
1. Matrix-metalloproteases
2. Cathepsins
3. Cadherins and catenins
4. Desmoplakin
• CELL SURFACE MARKERS
1. Carbohydrates- blood group antigen
2. Histocompatibility antigen (HLA)
3. CD57 antigen
• INTRACELLULAR MARKERS
1. Cytokeratins (CKs).

25. • MARKERS OF ANOMALOUS KERATINIZATION
1. Filagrins
2. Invoulcrin
3. Desmosomal proteins
4. Intercellular substance antigen
5. Nuclear analysis.
• ARACHIDONIC ACID PRODUCTS
1. Prostaglandin E2 (PGE2)
2. Hydroxyeicosatetraenoic acid
3. Leucotriene B4.
• ENZYMES
1. Glutathione S-transferase.

26. Journal of Indian Academy of Oral Medicine and Radiology, July-September
2010;22(3):147-150

27. 1.Screening in General Population
• find out the presence of occult disease at an
early stage
• However, inadequate test sensitivity and
specificity in discrimination of a low prevalence
situation, limits the role of these markers to
smaller confines
• For instance, human chorionic gonadotropin is
produced in measurable amounts in
choriocarcinoma by as few as 1,00,000
malignant cells/1 mg of tissue.

28. 2.Diagnosis
• The identification of primary disease is an
important function of any tumor marker.
• For definitive results it is essential that
the marker be 100% specific and 100%
sensitive.
• For example, the presence of Bence Jones
proteins in the urine remains one of the
strongest diagnostic indicators of multiple
myeloma.

29. 3.Differential Diagnosis
• Most of the tumor markers are present in
normal, benign and cancerous tissue and are
usually ambiguous.
• However, they can still be used in differential
diagnosis of suspicious lesions.
• The tumor markers are commonly employed
to decide the histogenetic origin of oral cavity
neoplasms

30. 4.Clinical Staging of Cancer
•Clinical staging of the cancer is aided
by quantitation of the marker, that is,
the serum level of the marker reflects
the tumor burden present.
•Markers can also detect microscopic
metastasis with radioimmune
detection

31. 5.Nuclear Scanning of Injected
Radioactive Antibodies
• Radioactive labeled antibody specific tumor
marker is injected into patients suspected of
having undetected tumor metastasis.
• Accumulation of specific antibody in tumor cells
may be visualized by isotope scanning with
appropriate subtraction techniques to overcome
background activity or by emission tomographic
scanning.
• The labeled antibody can be injected
intravenously or into the lymphatic circulation
for more efficient binding to metastatic site

32. 6.Prognostic Indicators for Disease
Progression
• Tumor markers can provide prognostic
information, which may include
indications for choice of therapy and
likelihood of response.
• The estimate of survival time based on
evidence of metastatic disease can also
be predicted

33. 7. Evaluating the Success of Treatment /
Monitoring the Response to Therapy
• The rate of the alteration can be predicted
by using the half-life of the marker.
• For e.g. If the marker is supposed to be
decreased after t/t, but the observed half-life
of the marker after treatment is longer than
the expected half-life, then the treatment
has not been successful in completely
eliminating the tumorous tissue.

34. 8.Detecting the Recurrence of Cancer
•It is of utmost importance to
precede and to predict
recurrence so that relapse can be
picked up as soon as possible and
appropriate measures may be
undertaken.

35. CHARACTERISTICS OF IDEAL
TUMOR MARKER
CHARACTERISTICS REMARKS
Highly specific Detectable only in one tumor type
Highly sensitive
Non-detectable in physiological or
benign disease states
Long lead-time
Sufficient time for alteration of
natural course of disease
Levels correlate with tumor Prognostic and predictive utility of
burden the tumor marker
Short half-life
Frequent serial monitoring of the
marker levels after 5-6 half lives
Simple and cheap test Applicability as screening test
Easily obtainable specimens Acceptability by target population

36. Indian J Med Paediatr Oncol. 2009 Jan-Mar; 30(1): 1–8

37. 1. molecular methods
a. Polymerase chain reaction
b. Filter hybridization
c. In situ hybridization
d. Fluorescent in situ hybridization
e. Comparative genomic hybridization
f. Complemantry DNA (cDNA) microarrays
g. Flow cytometry.

40. 2. Immunologic methods
a. Immunohistochemistry
b. Immunofluorescency.

