Purpose: The initial stage of proliferation of epithelial ovarian carcinoma (EOCa) is usually asymptomatic. Due to the lack of sensitive and reliable markers in majority of patients the disease is widespread at the time of diagnosis. The reliable serum biomarkers currently accepted is CA125 but there is limitation in case of sensitivity of CA125 as it is detectable only in 50% of patients in stage I and 80% of patients with advanced stage. We have investigated a correlation between serum CA125 and ceruloplasmin (as a marker of angiogenesis) in ovarian cancer in pre-treatment and post-treatment patients, compared with controls and found to be a significant marker for diagnosis. Material and Methods: A study was done in age group between 18-45 years diagnosed with ovarian cancer. (cases: n=50, controls: n=50). Cancer was diagnosed based on biopsy and histopathological examination. Serum Ceruloplasmin and CA 125 were estimated in pre-treatment and post-treatment patients and statistically significant decrease of these biomarkers observed in post treatment when compared with pre treatment patients. Result: We found that serum CA 125 to ceruloplasmin ratio was moderately increased in pre-treatment ovarian cancer patient. The serum ceruloplasmin (p<0.0001) level was significantly increased in ovarian cancer patients as compared to controls. Conclusion: Serum ceruloplasmin as well CA-125 level decline after treatment, and have been associated with efficacy and safety of novel therapeutic strategy to improve diagnosis and treatment for cancer. Key words: Epithelial ovarian carcinoma (EOCa), Ceruloplasmin, Carbohydrate antigen 125 (CA-125). ÖZETAmaç: Epitelial ovarian karsinomunda proliferasyonunun başlangıç aşaması genellikle asemptomatiktir. Hastaların büyük kısmında hassas ve güvenilir belirteçlerin eksikliği nedeni ile hastalık teşhis aşamasında artık yayılmış bulunmaktadır. Güvenilir olarak kabul edilen serum belirteci CA-125'tir ancak evre I hastalarının sadece %50'sinde ve ilerlemiş evre hastaların %80'ninde saptanabilmesinden dolayı, CA-125'in hassasiyeti konusunda bir sınırlama mevcuttur. Bu çalışmada, tedavi öncesi ve tedavi sonrası over kanserli hastalarda CA-125 ve seruloplazmin'in (anjiyogenez belirteci) serum seviyeleri arasındaki korelason araştırılmış, kontroller ile karşılaştırılmış ve teşhis için anlamlı bir belirteç olduğu bulunmuştur. Materyal ve Metod: Çalışma 18-45 yaş arası over kanseri teşhisi alan hastalar ile yapılmıştır (vaka n=50, kontrol n=50). Kanser teşhisi, biyopsi ve histopatolojik değerlendirme sonucu konulmuştur. Tedavi öncesi ve tedavi sonrası serum seruloplazmin ve CA-125 seviyeleri değerlendirilmiş ve tedavi öncesi ile karşılaştırıldığında, bu belirteçlerin tedavi sonrası hastalarda anlamlı derecede düştüğü gözlenmiştir. Araştırma Makalesi / Research Article

Background: Ovarian malignancy is the most common gynecological malignancy after the cancer of the cervix. A woman's risk at birth of ovarian cancer at some time in her life is 1 % to 1.5% and that of dying from cancer is almost 0.5 %. The most commonly occurring ovarian tumors are of epithelial in origin. It has the highest case-fatality ratio of all gynecological malignancies. Hence the early diagnosis is the most important factor for better prognosis. A clinical evaluation of the patient, followed by ultrasonography and CA-125 is helpful. This study aims to determine the role of Risk of Malignancy Index (Jacob’s RMI) in ovarian tumors for prediction of ovarian malignancy.Methods: This is a prospective cohort study. The present study was carried out at department of OBG, in collaboration with the Departments of Radio diagnosis and Pathology, AHRR, New Delhi. 100 patients meeting the inclusion and exclusion criteria were considered. Detailed clinical history, examination and ultrasonography (Abdomen and pelvis) were done. Estimation of CA125 was done thereafter. Calculated JACOBS RMI score was compared with operative surgical staging and histopathological-cytological examination of the specimen. Data obtained thereafter was analysed using appropriate and relevant statistical software.Results: In present study sensitivity of RMI Score in the pre-menopausal women was 66.7% and in post-menopausal women was 83.3%. Specificity of RMI Score in the pre-menopausal women was 96.3% and in post-menopausal women was 81.8%. The positive predictive value in the pre-menopausal women was 40% and in post-menopausal women was 71.4%. The negative predictive value in the pre-menopausal women was 98.7% and in post-menopausal women was 90%. Diagnostic accuracy in a case of premenopausal women was is 95.2% and 82.4% for postmenopausal women.Conclusions: The present study shows that RMI Score helps in identifying effectively those patients who require Staging Laparotomy and hence referral to Gynecologist Oncologist. Patients with ovarian masses with low risk of malignancy index can be treated by minimal access procedures.