Ovarian cancer is one of the leading causes of cancer-related deaths in women. Its vague and non-specific symptoms often result in late presentation with advanced disease. Early detection of ovarian cancer, which allows timely treatment, can improve survival. Nevertheless, the search for a highly accurate screening tool for ovarian cancer has proven vastly unsuccessful so far.
By Yong Soon Leong
Cancer antigen 125 (CA 125) is the most widely used blood test to detect ovarian cancer. However, CA 125 misses half of the early cancer and is also falsely raised in benign gynaecologic conditions such as fibroid, endometriosis, and pelvic infections.
The human epididymal protein 4 (HE4), which was discovered to be over-expressed in ovarian cancer, has been suggested as a new blood test for ovarian cancer. Furthermore, the accuracy rate is higher when CA 125 is combined with HE4. More importantly, HE4 is not increased in benign gynaecologic diseases.
In a recently published study from the journal Hormone Molecular Biology and Clinical Investigation, the authors evaluated the predictive values of HE4, CA 125 and a combination of both via Risk of Ovarian Malignancy Algorithm (ROMA) in detecting ovarian malignancy in women displaying pelvic masses (pelvic tumours or growths).
More sensitive and specific
Overall, CA 125 is more sensitive but less specific than HE4. HE4 is useful to rule out an ovarian malignancy in premenopausal women. For postmenopausal women, ROMA appears to be an all-rounder with overall good sensitivity and specificity.
Given these findings, an ovarian cancer risk stratification algorithm has been proposed for the accurate selection of patients with high risk pelvic mass for referral to gynae-oncology centres. In this algorithm, HE4 and ROMA are used to determine the risk for premenopausal and postmenopausal women, respectively.
As the algorithm does not include ultrasound criteria, it can be proposed as a reliable method to prioritize pelvic masses and will be useful for district hospitals in which ultrasound expertise is less widely available.
Read the original article here
Beng Hock Teh, Soon Leong Yong, Wee Wee Sim, Kim Bee Lau, Haris Njoo Suharjono: Evaluation in the predictive value of serum human epididymal protein 4 (HE4), cancer antigen 125 (CA 125) and a combination of both in detecting ovarian malignancy. 31.07.2018