The Diagnostic Superiority of the HE-4 Marker over CA-125 and CA 19-9 in the Differentiation of a Large Pelvic Tumor – a Case Report

2013 ◽  
Vol 5 (1) ◽  
pp. 40-45
Author(s):  
Anita Chudecka-Głaz ◽  
Janusz Menkiszak ◽  
Aneta Cymbaluk-Płoska ◽  
Donald Rutkowski ◽  
Miłosz Kawa ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Ca 125 ◽  
Greater Omentum ◽  
Specific Marker ◽  
Pelvic Tumor ◽  
Ovarian Endometriosis ◽  
Primary Ovarian Cancer ◽  
Normal Limits ◽  
Pelvic Tumors ◽  
Ovarian Diseases

The HE-4 protein is a promising specific marker for the diagnosis of malignant pelvic tumors. The paper presents the case of a 41-year-old patient with a multi-chamber ovarian tumor several centimeters in diameter suspected to be a primary ovarian cancer or a metastatic one of gastrointestinal origin. The value of the HE-4 marker which is highly specific for an ovarian cancer was within normal limits and amounted to 24.33 pmol/L. The patient underwent surgery involving the unilateral removal of adnexa and the greater omentum during which the sample from the second ovary was collected. Histologic examination revealed ovarian endometriosis; however, diagnosis of the gastrointestinal tract did not reveal any abnormalities. The case presented also confirms the excellent sensitivity of the HE-4 marker in very difficult clinical cases, as well as its utility in the differential diagnosis of advanced endometriosis and malignant ovarian diseases.

scholarly journals Comparison of seven immunoassays for the quantification of CA 125 antigen in serum

1998 ◽  
Vol 44 (7) ◽  
pp. 1417-1422 ◽  
Author(s):  
Elvira M Davelaar ◽  
Gerard J van Kamp ◽  
Rob A Verstraeten ◽  
Peter Kenemans
Keyword(s):  
Ovarian Cancer ◽  
Clinical Performance ◽  
Correlation Coefficients ◽  
Roc Curves ◽  
Ca 125 ◽  
Serum Samples ◽  
Pelvic Tumors ◽  
Value Range ◽  
Patient Groups ◽  
Ca 125 Antigen

Abstract Seven CA 125 immunoassays were compared for their clinical performance. CA 125 concentrations were determined in 289 serum samples obtained from women with benign pelvic tumors (samples from 98 patients) and patients with various cancers (samples from 111 patients). In the range of 0–1000 kilounits/L, all assays tested were linearly correlated, with correlation coefficients ranging from 0.89 to 0.99. In relation to the original Centocor CA 125 assay, there was an overall tendency to measure higher absolute values in the lower CA 125 value range. This was not seen in relation to the Centocor CA 125 II assay. ROC curves (benign vs pretreatment ovarian cancer patients) were nearly identical for all assays, and the areas under the ROC curves were not markedly different. We conclude that the CA 125 assays tested are strongly related to each other and are clinically reliable for the quantification of serum CA 125 and that none of the assays offers higher diagnostic accuracy or better discrimination between patient groups, especially not in the lower ranges.

Total Inhibin Is a Potential Serum Marker for Epithelial Ovarian Cancer

2007 ◽  
Vol 92 (7) ◽  
pp. 2526-2531 ◽  
Author(s):  
Anastasia Tsigkou ◽  
Daniele Marrelli ◽  
Fernando M. Reis ◽  
Stefano Luisi ◽  
Agnaldo L. Silva-Filho ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Postmenopausal Women ◽  
Serum Marker ◽  
Ovarian Tumors ◽  
Ca 125 ◽  
Surgical Removal ◽  
Specific Marker ◽  
Ovarian Cancers ◽  
Blood Specimens

