Transcript Menopausal status is scored as

Ovarian tumor
markers
Fariba Behnamfar
Associate Professor
Esfahan University of Medical
Sciences
CA 125 antigen
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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
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•
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
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•
•
•
•
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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.
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
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•
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
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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
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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 antiMüllerian hormone), which can serve as
diagnostic markers
=