Ovarian tumor markers Associate Professor Fariba Behnamfar Esfahan University of Medical Sciences

CA 125 antigen CA 125 antigen is a large transmembrane glycoprotein derived from both coelomic (pericardium, pleura, peritoneum) and müllerian (fallopian tubal, endometrial, endocervical) epithelia Both tests I,II are commonly used in clinical practice. While CA 125 II may be more specific, there are no data to support the superiority of one test over the other

normal values may range from 20 to 200 due to benign indications common in premenopausal women, such as menses, fibroids, or ovulation same assay and same laboratory be used when serial CA 125 testing is performed

Human epididymis protein 4 The human epididymis protein 4 (HE4) assay was approved by the FDA in 2008 for monitoring for recurrent or progressive disease in patients with EOC It is also used for the evaluation of an adnexal mass as a component of the Risk of Malignancy Algorithm (ROMA).

CA 19-9 A 19-9 is used primarily to monitor disease response to therapy or detect documented cancer recurrence in patients with a gastric cancer, pancreatic cancer, gallbladder cancer, cholangiocarcinoma, adenocarcinoma of the ampulla of Vater

CA 19-9 Biliary tract obstruction [3] Cholangitis [4] Inflammatory bowel disease [5] Acute or chronic pancreatitis [6] Liver cirrhosis [7] Cystic fibrosis [8] Thyroid disease 9}

The clinical significance of elevated levels of serum CA 19-9 The clinical significance of elevated levels of serum CA 19-9. Pavai S1,2003 69 patients were found to have CA 19-9 level above the cut-off value (37 U/ml). Thirty-six patients had malignant and the remaining 33 had benign lesions. CA 19-9 was found to be elevated in malignancies of pancreas, colorectum, lung, liver and ovary. Benign conditions associated with elevation of CA 19-9 included disease of the hepatobiliary system, pneumonia, pleural effusion, renal failure and SLE CA 19-9 can be used to assist in the diagnosis of pancreatic cancer assessment of resection adequacy post-operatively.

ROMA The Risk of Malignancy Algorithm (ROMA) includes CA 125 and HE4. It was approved by the FDA in 2011 to further assess the likelihood of malignancy in women who are planning to have surgery for an adnexal mass

RMI RMI I is a product of the ultrasound scan score (U), menopausal status (M), and serum CA 125 level (RMI I = U x M x CA 125). all women with an RMI I score of ≥200 should be referred to a specialist. .

RMI The ultrasound result is scored 1 point for each of the following characteristics: multi-locular cyst, solid areas, metastases, ascites, and bilateral masses. U = 0 for an ultrasound score of 0 points, U = 1 for an ultrasound score of 1 point, and U = 3 for an ultrasound score of 2 to 5 points.

RMI Menopausal status is scored as 1 = premenopausal and 3 = postmenopausal. “ Postmenopausal" is defined as no period for more than one year or a woman over 50 years of age who has had a hysterectomy.

OGCTs arise primarily in young women between 10 and 30 years of age; they represent 70 percent of ovarian neoplasms in this age group . For unclear reasons, malignant OGCTs occur more frequently among Asian/Pacific Islander and Hispanic women than Caucasians OGCTs often produce hormones, particularly the beta subunit of human chorionic gonadotropin (hCG) or alpha fetoprotein (AFP:

cord-stromal neoplasms Some sex cord-stromal neoplasms secrete substances (eg, inhibin, estrogen, androgens, alpha-fetoprotein, and anti-Müllerian hormone), which can serve as diagnostic markers

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