41. ELISA

42. Serology Enzyme assays
Immunological Immuno histo chemistry
Radio immuno assay
Enzyme-linked immuno sorbent assay
Flow cytometry
Cytogenetic analysis Fluorescent in-situ hybridization
Spectral karyotyping
Comparative genomic hybridization
Genetic analysis Sequencing (automated)
Reverse transcription
Gel electrophoresis
DNA micro-array analysis
Proteomics
Surface-enhanced laser
desorption/Ionization
Indian J Med Paediatr Oncol. 2009 Jan-Mar; 30(1): 1–8.

43. • Immunological detection usually relies on
monoclonal antibodies that specifically bind to
epitopes on tumor markers and are in turn tagged
for identification with dyes in
immunohistochemistry (IHC), radioactive tags in
radio-immuno assay (RIA), or enzymes in enzyme-
linked immunosorbent assay (ELISA).
• Alternatively, in a suspension, flow cytometry can
analyze the presence and percentage of antibody-
tagged cells.These methods are highly sensitive
and can detect quantities in the nanogram to
picogram range (10–6to 10−9g). Of these, the most
commonly used technique today is IHC.

44. Uses of IHC in oncology include :
• categorization of undifferentiated malignant
tumors,
• categorization of leukemias and lymphomas,
determination of site of origin of metastatic
tumors and
• detection of molecules of prognostic or
therapeutic significance (e.g.,
Estrogen/progesterone receptors (ER/PR) in
breast cancer)

45. 1. Varghese SS, Mathew P, Jose J. Diagnostically Relevant Molecular
Markers in Head and Neck Neoplasms. 2013;2013.

46. TUMOR MARKER SIGNIFICANCE
DIAGNOSTIC MARKERS FOR TUMORS WITH MUSCLE CELL DIFFERENTIATION
DESMIN • Desmin is a type III intermediate filament found near the
Z line in sarcomeres.
• detected in rhabdomyosarcoma of all subtypes, benign
smooth muscle tumours, benign skeletal muscle tumours
and leiomyosarcoma (50%)
• Neuroectodermal tumours, Ewing’s sarcoma,
fibrosarcoma, neuroblastoma, and mesothelial cell
tumours show expression of desmin occasionally
ACTIN • Actins are family of contractile proteins
• Expressed in leiomyosarcoma, rhabdomyosarcoma
MyoD1 • MyoD1 is a protein with a key role in regulating muscle
differentiation.
• strongly expressed in alveolar rhabdomyosarcomas
Myoglobin • Myoglobulin is found in cardiac and skeletal muscles.
• Myoglobulin was found to be expressed only in 50% of
the rhabdomyosarcomas

47. Diagnostic Markers for Tumourswith Neural
Differentiation
S-100 • Schwann cells, glial cells, skeletal muscle,
chondrocytes, lipocytes, macrophage subsets, and
myoepithelial cells express S-100 normally
• S100 protein is widely distributed in central and
peripheral nervous systems
• S100 is positive in neurilemomas and
neurofibroma
• In mixed tumour of salivary gland myoepithelial
cells demonstrate S100 proteins .
• Ductal cells of adenoid cystic carcinoma show
positivity for S100protein
• Desmoplastic ameloblastoma and odontogenic
myxoma show a variable expression of S100
protein .

48. Neuron
Specific
Enolase
• Enolase is an enzyme involved in
glycolytic pathway.
• Fiſty percent of neuroblastomas,
paragangliomas, and
neuroendocrine tumours express
neuron specific enolase.
• About one-third of the malignant
melanomas also produce the
enzyme

49. Diagnostic Markers for Tumours with Vascular Cell
Differentiation
Factor-
VIII-
Associate
d Antigen
(von
Willebran
d Factor).
• Factor-VIII-associated antigen (Von
Willebrand factor) is synthesized by
endothelial cell. It is also found in platelets
and megakaryocyte.
• Demonstrated in benign vascular tumours
(hemangiomas, pyogenic granuloma)
• Capillary hemangiomas, Cavernous
hemangiomas, Epitheloid hemangiomas,
Synovial hemangiomas and Hemangiomas
of peripheral nerve show the expression
expression of factor-VIII-associated antigen.