Abstract Context: Total inhibin is the sum of precursors, subunits, and mature molecules of inhibin, which the normal ovary nearly stops to produce after menopause, whereas ovarian tumors still release. Objective: The aim of the present study was to evaluate whether the serum concentration of total inhibin has the sensitivity/specificity characteristics to become a diagnostic test for epithelial ovarian cancer in postmenopausal women. Design: This was a controlled, cross-sectional study. Setting: The study was conducted at the University of Siena. Patients: Blood specimens were collected from postmenopausal women with: 1) epithelial ovarian cancer, stage II-III (n = 89); 2) benign ovarian tumors (n = 25); 3) breast (n = 10), colon (n = 10), and stomach (n = 10) cancers; and 4) controls (n = 95). In the group of women with epithelial ovarian cancer, blood specimens were also collected after surgical removal of the tumor. In four cases of women with stage IIC mucinous tumor, blood specimens were collected during the follow-up time. Intervention: Total inhibin was measured by a new double-antibody ELISA. Results: Women with epithelial ovarian cancers showed serum total inhibin levels significantly higher than those with benign tumor or with nonovarian tumors or controls (P < 0.001). Patients with serous (n = 40) or mucinous tumors (n = 17) showed the highest total inhibin levels (P < 0.001). At 95% specificity, the total inhibin assay detected 37 of 40 (93%) serous tumors and 16 of 17 (94%) mucinous tumors. When total inhibin was combined with CA-125, all cases of serous and mucinous tumors were detected, and the overall sensitivity for epithelial ovarian cancers was 99% at 95% specificity. A significant decrease of total inhibin levels was shown in women with serous and mucinous carcinoma as result of surgery (P < 0.001). In the four women who were followed up, recurrence was associated to an increase of total inhibin levels. Conclusions: The present data show that total inhibin is a sensitive and specific marker of epithelial ovarian cancers in postmenopausal women. Total inhibin may therefore be combined with CA-125 for noninvasive diagnosis of epithelial ovarian cancer and may also be a useful serum marker to monitor disease-free intervals.

scholarly journals Ovarian metastasis from nongynecologic primary sites: a retrospective analysis of 177 cases and 13-year experience

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Jing-Jing Zhang ◽  
Dong-Yan Cao ◽  
Jia-Xin Yang ◽  
Keng Shen
Keyword(s):  
Ovarian Cancer ◽  
Adjuvant Treatment ◽  
Cytoreductive Surgery ◽  
Ovarian Metastasis ◽  
Primary Site ◽  
Prognostic Indicators ◽  
Ca 125 ◽  
College Hospital ◽  
Primary Ovarian Cancer ◽  
Postoperative Adjuvant Treatment

Abstract Background Metastasis to the ovary from nongynecologic organs accounts for 9% of all ovarian malignancies. Although the most common nongynecologic primary site of ovarian metastasis is the gastrointestinal tract, metastasis from other sites to the ovary is not uncommon. Differential diagnosis of primary and metastatic ovarian tumors is important; otherwise, appropriate treatment cannot be determined. Furthermore, an optimal treatment strategy for ovarian metastasis from nongynecologic primary sites still needs to be explored. Methods One hundred seventy-seven patients with ovarian metastasis from nongynecologic primary sites admitted to Peking Union Medical College Hospital between May 2005 and May 2018 were retrospectively evaluated. Results The mean age was 48 years (range, 18–83). Approximately 60% of patients were premenopausal women. The two most common nongynecologic primary sites of ovarian metastasis were the colorectum (68 cases) and stomach (61 cases). In addition to the most common symptoms of abdominal distension (39.0%), abdominal pain (37.9%), and ascites (27.7%), 18.1% of patients presented with abnormal uterine bleeding. Half of the patients who tested serum CA-125 preoperatively had elevated CA-125 levels within the range of 35 U/ml to 200 U/ml. More than 70% of synchronous ovarian metastases were preoperatively misdiagnosed as primary ovarian cancer. Of all included cases, 56.5% achieved optimal cytoreductive surgery (the diameter of the largest residual lesion < 2 cm). The overall 5-year survival rate and median survival time were 10% and 20 months, respectively. The primary site, optimal cytoreductive surgery, tumor differentiation, and postoperative adjuvant treatment were identified as prognostic indicators. Conclusions The colorectum and stomach are the most common nongynecologic primary sites of ovarian metastasis. Synchronous ovarian metastasis is easily misdiagnosed as primary ovarian cancer. Optimal cytoreductive surgery and postoperative adjuvant treatment can be performed to confer survival benefit in selected patients.

