Screening in Ovarian Neoplasm

Ovarian neoplasm is extremely aggressive and has a high mortality rate among affected women; therefore, the crucial role of screening tests is easy to understand. Prevention and early diagnosis should be essential priorities in the management of this malignancy. Since a complete and correct clinical examination can select the cases that require specialized investigations, we can consider it a first screening test.


Dosage of tumor markers: -CA 125
It represents a repetitive epitope protein of MUC-16 with a role in supporting neoplastic cell proliferation and inhibiting the antitumor immune response.
It is the most widely used tumor marker in the screening of ovarian neoplasm. * Phone: (+40)722353789 90% of patients with advanced ovarian neoplasm have elevated concentrations because this marker is released by tumor cells from serum-modified ovarian epithelium through stimulation by alpha TNF and gamma IFN [6].
Because CA 125 can also be secreted by unmodified malignant cells, it may also have increased concentrations in benign pathologies, eg, uterine fibroids, functional or endometriotic ovarian cysts, inflammatory pelvic diseases. Therefore, it cannot be used singly in the screening of ovarian neoplasm. As a reference value, the upper limit of normal is 35 U / mL [7].
Thus, the paraclinical combination between imaging and CA125 dosing is much more useful than single dosing of tumor markers, especially in advanced stages of the disease. For stages I and II of the disease it seems that the imaging investigations were superior to the CA125 dosage for raising the suspicion of malignancy [8].
As it has been shown statistically that ovarian neoplasm has an important recurrence rate (with localization, especially locoregional, intraperitoneal), the CA 125 marker accompanied by imaging investigations (especially PET-CT) is used in the post-operative follow-up of patients. Most of them have high levels of CA 125, except for patients with extraperitoneal recurrence: distant dissemination at lung or brain level [9].
Considering that CA 125 may be normalized after preoperative neoadjuvant chemotherapy (in the advanced stages of the disease), it was found that an increase in its postoperative status is not systematically associated with the suspicion of disease recurrence [10].
Recently, some special laboratory immunological methods have been investigated to detect very low serum concentrations of CA125 in plasma. Specifically, the method consists in isolating anti-CA125 antibodies on the biointerface of graphene-modified nanoparticles with silver nanoparticles (Ag Nps-GQDs). In fact, this could greatly help in the early detection of the disease, and even its recurrence, with prompt treatment [11].
Score ROMA It is formed by correlating the preoperative CA 125 and HE4 concentrations, depending on the reproductive status of the woman (pre or postmenopausal) and represents a profile for estimating the risk of ovarian cancer. HE4 is the human epididymal protein 4, with strong expression in the cell lines from ovarian tumors and with much lower variability than CA125 in benign conditions. It was approved as a marker in ovarian neoplasm by the FDA in 2008. This algorithm has the main role of calculating the probability of detecting an intraoperative malignant ovarian process.
Isolated dosage of HE4 in high concentrations in the ascites fluid of patients with ovarian neoplasm represents an adverse prognostic factor in the postoperative evolution of the disease (risk of relapse of the ascites fluid), correlating with an increased resistance to neoadjuvant chemotherapy. Also, the serum dosage as well as the ascites fluid of the two tumor markers, can help to individualize and improve the therapeutic management of the disease [13].

Score Roca
It represents a calculation algorithm, composed of the following criteria: age, reproductive status, risk status (genetic or family histor y mutations) and serial determinations of CA125. This test has a sensitivity of 85.8% and has been shown to have much greater accuracy of detection, especially for stage I and II disease, compared to single CA 125. Test values: it appreciates the numerical risk and the classification in normal, intermediate and high. In the case of intermediate and high classes, it is recommended to scan the ovaries and repeat the test at 3 months and 6 weeks respectively [14;15].
-Other tumor markers used may also be: CEA, CA 15-3, Alpha-fetoprotein (with overexpression especially in young patients) and Inhibin A (with overexpression especially in tumors of sexual cord cells).
-Given that single dosing of CA125 marker was associated with omission of suspected ovarian neoplasm, a more complex algorithm for dosing multiple tumor markers was proposed, so that the rate of ovarian cancer detection in early stages of disease may increase. Therefore, following a study in which 16 serum biomarkers were tested in 101 ovarian cancer patients and 92 healthy patients, it was found that the dosage of the following biomarkers was associated with a significantly improved disease detection rate: HE4-ELISA, PDGF-AA (Platelet Derivered Growth Factor), Prolactin, TTR (Transtyretin) [16].

Transvaginal ultrasound
Combining transvaginal ultrasound with biomarker dosing is the best choice for ovarian cancer screening.
Given that some patients are unfortunately evaluated, either by dosing CA125 or by transvaginal ultrasound, it was found that patients who underwent ultrasound examination had suspected ovarian neoplasm had a much worse prognosis than those who had suspected disease based strictly on a modified CA125 [17][18][19][20][21][22].