50. CD-34 • The CD-34 antigen is expressed on hematopoietic
progenitor cells of lymphoid and myeloid linage in
the bone marrow and in some acute leukemias.
• About80– 90% of malignant tumours including
Kaposi’sarcoma contain this antigen.
CD-31
(Platelet-
Endothelial
Cell
Adhesion
Molecule).
• CD-31 antigen is a transmembrane glycoprotein
expressed by endothelial cells as well as various
hematopoietic cells, including megakaryocytic,
plasma cells, and platelets.
•
• All benign vascular tumours express this antigen
and in addition about 80–100% of angiosarcomas
have identifiable immunoreactivity

51. Diagnostic Marker for Mesenchymal Tumors
VIMENTIN
• Vimentin is the intermediate filament traditionally
associated with mesenchymal cells and
mesenchymal tumours which is present in a wide
variety of cells during early embryological
development and is replaced by a type of specific
intermediate filament in the course of
differentiation.
• Vimentin is normally expressed in fibroblast,
chondroblast, smooth muscle cells, mesothelium,
pericytes, melanocytes, and endothelial cells
• Vimentin is expressed in most of the sarcomas.
• Among odontogenic tumours solid multicystic
ameloblastoma, myxoma, ameloblastic-
fibroodontoma and complex odontome shows the
expression of vimentin .

52. DiagnosticvMarker for Epithelial Tumours
Cytokeratin
• most abundant proteins in epithelial cells.
• grouped into simple epithelia specific cytokeratins
(7,8,18, 19,and 20), stratified epithelia specific
cytokeratins (4,5,13, 14,1,6,10, and19),keratinized
stratified squamous epithelium cytokeratins (5, 14, 1,
6, 10, and16),nonkeratinized epithelium having
cytokeratins (4,13, 19,5,and 14), squamous epithelial
cytokeratins (2, 56, and 10) and odontogenic epithe-
lium expressing cytokeratins 8 and 19
• mixed tumour of salivary gland, ductal epithelial cells
• Among odontogenic tumours solid multicystic
ameloblastoma shows the expression of cytokeratin

53. Exogenous viral
EBV in NPC, Burkitt′s
lymphoma; HPV in
cervical cancer, scc

55. marker significance
Bcl-2 • prognostic indicator in early
Squamous Cell Carcinoma of
head and neck.
Beta 2-
Microglobulin
• increase in the level of beta 2-
microglobulin was observed in
patients with oral submucous
fibrosis and oral cancer
Cathepsin-d • predictor of cervical lymph
node metastasis in Head and
Neck SCC

56. Calretinin • specific immunohistochemical marker for
neoplastic ameloblastic epithelium and it may
be an important diagnostic aid in the
differential diagnosis of cystic odontogenic
lesions and ameloblastic tumours
p53 • Mutation in the p53 tumour suppressor gene
is the most common genetic alteration in
human cancer.
• P53 expression may be a valuable marker for
identifying individuals at high risk of
developing a recurrence of primary disease
and second primary tumours of SCCHN.
1. B SR, B MR, Ndvn S. Tumour Markers in Oral Neoplasia Abstract : Indian J Dent
Adv. 2010;2(1):103-114.

57. Malignant disease Major marker Other markers
Bone cancer
Alkaline
phosphatase
Bence Jones protein, serum calcium
Breast cancer CA 15-3
CEA, calcitonin, β-hCG, LASA-P,
Prolactin
Cervical cancer SCC-A AG-4 antibodies, CA 125, CEA, TPA
Leukemia TdT
ALP, β2M, ferritin, LDH, myelin basic
protein, adenosine deaminase, PNP
Lung cancer NSE
ACTH, CK-BB, calcitonin, CA 72-4,
CEA, AFP, ferritin, LASA-P, TPA
Lymphoma β2M TdT, Ki-67, LASA-P
Multiple myeloma
Immunoglobuli
n heavy and
light chain
Bence Jones protein, β2M, IgA
Pheochromocytoma Metanephrine
Chromogranin A, plasma
catecholamines
Prostate carcinoma PSA PAP, ALP, CEA, CK-BB, TPA

58. Odontogenic tumor markers

59. CK 14,19
(intermediate
filaments)
Differentiates
odontogenic epithelial
tumors from other
epithelial tumors
AOTs, ameloblastomas
Amelogenin
(enamel
matrix
protein)
Expressed in
odontogenic tumors
with odontogenic
epithelial component
Ameloblastoma, AOT,
CEOT, ameloblastic
fibroma, malignant
ameloblastoma,
ameloblastic carcinoma
Ameloblastin
(cell adhesion
molecule)
Mutated in odontogenic
tumors with
odontogenic epithelial
component
Ameloblastoma, AOT,
CEOT, squamous
odontogenic tumor