scholarly journals Ovarian metastasis from nongynecologic primary sites: a retrospective analysis of 177 cases and 13-year experience

2020 ◽  
Author(s):  
Jing-Jing Zhang ◽  
Dong-Yan Cao ◽  
Jia-Xin Yang ◽  
Keng Shen
Keyword(s):  
Ovarian Cancer ◽  
Adjuvant Treatment ◽  
Cytoreductive Surgery ◽  
Premenopausal Women ◽  
Ovarian Metastasis ◽  
Primary Site ◽  
Ca 125 ◽  
College Hospital ◽  
Primary Ovarian Cancer ◽  
Postoperative Adjuvant Treatment

Abstract Background: Metastasis to the ovary from nongynecologic organs accounts for 9% of all ovarian malignancies. Although the most common nongynecologic primary site of ovarian metastasis is the gastrointestinal tract, metastasis from other sites to the ovary is not uncommon. Differential diagnosis of primary and metastatic ovarian tumors is important; otherwise, appropriate treatment cannot be determined. Furthermore, an optimal treatment strategy for ovarian metastasis from nongynecologic primary sites still needs to be explored.Methods: One hundred seventy-seven patients with ovarian metastasis from nongynecologic primary sites admitted to Peking Union Medical College Hospital between May 2005 and May 2018 were retrospectively evaluated.Results: The mean age was 48 years (range, 18 - 83). Approximately 60% of patients were premenopausal women. The two most common nongynecologic primary sites of ovarian metastasis were the colorectum (68 cases) and stomach (61 cases). In addition to the most common symptoms of abdominal distension (39.0%), abdominal pain (37.9%), and ascites (27.7%), 18.1% of patients presented with abnormal uterine bleeding. Half of the patients who tested serum CA-125 preoperatively had elevated CA-125 levels within the range of 35 U/ml to 200 U/ml. More than 70% of synchronous ovarian metastases were preoperatively misdiagnosed as primary ovarian cancer. Of all included cases, 56.5% achieved optimal cytoreductive surgery (the diameter of the largest residual lesion < 2 cm). The overall 5-year survival rate and median survival time were 10% and 20 months, respectively. The primary site, optimal cytoreductive surgery, tumor differentiation, and postoperative adjuvant treatment were identified as prognostic indicators.Conclusions: The colorectum and stomach are the most common nongynecologic primary sites of ovarian metastasis. Synchronous ovarian metastasis is easily misdiagnosed as primary ovarian cancer. Optimal cytoreductive surgery and postoperative adjuvant treatment can be performed to confer survival benefit in selected patients.

scholarly journals Correlation of Clinicopathological and Prognostic Characteristics between Endometriosis-Associated and Primary Ovarian Cancer

2021 ◽  
Author(s):  
Huimin Wang ◽  
Cong Chen ◽  
Danbo Wang ◽  
Yanmei Zhu ◽  
Peng Chen
Keyword(s):  
Ovarian Cancer ◽  
Diagnostic Criteria ◽  
Malignant Transformation ◽  
Progression Free Survival ◽  
Clinicopathological Characteristics ◽  
Ovarian Endometriosis ◽  
Reference Guide ◽  
Primary Ovarian Cancer ◽  
Cancer Group ◽  
Platinum Chemotherapy

