abstract: Risk of Malignancy in Sonographically Confirmed Ovarian Tumors

Abstract

Ovarian cancer is the leading cause of gynecologic cancer death in the United States. Once an ovarian tumor is identified, a pelvic ultrasound is recommended, including tumor volume and tumor structure. Unilocular and simple septate tumors are unlikely to be malignant and when asymptomatic, can be safely followed conservatively without surgery. Complex ovarian tumors are at an increased risk for malignancy and secondary testing is recommended. Secondary testing may include CA125, OVA1, the RMI, ROMA, or the ACOG referral guidelines. When secondary testing indicates that an ovarian tumor is at high risk for malignancy, referral to a gynecologic oncologist is recommended.

open access: TB Peritonitis Mistaken for Ovarian Carcinomatosis Based on an Elevated CA-125

Discussion

"In this patient, the delay in the diagnosis of tuberculous pertitonitis resulted in what may have been unnecessary radical resection of her reproductive organs. This was unfortunate as peritoneal TB is felt to be medically manageable with the standard four-drug antituberculous regimen for 6 months with the expectation that symptoms will start improving after the first week of therapy [2, 6]. If surgery is indicated, delayed surgery following medical management significantly reduces complications [3]........This case outlines the unfortunate consequences of the misdiagnosis of what probably was an antibiotic responsive illness, resulting in an unnecessarily aggressive surgical procedure."

also:

Two Cases of Ascites. - The Hong Kong Society for Infectious ...

www.hksid.org/pdf/twocasesofascites.pdf -

abstract: Changes in serum CA-125 can predict optimal cytoreduction to no gross residual disease in patients with advanced stage ovarian cancer treated with neoadjuvant chemotherapy

Objective

To evaluate the predictive power of serum CA-125 changes in the management of patients under going neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) for a new diagnosis of epithelial ovarian carcinoma (EOC).

Methods

Using the Cancer Registry databases from our institutions, a retrospective review of patients with FIGO stage IIIC and IV EOC who were treated with platinum-based NACT-IDS between January 2006 and December 2009 was conducted. Demographic data, CA-125 levels, radiographic data, chemotherapy, and surgical-pathologic information were obtained.

Results

One hundred-three patients with stage IIIC or IV EOC met study criteria. Median number of neoadjuvant cycles was 3. Ninety-nine patients (96.1%) were optimally cytoreduced. Forty-seven patients (47.5%) had resection to no residual disease (NRD). The median CA-125 at diagnosis and before interval debulking was 1749 U/mL and 161 U/mL, respectively.

Comparing patients with NRD (no residual disease)  v. optimal macroscopic disease (OMD), there was no statistical difference in the mean CA-125 at diagnosis (1566 U/mL v. 2077 U/mL, p = 0.1).

There was a significant difference in the mean CA-125 prior to interval debulking, 92 v. 233 U/mL (p = 0.001).

In the NRD group, 38 patients (80%) had preoperative CA-125 ≤ 100 U/mL compared to 33 patients (63.4%) in the OMD group (p = 0.04).

Conclusions

 Patients who undergo NACT-IDS (neoadjuvant chemotherapy followed by interval debulking surgery) achieve a high rate of optimal cytoreduction. In our series, after treatment with taxane and platinum-based chemotherapy, patients with a preoperative CA-125 of ≤ 100 U/mL were highly likely to be cytoreduced to no residual disease.

Highlights

► Patients with advanced ovarian cancer treated with neoadjuvant chemotherapy have high rates of optimal cytoreduction.
► Preoperative CA-125 < 100 may indicate a high probability of debulking to no gross residual disease.
► A drop of > 80% in CA-125 during neoadjuvant treatment may suggest platinum sensitive disease.

abstract: Predictive value of serum CA-125 levels in patients with persistent or recurrent epithelial ovarian cancer or peritoneal cancer treated with Bevacizumab (Avastin) Gynecologic Oncology Group phase II trial

Purpose

To compare two methods of determining therapeutic response and disease progression — modified Gynecologic Cancer Intergroup (GCIG) criteria based on CA-125 and Radiographic Evaluation Criteria in Solid Tumors (RECIST), in a phase II trial of bevacizumab for patients with recurrent or persistent epithelial ovarian and peritoneal carcinoma.

Results

Sixty-two patients were evaluable by RECIST, 59 for progression by CA-125, and 45 for response by CA-125..........

Conclusions

In this study, disease assessment by RECIST and CA-125 appears to correlate in general. However, approximately 10% of patients might demonstrate progression earlier by CA-125.

---

Highlights

► CA125-defined response and progression were assessed for women with recurrent ovarian cancer.
► CA125 and RECIST-defined response and progression correlated in most cases, but CA125 progression significantly preceded RECIST in 8 cases.
► CA125-defined response to bevacizumab was associated with a statistically significant correlation with overall survival.

