Endgames Case Review

Tumour biomarkers: diagnostic, prognostic, and predictive

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3449 (Published 03 July 2015) Cite this as: BMJ 2015;351:h3449
  1. Abigail Shaw, fourth year medical student1,
  2. Marcus D Bradley, consultant neuroradiologist2,
  3. Sean Elyan, consultant oncologist3,
  4. Kathreena M Kurian, consultant neuropathologist4
  1. 1University of Bristol Medical School, Bristol BS8 1TH, UK
  2. 2Institute of Clinical Neurosciences, Bristol
  3. 3Gloucestershire Oncology Centre, Cheltenham General Hospital, Cheltenham, UK
  4. 4Department of Neuropathology, Southmead Hospital, Bristol
  1. Correspondence to: A Shaw as0370{at}my.bristol.ac.uk

A 63 year old woman presented with a one month history of difficulty speaking and imbalance. She had been diagnosed with breast cancer two years earlier and had been treated with surgery, chemotherapy, and radiotherapy. This was followed by a year of trastuzumab (Herceptin) and continuous tamoxifen treatment.

Magnetic resonance imaging (figure) of the brain showed that she had a large solitary rounded enhancing mass lesion in the left inferior parietal lobe. It was present at the grey-white interface and there was extensive surrounding vasogenic oedema. The lesion was avidly enhanced after the administration of gadolinium (not shown). The appearances were suspicious of a solitary brain metastasis, but the differential diagnoses included a primary intrinsic malignant brain tumour.

T2 weighted axial magnetic resonance image of the brain showing a rounded mass lesion in the left inferior parietal lobe

After starting steroids, she underwent neurosurgical craniotomy and a gross total resection was achieved. Histological examination showed extensively necrotic metastatic carcinoma.

On immunohistochemical analysis, the tumour cells were strongly positive for E-cadherin, oestrogen receptors (ERs), and progesterone receptors (PRs). Human epidermal growth factor 2 (Her2) amplification was identified by fluorescence in situ hybridisation.


  • 1. What is a tumour biomarker?

  • 2. How has our knowledge of biomarkers affected the treatment of this patient?

  • 3. What specific information did the diagnostic biomarkers, E-cadherin and ER, provide?

  • 4. What specific information did the prognostic biomarkers, ER and PR, provide?

  • 5. What specific information did the predictive biomarkers, ER and Her2, provide?


1. What is a tumour biomarker?


Tumour (or cancer) biomarkers are biological molecules that suggest the presence of cancer in a patient. Biomarkers may also be used to characterise known tumours. They are either produced by the tumour itself or by the body in response to the tumour.


The National Cancer Institute defines a biomarker as “a biological molecule …

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