Abstract Background: To establish the clinicopathological and prognostic correlations between endometriosis-associated and non-endometriosis-associated primary ovarian cancer, with a view to providing a reference guide for revision of diagnostic criteria for malignant transformation of endometriosis.Methods: Retrospectively collected clinicopathological and follow-up data of 174 clear cell and endometrial ovarian cancer patients. Cases were divided into endometriosis-associated and non-endometriosis-associated primary ovarian cancer, and comparative analysis of the clinicopathological characteristics and prognosis conducted.Results: Average age and proportion of menopausal patients in the endometriosis-associated ovarian cancer group were lower relative to the primary ovarian cancer group (P<0.05). Other clinicopathological features examined, including body mass index, age at menopause, operation history, dysmenorrhea, complications, tumor size, tumor side, ascites, CA125, HE4, CA199, stage, differentiation, expression of ER, PR, P53, P16, Ki67, MMR, HNF-1β and Napsin A were not significantly different between the groups (P>0.05). Furthermore, rates of resistance to platinum chemotherapy, relapse, progression-free survival and overall survival were comparable between the two groups (P > 0.05).Conclusion: Endometriosis-associated and primary ovarian cancers of the same pathological type are speculated to be homologous in terms of origin from malignant transformation of endometriosis. It may therefore be necessary to revise the diagnostic criteria for ovarian endometriosis malignancy.

scholarly journals Ultrasound and Clinical Preoperative Characteristics for Discrimination Between Ovarian Metastatic Colorectal Cancer and Primary Ovarian Cancer: A Case-Control Study

Diagnostics ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. 210
Author(s):  
Maciej Stukan ◽  
Juan Luis Alcazar ◽  
Jacek Gębicki ◽  
Elizabeth Epstein ◽  
Marcin Liro ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Ovarian Cancer ◽  
Characteristic Curve ◽  
Subjective Assessment ◽  
Ca 125 ◽  
Control Group ◽  
Tree Model ◽  
Ovarian Metastases ◽  
Primary Ovarian Cancer ◽  
Student’S T

The aim of this study was to describe the clinical and sonographic features of ovarian metastases originating from colorectal cancer (mCRC), and to discriminate mCRC from primary ovarian cancer (OC). We conducted a multi-institutional, retrospective study of consecutive patients with ovarian mCRC who had undergone ultrasound examination using the International Ovarian Tumor Analysis (IOTA) terminology, with the addition of evaluating signs of necrosis and abdominal staging. A control group included patients with primary OC. Clinical and ultrasound data, subjective assessment (SA), and an assessment of different neoplasias in the adnexa (ADNEX) model were evaluated. Fisher’s exact and Student’s t-tests, the area under the receiver–operating characteristic curve (AUC), and classification and regression trees (CART) were used to conduct statistical analyses. In total, 162 patients (81 with OC and 81 with ovarian mCRC) were included. None of the patients with OC had undergone chemotherapy for CRC in the past, compared with 40% of patients with ovarian mCRC (p < 0.001). The ovarian mCRC tumors were significantly larger, a necrosis sign was more frequently present, and tumors had an irregular wall or were fixed less frequently; ascites, omental cake, and carcinomatosis were less common in mCRC than in primary OC. In a subgroup of patients with ovarian mCRC who had not undergone treatment for CRC in anamnesis, tumors were larger, and had fewer papillations and more locules compared with primary OC. The highest AUC for the discrimination of ovarian mCRC from primary OC was for CART (0.768), followed by SA (0.735) and ADNEX calculated with CA-125 (0.680). Ovarian mCRC and primary OC can be distinguished based on patient anamnesis, ultrasound pattern recognition, a proposed decision tree model, and an ADNEX model with CA-125 levels.

What do patients think about CA-125 monitoring in the follow-up? Results from a multicenter trial in 1,060 patients with ovarian cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5522-5522
Author(s):  
G. Oskay-Oezcelik ◽  
A. du Bois ◽  
P. A. Fasching ◽  
S. Mahner ◽  
C. Liebrich ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Care ◽  
Clinical Symptoms ◽  
Survey Methods ◽  
Multicenter Trial ◽  
Ca 125 ◽  
Primary Ovarian Cancer ◽  
Primary Surgery ◽  
Physician Patient

5522 Background: In the clinical day CA-125 monitoring is frequently used as a part of follow-up care for patients with ovarian cancer (OC). However, the potential benefit of CA-125 controls in the absence clinical symptoms are still unclear.There is little known about the expectations and preferences of patients with OC. Therefore we have initiated a multi-institutional survey. Methods: A semi-structered consisting 15 questions was developed in a pilot-study of 20 patients. After this validation all gynecological departments and gynecological-oncological practices were invited to participate in this trial using an anonynomous print version of the questionaire Results: Between December 2006 and December 2007 a total of 1,060 patients were enrolled. The median age of the patients was 58 years (range 16–87). 60% of the patients had primary ovarian cancer, 40% had relapsed ovarian cancer. Routine follow-up visits were mostly performed by gynaecologists in a gynaecological practice (56.9%) and in hospitals (49.5%). Patients were informed about the procedures and goals of cancer care predominantly after primary surgery (62.5%) and in 15.7% after last cycle of first-line chemotherapy. 7.7% declared that they were informed only at the first follow-up visit, 9.2% stated that they have never received any information about their cancer care management. According the patient´s opinion the main objective for the follow-up is the early detection of relapse and a prolongation of overall survival (95.8%). About more than 90% get CA-125 measurements. These were the procedures with highest anxiety but also the most important procedure for the patient. Finally, most patients (89%) were satisfied from their management of cancer care. Conclusions: The present study is the largest survey about cancer care so far and provides several important data for physician-patient communication concerning the follow-up management of patients OC. No significant financial relationships to disclose.

scholarly journals Observational study on serum markers and circulating tumor cells in ovarian cancer

2021 ◽  
Vol 6 (3) ◽  
pp. 181-186
Author(s):  
Riddhi Jaiswal ◽  
Piyush Tripathi ◽  
Vimala Venkatesh ◽  
Pravesh Gupta
Keyword(s):  
Ovarian Cancer ◽  
Observational Study ◽  
Epithelial Ovarian Cancer ◽  
Surgical Intervention ◽  
Serum Markers ◽  
Ca 125 ◽  
Diagnostic Efficacy ◽  
Genes Expression ◽  
Ovarian Diseases ◽  
One Year

1) To detect Cyclophilin, APC and SFRP5 genes associated with Epithelial ovarian cancer by PCR. 2) To study and compare the prognostic and diagnostic efficacy of serological markers like Ca 125 and HE4 and their correlation with epithelial/ non epithelial ovarian neoplasms.Comparative observational study, Prospective study 64 cases fulfilling the inclusion criteria and giving their consent for inclusion in the study were enrolled as subjects of the present study over a period of one year. After DNA extraction (Invitrogen mini kit, USA) conventional PCR to amplify the extracted DNA and further subjected them to agarose gel electrophoresis for the identification(expression) of 3 genes i.e Cyclophillin, APC and SFRP5, was done; However, none expressed.ELISA was used to assess CA125 and HE4 pre and post surgical intervention. The serum markers were raised more in malignant epithelial ovarian cancer cases and levels plummeted after surgical intervention, as compared to benign masses. We could not establish correlation of the genes’ expression with the serum markers and histopathology. Combining HE4 and CA125 both might be more helpful than either of them using alone, in diagnosing as well as prognosticating ovarian diseases. A panel of multiple genes on a larger sample size may be needed for CTC detection.Early detection of ovarian tumors leads to early diagnosis and hence early institution of intervention and hence decreased morbidity and mortality.

scholarly journals Ovarian metastasis from non-gynecologic primary sites: a retrospective analysis of 177 cases and 13-year experience

2020 ◽  
Author(s):  
Jingjing Zhang ◽  
Dong-Yan Cao ◽  
Jia-Xin Yang ◽  
Keng Shen
Keyword(s):  
Ovarian Cancer ◽  
Adjuvant Treatment ◽  
Cytoreductive Surgery ◽  
Ovarian Tumor ◽  
Ovarian Metastasis ◽  
Prognostic Indicators ◽  
Ca 125 ◽  
Clinicopathologic Characteristics ◽  
Primary Ovarian Cancer ◽  
Postoperative Adjuvant Treatment

