Everything You Need To Know About Ovarian Cancer Diagnosis

Women have to deal with a complete set of gynaecological cancers unique to their biology. These include cancers of the female reproductive system namely the uterus, cervix and ovaries. Ovarian cancer is the 5th most common cause of cancer deaths in women globally. It also has the highest death rate among all gynaecological cancer. There are various risk factors for ovarian cancer, some of the important ones include family history, 65 years of age, early onset menstrual cycle, late menopause, infertility, obesity, women on hormone replacement therapy and those who have breast care or are above the age of 65 years.

Signs and symptoms of ovarian cancer are frequently absent or very subtle in the early stages. Hence, most women are diagnosed with cancer only at a later stage.

Symptoms range from

• Pain in the pelvis
• Back pain
• Pain during sexual intercourse
• Feeling bloated
• Abdominal swelling/discomfort
• Loss of appetite
• Increased urinary frequency
• Breathlessness

Diagnosis of ovarian cancer

1. CA-125 is a screening and monitoring test. It should be noted that CA-125 may also be elevated in cancers of pancreas, breast, bladder, lung and in benign conditions like menstruation, pregnancy, fibroids, ovarian cysts, pelvic inflammation and endometriosis. Levels of CA 125 are high in about 85% women with ovarian cancer. If the CA125 value is greater than 200 u/ml and 35 u/ml in premenopausal and postmenopausal women respectively, then the likelihood of the disease is unlikely. CA125 is usually combined with transvaginal sonography or rectovaginal pelvic examination for a more accurate diagnosis.

Also read: How Is Ovarian Cancer Diagnosed? Everything You Need To Know

2. ROMA index: Risk of ovarian malignancy algorithm

It is the most promising marker for ovarian cancer. The ROMA score can be used by a healthcare practitioner prior to surgery to help determine whether a lump in the pelvis (pelvic mass) is likely to be malignant or not. The test is not intended to be used for screening. The test assigns a risk value that is numerical basis the below parameters

• CA 125 value (cancer antigen 125)
• HE4 value (Human Epididymis protein 4)
• Menopause status

A change in HE4 level of less than or equal to 25% is considered significant. Elevated HE4 levels are associated with ovarian cancer but are not disease-specific. It can also rise in healthy women with hypertension and non-cancerous gynaecological diseases.

ROMA is applied for women who meet the following criteria:

• older than age 18,
• presenting with an adnexal mass for which surgery is planned,
• patients who have not yet been referred to an oncologist

The ROMA assessment is to be interpreted in conjunction with clinical and radiological assessment.

3. CA-72.4: It is elevated in cancer of pancreas, stomach, gall bladder, colon, ovaries, cervix and endometrium. It is an independent marker for the therapeutic monitoring and follow up care of ovarian patients and in particular CA125 negative patients.

4 CEA: It is a non-specific marker which is increased in ovarian tumours, along with tumours of lung, breast, and liver.

Also read: Ovarian Cancer Is Deadly, But New Tests, Treatments Start To Emerge

5. Peritoneal wash and histopathological examination of ovarian cancer: Examination of fluid collected in abdominal cavity to look for tumour cells, histopathological examination of tumour mass and immunohistochemistry for staging and grading of tumour for appropriate therapy.

6. NGS for hereditary breast and ovarian cancer syndrome (HBOC):

The syndrome is characterised by early onset cancers of breast, ovary and other organs like pancreas, prostate, melanomas. It is associated with over 2600 mutations in BRCA 1 and 2 genes. It is helpful in early detection and screening of family members of affected individuals, early clinical intervention, and benefits of certain specific treatment modalities. Pre and post-test genetic counselling are very important before and after BRCA analysis.

(Dr. Kirti Chadha is Histopathologist/Surgical Pathologist and  Senior Vice President, Medical Affairs, Metropolis)

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