Tumor Markers for Ovarian Cancer

Introduction to Tumor Markers

The British Journal of Cancer recommends that CA-125 be measured before surgery and before the start of chemotherapy in all patients with suspected ovarian cancer 1, 2

The National Comprehensive Cancer Network recommends that CA-125 be measured in all patients with suspected ovarian cancer, with a specificity of 98.5% in women over 50 years old when using a threshold of 35 U/mL 3
CA-125 is elevated in approximately 80-90% of serous carcinomas (low and high grade) 4
The American College of Obstetricians and Gynecologists notes that CA-125 has a critical limitation: it only detects 50% of ovarian cancers in stage I, so a normal level does not exclude early cancer 3
The British Journal of Cancer recommends that CA-125 be measured before each of the six cycles of chemotherapy and one month after the last cycle to monitor response to treatment 1, 2

The British Journal of Cancer recommends that other markers be measured when CA-125 is not elevated, especially in mucinous or endometrioid tumors 1, 2
The National Comprehensive Cancer Network recommends that CA 19-9 be measured when CA-125 is normal, particularly in clear cell tumors, teratomas, and mucinous tumors 1, 2

The Journal of the National Comprehensive Cancer Network notes that HE4 and other markers (mesothelin, B7-H4, DcR3, spondin-2) do not increase early enough to be useful in the detection of early-stage ovarian cancer 5, 6

The British Journal of Cancer recommends that additional markers be measured in young women to exclude germ cell tumors, including alpha-fetoprotein (AFP) and beta-HCG 1, 2

The Journal of the National Comprehensive Cancer Network notes that the OVA1 test (which uses 5 markers: transthyretin, apolipoprotein A1, transferrin, beta-2 microglobulin, and CA-125) should not be used as a screening tool according to the Society of Gynecologic Oncologists and the FDA 5, 6

The Praxis Medical Insights recommends that CA-125 results be interpreted in conjunction with clinical, imaging, and histological findings, as false positives can occur in multiple benign conditions, including endometriosis, adenomyosis, pelvic inflammatory disease, and benign ovarian cysts 3, 4
The National Comprehensive Cancer Network notes that a progressively elevated CA-125 level over time, even within the normal range, should prompt further evaluation as it may indicate malignancy 3

The National Comprehensive Cancer Network recommends measuring alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (beta-hCG) in young women, particularly those under 35 years, to exclude germ cell tumors 7

The National Comprehensive Cancer Network suggests that alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (beta-hCG) should be measured in young women to exclude germ cell tumors 7

The Society of Gynecologic Oncologists and FDA recommend that the OVA1 test should NOT be used as a screening tool for ovarian cancer 8, 9
The OvaSure test requires additional validation before use outside clinical trials, according to the National Comprehensive Cancer Network 8

The National Comprehensive Cancer Network states that currently, no effective and sensitive screening test for ovarian cancer is available, and none is recommended by NCCN or any major organization 10
The PLCO trial found that screening with transvaginal ultrasonography and CA-125 did not decrease mortality from ovarian cancer, and false-positive screening results led to serious complications in some women 10