(still) recruting: Official Title: Use of the CA 125 Algorithm for the Early Detection of Ovarian Cancer in Low Risk Women - ClinicalTrials.gov

Early Detection of Ovarian Cancer - Official Title: Use of the CA 125 Algorithm for the Early Detection of Ovarian Cancer in Low Risk Women

This study is currently recruiting participants.

Verified January 2012 by M.D. Anderson Cancer Center

First Received on October 3, 2007. Last Updated on January 13, 2012 History of Changes

Vignette-Based Study of Ovarian Cancer Screening: Do U.S. Physicians Report Adhering to Evidence-Based Recommendations?

Abstract

"Background: No professional society or group recommends routine ovarian cancer screening, yet physicians' enthusiasm for several cancer screening tests before benefit has been proven suggests that some women may be exposed to potential harms.

Objective: To provide nationally representative estimates of physicians' reported nonadherence to recommendations against ovarian cancer screening.

Design: Cross-sectional survey of physicians offering women's primary care. The 12-page questionnaire contained a woman's annual examination vignette and questions about offers or orders for transvaginal ultrasonography (TVU) and cancer antigen 125 (CA-125).........."

How the CA-125 became a $50,000 blood test (blog) including public/professional responses

How the CA-125 became a $50,000 blood test

abstract: Physician Knowledge and Awareness of CA-125 as a Screen for Ovarian Cancer in the Asymptomatic, Average-Risk Population - CDC study

Physician Knowledge and Awareness of CA-125 as a Screen for

Abstract

Effective early detection strategies for ovarian cancer do not exist. 

Current screening guidelines recommend against routine screening using CA-125 alone or in combination with transvaginal ultrasonography (TVS). 

In this study, the authors used the 2008 DocStyles survey to measure clinician beliefs about the effectiveness of CA-125 and TVS in the asymptomatic, average-risk population in the United States. 

To assess the need for provider education, the authors used the 2008 HealthStyles survey to examine public awareness of CA-125. 

Of 1,250 physician respondents, 40.4% said both CA-125 and TVS were effective screens, and 28.3% said neither was an effective ovarian cancer screen in the asymptomatic, average-risk population. 

Obstetrician/gynecologists [OB/GYNs] more often had responses consistent with current guidelines: 56.5% of OB/GYNs, compared with 34.4% and 29.8% of family/general practitioners and internists, respectively, said neither CA-125 nor TVS was an effective screen. 

Almost one third of women (patients/the public) surveyed reported having heard of CA-125, and about one tenth said they had the CA-125 test. 

These findings support the need for additional provider education. Educational efforts should include lack of evidence for, as well as the potential harms of, screening for ovarian cancer with CA-125.

(UK) Minister denies (ovarian) cancer test pressure - GP online

Blogger's Note: assumption: the ovarian 'cancer test' refers to the CA-125

abstract: Reference ranges for HE4 and CA125 in a large Asian population by automated assays and diagnostic performances for ovarian cancer

"The new automated HE4 assay showed good analytical and diagnostic performances. The reference limits established in our study could be used as cutoff levels to facilitate more accurate diagnosis of ovarian cancer in Asian population."

Access : CA-125 can be part of the tumour evaluation criteria in ovarian cancer trials: experience of the GCIG CALYPSO trial : British Journal of Cancer

Background:

CA-125 as a tumour progression criterion in relapsing ovarian cancer (ROC) trials remains controversial. CALYPSO is a large randomised trial incorporating CA-125 (GCIG criteria) and symptomatic deterioration in addition to Response Evaluation Criteria in Solid Tumours (RECIST) criteria (radiological) to determine progression.

......In patients with CA-125 first progression who subsequently progressed radiologically, a delay of 2.3 months was observed between the two progression types......

Conclusion:

CA-125 and radiological tests performed similarly in determining progression with C-PLD (carboplatin-pegylated liposomal doxorubicin) or C-P (carboplatin–paclitaxel). Additional follow-up with CA-125 measurements was not associated with overtreatment.

