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Tumor Marker

This document discusses ovarian cancer markers CA-125 and HE4. It provides information on using the markers to evaluate ovarian masses, monitor recurrence of epithelial ovarian cancer, and assess prognosis. It also describes test methodology, interpretation of results, disease overview and limitations of the markers.

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Nana Setiawan
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73 views2 pages

Tumor Marker

This document discusses ovarian cancer markers CA-125 and HE4. It provides information on using the markers to evaluate ovarian masses, monitor recurrence of epithelial ovarian cancer, and assess prognosis. It also describes test methodology, interpretation of results, disease overview and limitations of the markers.

Uploaded by

Nana Setiawan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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APRIL 2014 | 2014 ARUP LABORATORIES | ARUP is a nonprofit enterprise of the University of Utah and its Department of Pathology.

500 Chipeta Way, Salt Lake City, UT 84108 | (800) 522-2787 | (801) 583-2787 | www.aruplab.com | www.arupconsult.com
Ovarian Cancer Markers
Indications for Ordering
Adjunct tests for evaluation of an ovarian mass
Monitor for recurrence in women with epithelial ovarian
cancer
Test Description
Cancer Antigen 125 (CA-125)
Quantitative electrochemiluminescent immunoassay
Human Epididymis Protein 4 (HE4)
Quantitative enzyme immunoassay
Tests to Consider
Primary tests
Cancer Antigen 125 0080462
Evaluation and monitoring of ovarian cancer (usually
epithelial subtype)
o Use for monitoring requires elevated pretreatment
value of CA-125
o Combination with HE4 may enhance sensitivity
Human Epididymis Protein 4 (HE4) 2003020
May be used in conjunction with CA-125 for monitoring of
ovarian cancer (usually epithelial subtype)
o Requires elevated pretreatment value of CA-125
Not recommended for monitoring patients with known
mucinous or germ-cell ovarian cancer
Related tests
Granulosa cell tumors
Inhibin B 0070413
Estradiol, Adult Premenopausal Female, Serum or
Plasma 0070045
o Monitor mucinous subtype tumors with concurrent CA-
125 measurements
Germ cell tumors
Alpha Fetoprotein, Serum (Tumor Marker) 0080428
Neuron Specific Enolase 0098198
Beta-hCG, Quantitative (Tumor Marker) 0070029
Disease Overview
Incidence
Ovarian cancer >22,000 new cases and >14,000 deaths
annually
o Epithelial subtype 40/100,000 for postmenopausal
women
Diagnosis
Markers cannot be used to diagnose ovarian cancer
Markers may be useful in evaluation of a pelvic mass in
postmenopausal women
Prognosis
Pretreatment CA-125 and HE4 levels are highly predictive
of overall survival
Pathophysiology
CA-125
o Secreted in tumors of epithelial origin (~80% of tumors)
o Frequency of elevation of CA-125 correlates with
Clinically detected stage of cancer (higher elevation of
CA-125 levels in later stages)
Tumor burden (correlates with stage)
Type of tumor (usually in epithelial tumors)
HE4
o Secreted in tumors of epithelial origin (~80% of tumors)
o Relapse
HE4 increases by 25% in 60% of women with ovarian
cancer relapse or progression
HE4 remains constant in 75% of women without
progression of ovarian cancer
Monitoring
CA-125
o Uses
Evaluate ovarian mass
Determine pretreatment level for use in monitoring
Assess patient response to chemotherapy
Detect early relapse
o Suggested monitoring is every 2-4 months for the first 2
years
o Absolute serum value of CA-125 before third cycle of
chemotherapy is most important factor for predicting
progression at 12 months
o Persistent postoperative elevation suggests poor
prognosis
HE4
o May be complementary for monitoring when used in
conjunction with CA-125
o May be useful because some individuals do not have
elevated CA-125 level but will manifest with elevated
HE4 level

APRIL 2014 | 2013 ARUP LABORATORIES
Test Interpretation
Results
CA-125
o Normal <35 U/mL
Ovarian cancer less likely but not ruled out
In patients with ovarian cancer, a rising level from
individuals baseline level may reflect progression of
disease
o Abnormal 35 U/mL
Ovarian cancer possible if clinical suspicion is high
The higher the level, the more probable the mass is
malignant
HE4
o Normal 150 pmol/L
HE4 remains constant in 75% of women without
disease progression
An elevation in HE4 concentration of 25% is clinically
significant even if within the normal range
An increase of this magnitude suggests recurrence or
disease progression
o Abnormal >151 pmol/L
An increase of 25% suggests recurrence or disease
progression
HE4 increases by 25% in 60% of women with
ovarian cancer relapse or progression
The higher the level, the more probable the mass is
malignant
A decrease of 25% suggests therapeutic response
Limitations
CA-125 and HE4 tests are not useful in cancer screening
Individuals with confirmed ovarian carcinoma may have
pretreatment CA-125 value in the same range as healthy
individuals
CA-125 levels may be elevated in patients with
nonmalignant disease
Test values for CA-125 are not interchangeable between
different laboratories or test platforms
o Sequential monitoring should be performed at the same
laboratory

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