From the Guidelines
Tumor markers for ovarian cancer primarily include CA-125, with levels above 35 U/mL considered elevated, though it's not specific to ovarian cancer and can be elevated in other conditions like endometriosis or pregnancy, as noted in the study by 1. The use of CA-125 as a tumor marker is supported by its high correlation with the clinical course of the patient during chemotherapy, as well as its ability to predict tumor recurrence in patients who are clinically tumor free 1. Other tumor markers, such as CA-19-9 and carcinoembryogenic antigen (CEA), can also be elevated with epithelial ovarian neoplasms, but have limited specificity individually 1. Key points to consider when using tumor markers for ovarian cancer include:
- CA-125 is the most widely used marker, but it is not specific to ovarian cancer and can be elevated in other conditions
- A high CA-125/CEA ratio has been shown to optimize specificity for ovarian versus gastrointestinal primary neoplasms 1
- Tumor markers are most valuable for monitoring treatment response and detecting recurrence rather than initial diagnosis
- Regular monitoring of CA-125 can detect disease progression an average of 3-4 months before clinical symptoms appear, highlighting the importance of ongoing surveillance in patients with ovarian cancer 1. It is essential to interpret tumor markers alongside imaging studies and clinical findings, as no single marker is perfectly sensitive or specific for ovarian cancer.
From the Research
Tumor Markers for Ovarian Cancer
The following tumor markers have been identified as valuable tools in the diagnosis and management of ovarian cancer:
- CA-125: the most widely used tumor marker for ovarian epithelial cancer 2
- CA15-3: a tumor marker that can be used in combination with CA-125 for improved sensitivity and specificity 3
- CA 19-9: a tumor marker that can be elevated in certain types of ovarian cancer, including clear cell tumors and teratomas 4
- HE4: a tumor marker that can be used in combination with CA-125 for improved sensitivity and specificity, particularly in early-stage detection 3, 5
- hCG: a tumor marker that can be used as a prognostic marker, aiding treatment response prediction and outcome assessment 3
- Inhibin: a tumor marker that can be used in the diagnosis and management of ovarian cancer 3
- AFP: a tumor marker that can be elevated in certain types of ovarian cancer, including germ cell tumors 3
- LDH: a tumor marker that can be elevated in certain types of ovarian cancer, including dysgerminomas 3
Combination of Tumor Markers
Combining multiple tumor markers can improve sensitivity and specificity in ovarian cancer diagnosis:
- CA-125 and HE4: a combination that shows improved sensitivity and specificity, particularly in early-stage detection 3, 5
- ROMA (Risk of Ovarian Malignancy Algorithm) value: a combination of CA-125 and HE4 that can be used to distinguish malignant and borderline tumors from benign tumors 5
Clinical Usefulness of Tumor Markers
Tumor markers can be used in various clinical settings, including: