Cancer Marker for Fallopian Tube Cancer
CA-125 is the primary cancer marker used for fallopian tube cancer, though it is neither specific nor sensitive enough for screening purposes. 1, 2
Primary Tumor Marker: CA-125
CA-125 is the most commonly used tumor marker for fallopian tube cancer, as these malignancies are managed identically to epithelial ovarian and primary peritoneal cancers. 1
CA-125 demonstrates powerful predictive value in postmenopausal women: a concentration ≥30 U/mL increases the relative risk of developing fallopian tube or ovarian cancer 14.3-fold within five years, and ≥100 U/mL increases risk 74.5-fold. 2
However, CA-125 is not recommended for screening even in high-risk women with family history, as the PLCO trial showed no mortality benefit and significant harms from false-positive results (positive predictive value only 1-2%). 3
Emerging Marker: HE4
HE4 (human epididymis protein 4) is increasingly recognized as a complementary marker for fallopian tube cancer follow-up and recurrence detection. 4
A dynamic increase of 15 pmol/L in HE4 from baseline demonstrates 74% sensitivity and 92% specificity for predicting relapse up to three months before CT scan detection. 4
Dynamic changes in both HE4 and CA-125 are more valuable than static cut-off values for early relapse detection in advanced-stage disease. 4
Clinical Application in Your Patient
For a postmenopausal woman with family history of fallopian tube cancer:
Baseline CA-125 measurement is appropriate if she develops suspicious symptoms (bloating, pelvic pain, abdominal distention, early satiety, or urinary urgency/frequency). 1
Routine screening with CA-125 is not recommended despite family history, as the USPSTF gives a Grade D recommendation against ovarian cancer screening due to harms outweighing benefits. 3
Genetic counseling and BRCA1/2 testing should be prioritized instead of marker-based screening, as 11% of fallopian tube cancer patients carry BRCA1 mutations and 5% carry BRCA2 mutations (28% if diagnosed at age ≤55). 5
Important Caveats
No marker is specific for fallopian tube cancer alone - CA-125 and HE4 are elevated in ovarian, fallopian tube, and primary peritoneal cancers, which are grouped together clinically. 1, 4
Other markers may be indicated based on histology: inhibin, β-hCG, AFP, LDH, and CEA are used for specific tumor subtypes (particularly germ cell and sex cord-stromal tumors). 1
WT1 immunohistochemistry is useful for confirming serous histology (80-90% positive in high-grade serous carcinomas of fallopian tube origin), but this is a tissue marker, not a serum marker. 1
Recommended Approach
Instead of marker-based screening, your patient should:
Undergo genetic risk evaluation with BRCA1/2 testing given her family history. 1, 5
Consider risk-reducing bilateral salpingo-oophorectomy if BRCA mutation is identified, which reduces risk by 80-90%. 1
Be educated about symptoms requiring immediate evaluation rather than relying on screening tests. 3
If she develops a pelvic mass or concerning symptoms, CA-125 should be measured alongside transvaginal ultrasound and CT/MRI imaging. 1