60. Nestin
(intermediate
filament, neural
stem marker)
Marker for odontogenic
ectomesenchyme
AF, AFO, ameloblastic
fibrodentinoma (AFD) and
ameloblastic fibrosarcoma (AFS)
Calretinin
(calcium binding
protein)
• Differentiates ameloblastoma
from other tumors
• Differentiates unicystic
ameloblastoma from
odontogenic cysts
Specific IHC marker for neoplastic
ameloblastic epithelium expressed
in solid or unicystic ameloblastoma
Bone
Morphogenic
Protein
(transforming
growrh factor)
Expressed in odontogenic tumors
with dental hard tissue
formation
BMP 2, 4, 7 in dental epithelium in
initial ltooth development stage,
cementoblastoma, dentinoma,
odontogenic fibroma and
odontoma showed BMP positivity
while ameloblastoma, AOT, CEOT
showed negativity

61. Tenascin
(multifunctio
nal
glycoprotein)
Expressed in tumors
forming calcified masses
CEOT, ameloblastic fibro-
odontoma (AFO) and
odontoma,
HMGA2 • Over expression in
odontogenic
mesenchymal tumors
OM, odontogenic
myxofibroma
Basement
membrane
proteins:
Laminin 1
Marker for odontogenic
epithelium
laminins 1 and 5, collagen
type IV and fibronectin in
ameloblastomas,
calcifying cystic
odontogenic tumors
(CCOT), and AOTs.

63. oral leukoplakia
VEGF , NQO1, MMP9, Cyclin A and
D1 (IHC), hypermethylation in
promotor region
OSMF
AGNOr (tissue), lDL: HDL ratio
alteration, serum iron level,
coper/zinc ratio decreased,
PREMALIGNANT LESIONS

66. human papilloma
virus
HPV 16
hpv DNA has been found in 15-25%
HNSCC
positve in 12-18% of
cancers of oral cavity
MMP
MMP 1, 10 in detection of cancer of
oral cavity and gingiva.
MMP 9 has 80%
positivity but poor
specificity
interleukin
IL 6, 8 for tumor progression and
metastasis
91% sensitivity and
specificity in oral cavity
cancers
melanoma
associated gene
carcinogenesis by suppressing
apoptosis, potential prognostic marker
90% expression rate in
HNSCC tissue
cytokeratins tumor progression and prognosis
p53
molecular marker, guards cellular
integrity
found in 50-60% tumor
cells

67. Salivary biomarkers for oral cancer detection

68. Salivary markers in malignancy
• Defensin 1 –SCC
• P53 IL 8 and thioredoxin –Spinocellular carcinoma
• c-erb B2 and CA 15-3 – Breast cancer
• CA125 – ovarian cancer
• CD44 –head n neck carcinoma
• Oral exfoliated cell in saliva
Dent Res J (Isfahan). 2013 May-Jun; 10(3): 287–295.

69. • Cost
• availaibility
• a negative marker value does not rule out recurrent disease
and other diagnostic modalities such as imaging still have to
be performed as part of the surveillance program
• there are currently no tests for tumor markers of adequate
sensitivity and specificity to permit routine screening or
early diagnosis of a particular type of cancer.
• Most tumor markers show some overlap between the levels
seen in controls and in cancer-affected individuals. Thus it
becomes necessary to choose a threshold at which level
particular marker is considered abnormal and suggestive of
the presence of that tumor type.

70. • Varghese SS, Mathew P, Jose J. Diagnostically Relevant Molecular
Markers in Head and Neck Neoplasms. 2013;2013.
• B SR, B MR, Ndvn S. Tumour Markers in Oral Neoplasia Abstract : Indian J
Dent Adv. 2010;2(1):103-114.
• Babu GS, Supriya AN, Kumar NGR, Swetha P. Tumor markers : An
overview. 2012;4(2). doi:10.4103/0975-8844.106192.
• Bhatt AN, Mathur R, Farooque A, Verma A, Dwarakanath BS. Cancer
biomarkers - Current perspectives. 2010;(August):129-149.
• Nayak AG, Chatra L. Tumor Markers : An Overview.
2010;22(September):147-150.
• Dent Res J (Isfahan). 2013 May-Jun; 10(3): 287–295.
• Indian J Med Paediatr Oncol. 2009 Jan-Mar; 30(1): 1–8.