Abstract BackgroundMetastasis to the ovary is not rare. Generally, the most common non-gynecologic primary site of Ovarian metastasis is gastrointestinal tract. Differential diagnosis between primary malignant ovarian tumor and metastatic ovarian tumor is important, otherwise appropriate treatment cannot be determined. Furthermore, optimal treatment strategy for ovarian metastasis from non-gynecologic primary sites still are needed to explore. This study described the clinicopathologic characteristics of ovarian metastasis from non-gynecologic primary sites and identified the significance of surgical treatment for these patients. Methods One hundred and seventy-seven patients with ovarian metastasis from non-gynecologic primary sites admitted in Peking Union Medical College Hospital between May 2005 and May 2018 were retrospectively evaluated. Results The mean age was 48 years (range 18 - 83). Approximately 60% of patients were premenopausal women. The mostly two common non-gynecologic primary sites of ovarian metastasis were colorectum (68 cases) and stomach (61 cases). Besides the most common symptoms of abdominal distension (39.0%), abdominal pain (37.9%), ascites (27.7%), there were 18.1% of patients presenting with abnormal uterine bleeding. A half of patients who tested serum CA-125 preoperatively had an elevated CA-125 within the range of 35U/ml to 200U/ml. More than 70% of synchronous ovarian metastasis were misdiagnosed as primary ovarian cancer preoperatively. Of patients, 56.5% achieved optimal cytoreductive surgery (the diameter of largest residual lesion < 2 cm). The overall 5-year survival rate and median survival time were 10% and 20 months, respectively. The primary sites, optimal cytoreductive surgery, differentiation of tumor, and postoperative adjuvant treatment were prognostic indicators. Conclusions Colorectum and stomach are the most common non-gynecologic primary sites of ovarian metastasis. Synchronous ovarian metastasis is easy to be misdiagnosed as primary ovarian cancer. Optimal cytoreductive surgery and postoperative adjuvant treatment can be done to confer survival benefit in selected patients.

Serum HE4 as a Useful Biomarker in Discriminating Ovarian Cancer From Benign Pelvic Disease

2012 ◽  
Vol 22 (6) ◽  
pp. 1000-1005 ◽  
Author(s):  
Hong Zheng ◽  
Yunong Gao
Keyword(s):  
Ovarian Cancer ◽  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Area Under The Curve ◽  
Pelvic Mass ◽  
Secretory Protein ◽  
Ca 125 ◽  
Serum Samples ◽  
Ovarian Endometriosis ◽  
Premenopausal Patients

ObjectiveTo evaluate the role of the novel tumor marker human epididymal secretory protein E4 (HE4) in discriminating ovarian cancer from benign pelvic disease in patients with a pelvic mass.MethodsSerum samples from 131 patients with epithelial ovarian cancer (EOC) and 126 patients with various benign pelvic diseases were collected preoperatively and tested for cancer antigen (CA)125 and HE4 levels. Receiver operator characteristic curves were constructed, and the area under the curve (AUC) was compared between the markers.ResultsThe median CA125 and HE4 levels were significantly higher in the patients with EOC than in those with benign disease (P < 0.001). Using benign controls as the comparison group for all cases, the AUC for combined HE4 and CA125 (0.955) was significantly higher than that for HE4 (0.941) or CA125 alone (0.924; P < 0.05). A comparison of premenopausal benign controls to EOC cases showed that the AUC for combined HE4 and CA125 (0.97) was significantly higher than that for CA125 (0.93; P < 0.004). The AUC for HE4 was significantly higher compared to that of CA125 in discriminating EOC from ovarian endometriosis (0.969 vs 0.904; P = 0.014) and pelvic inflammatory disease (0.909 vs 0.819; P = 0.034).ConclusionSerum HE4 testing is a more powerful tool than CA125 assay to discriminate EOC from ovarian endometriosis and pelvic inflammatory disease. For patients with a pelvic mass, especially premenopausal patients, the serum concentration of HE4 adds valuable information to CA125 in identifying patients with EOC from those with benign pelvic disease.

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