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Ovarian cancer

Ovarian cancer is the second most common gynecologic malignancy in developed countries and the third most common gynecologic malignancy in developing countries (cervical cancer is the most common) [1].Estimation of cancer antigen 125 (CA125) levels and transvaginal sonography are the best and most frequently recommended methods for diagnosing ovarian cancer [2,3,4]. HE4 and CA72-4 determination is the best approach to confirm the benign nature of ovarian endometrioma in women with high CA125 levels. [5]


Clinical Significance


when measured together with other tumoral markers (such as CA19.9 or CEA)CA125 was assessed by numerous investigators regarding its utility as a marker of stage, disease status, prognosis or even in the screening of ovarian cancer. [6]


HE4 is the most useful marker for the differ-ential diagnosis between EOC and ovarian endometriosis[7]. Different studies propose the use of a Risk of Ovarian Malignancy Algorithm (ROMA) to improve the sensitivity and specificity of the combined use of both HE4 and CA125 in patients with abdominal masses.[8]


CA 72-4 is a tumor marker for gastrointestinal cancer and ovarian cancer. Compared with CA125, the positive rate of CA72-4 is higher in mucinous ovarian cancer. The combination of the two tumor makers can improve the diagnostic sensitivity of ovarian cancer.


[1] Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65:87.

[2] Daly MB, Pilarski R, Berry MP, Buys SS, Friedman S, Garber JE, et al. NCCN Guidelines Insights: genetic/familial high-risk assessment: breast and ovarian, version 2.2017. J Natl Compr Canc Netw 2017;15:9-20.

[3] Fotopoulou C, Hall M, Cruickshank D, Gabra H, Ganesan R, Hughes C, et al. British Gynaecological Cancer Society (BGCS) epithelial ovarian/Fallopian tube/primary peritoneal cancer guidelines: recommendations for practice. Eur J Obstet Gynecol Reprod Biol 2017;213:123-139.

[4] Committee on Gynecologic Practice, Society of Gynecologic Oncology. Committee Opinion No. 716. Committee Opinion No. 716: the role of the obstetrician-gynecologist in the early detection of epithelial ovarian cancer in women at average risk. Obstet Gynecol 2017;130:e146-e149.

[5]Anastasi, E., Granato, T., Falzarano, R. et al. The use of HE4, CA125 and CA72-4 biomarkers for differential diagnosis between ovarian endometrioma and epithelial ovarian cancer. J Ovarian Res 6, 44 (2013).

[6]DANIELION,GEORGIANARADU,DANNICOLAEPĂDURARU, OCTAVIAN ANDRONIC, ALEXANDRA BOLOCAN. CA125 and CA242 markers' role in colorectal cancer diagnosis and management–a 30 year review. Romanian Biotechnological Letters 25(5):1977-1983. DOI:10.25083/rbl/25.5/1977.1983

[7]Moore RG, Miller MC, Steinhoff MM, Skates SJ, Lu KH, Lambert-Messerlian G,Bast RC Jr: Serum HE4 levels are less frequently elevated than CA125 inwomen with benign gynecologic disorders. Am J Obstet Gynecol 2012,206(4):351.

[8] Molina R, Escudero JM, Augé JM, Filella X, Foj L, Torné A, Lejarcegui J, Pahisa J. HE4 a novel tumour marker for ovarian cancer: comparison with CA 125 and ROMA algorithm in patients with gynaecological diseases. Tumour Biol. 2011 Dec;32(6):1087-95. doi: 10.1007/s13277-011-0204-3. Epub 2011 Aug 24. PMID: 21863264; PMCID: PMC3195682.

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