Emergence of CA125 Immunoreactivity in Recurrent or Metastatic Primary Ovarian Mucinous Neoplasms of the Intestinal Type : eClips Consult

BLOG CA-125: What is it good for? By David Holtz, MD | January 10, 2012

UK - Ovarian cancer test news is misunderstood says gynaecological cancer charity The Eve Appeal | CA125/NICE guidelines

"In light of recent media coverage following the introduction of new NICE guidelines on ovarian cancer, The Eve Appeal and UCL Gynaecology Cancer Research Centre are concerned that women are misunderstanding the advice recently reported on CA125 blood tests. ..."

abstract: Value of FDG PET/CT in Patients with Treated Ovarian Cancer and Raised CA125 Serum Levels

CONCLUSION:
PET/CT was able to detect active disease at relatively low levels of CA125, thereby facilitating the early diagnosis of recurrence or residual disease. Also in patients with low CA125 levels (<30).

media item: New Clues to Treating Ovarian Cancer Relapse

New Clues to Treating Ovarian Cancer Relapse
Starting chemotherapy when first signs reappear not especially effective, study finds "This paper, the first randomized trial to look at the timing of chemo in women with recurring ovarian cancer, appears in the Oct. 2 issue of The Lancet, a special themed issue on cancer...."

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61268-8/abstract
SOURCES: Andrew Berchuck, M.D., director, division of gynecologic oncology, Duke University Medical Center, Durham, N.C.; Robert A. Burger, M.D., professor of surgical oncology, section of gynecologic oncology and director, Women's Cancer Center, Fox Chase Cancer Center, Philadelphia; Oct. 2, 2010, The Lancet

Cancergazing? CA125 and post-treatment surveillanc... [Soc Sci Med. 2010] - PubMed result

Soc Sci Med. 2010 Aug 26

Cancergazing? CA125 and post-treatment surveillance in advanced ovarian cancer.

Jordens CF, Morrell B, Harnett P, Hobbs K, Mason C, Kerridge IH.

Centre for Values, Ethics and the Law in Medicine, The University of Sydney, Sydney, NSW, Australia.

Abstract

Post-treatment surveillance of advanced ovarian cancer involves regular testing of asymptomatic patients using the CA125 test. This practice is based on a rationale that is not supported by evidence from clinical trials. This paper aims to stimulate critical reflection concerning the effect of investigative tests on clinical decisions and interactions, and the experience of illness, particularly in the context of advanced malignant disease. Drawing on the idea of the "medical gaze", and building on previous health communication research, we present an analysis of in-depth interviews and psychometric tests collected in a prospective study of 20 Australian women with advanced ovarian cancer conducted between 2006 and 2009. We describe the demands placed on patients by the use of the CA125 test, some hazards it creates for decision-making, and some of the test's subjective benefits. It is widely believed that the CA125 test generates anxiety among patients, and the proposed solution is to educate women more about the test. We found no evidence that anxiety was a problem requiring a response over and above existing services. We conclude that the current debate is simplistic and limited. Focussing on patient anxiety does not account for other important effects of post-treatment surveillance, and educating patients about the test is unlikely to mitigate anxiety because testing is part of a wider process by which patients become aware of a disease that - once it has relapsed - will certainly kill them in the near future.

Cancer Newsline - CA-125 Change Over Time Shows Promise for Early Detection of Ovarian Cancer - MD Anderson Cancer Center

CA-125 Change Over Time Shows Promise for Early Detection of Ovarian Cancer

Cancer Newsline 

Evaluating its change over time, CA-125, the protein long-recognized for predicting ovarian cancer recurrence, now show promise as a screening tool for early stage disease. Karen Lu, M.D., and Robert Bast, M.D., discuss their study highlighted at the year's American Society of Clinical Oncology (ASCO) conference.
Guest(s): Karen Lu, M.D., Robert Bast, M.D.

• Listen to CA-125 Change Over Time Shows Promise for Early Detection of Ovarian Cancer
• Download CA-125 Change Over Time Shows Promise for Early Detection of Ovarian Cancer on iTunes U

In research - Georgia Tech Team Claims 100 Percent Accuracy for Metabolomic Ovarian Cancer Test in Initial Trial ProteoMonitor GenomeWeb

........"In ovarian cancer, the single protein that's commonly used [as a biomarker], CA-125, is not a very accurate test," he said. "The reason for that is that all cancers are variable. So if you're relying on a single biomarker, it's very unlikely that that single biomarker will be 100 percent accurate or even 99 or 95 percent accurate."
"Even going from one to five [biomarkers] increases accuracy tremendously. In our case we're using at the minimum 2,000 to 3,000 features. That should in theory give us an even higher degree of accuracy," he said.
By comparison, most protein-based tests that are commercially available or under development use a handful of markers. Vermillion's OVA1, for example, analyzes five protein markers, including CA-125. The HealthLinx OvPlex test also uses five proteins, including CA-125, and the company is currently evaluating two additional markers to add to the test (PM 6/18/2010)....cont'd

Current clinical use of biomarkers for epithelial ovarian cancer (abstract)

SUMMARY:
For more than 25 years CA125 has been the main biomarker for the management of women with EOC. Recently, novel biomarkers have become available clinically that improve upon the use of CA125 for the risk assessment and management of women with ovarian cancer.