Ovarian cancer: screening and future directions

Abstract

Ovarian cancer carries a lifetime risk of approximately 2% for women and is the leading cause of death from any gynecologic malignancy. Currently, no screening program for ovarian cancer exists for the general population in the UK. This review focuses on the evidence surrounding the efficacy of current markers and discusses future improvements in screening for this disease. One-off cancer antigen 125 (CA125) measurements for detecting ovarian cancer have been well researched. However, studies have highlighted low positive predictive values (5%) and high false positive rates leading to patient anxiety and unnecessary invasive follow-up. Commonly, in the UK, CA125 is combined with transvaginal ultrasound, but there is little evidence that this approach can decrease mortality from ovarian cancer. Recently the Risk of Ovarian Cancer Algorithm, involving a combination of serial CA125 measurements and age, has been shown to detect more early stage cancers. Nevertheless, these measures are not robust in decreasing mortality from ovarian cancer and are costly to implement. Newer markers, such as human epididymis protein 4, have shown greater specificity. Its combination with CA125 and menopausal status in the Risk of Ovarian Malignancy Algorithm can predict the risk of malignancy but provides no additional benefit as a screening tool. Advanced techniques are emerging, including ultrasound molecular imaging techniques using microbubbles targeted to kinase domain receptors, and fallopian tube cytology. To reduce mortality from ovarian cancer, detection of pre-invasive lesions is imperative as ovarian cancer may develop in the fallopian tube and spread to the peritoneal cavity before being detected systemically. It seems that screening tools for ovarian cancer are currently not worthwhile for implementation into a national program. An emphasis on reducing false positives rates, associated anxiety and subsequent overdiagnosis is needed.

Clinical value of TV-CDS combined with serum tumor markers in diagnosis of ovarian cancer

“…The detection of serum tumor markers is a common detection method in the diagnosis of malignant tumors, because it is simple and inexpensive, and the samples are easy to collect. CA125 is still the most commonly used biomarker for the diagnosis and efficacy monitoring of OC, providing valuable information for the determination of the benign and malignant ovarian tumors (11). It has been reported that CA125 is elevated in the serum of most ovarian epithelial carcinoma, and continuous elevation of CA125 level indicates a relatively poor prognosis (12).…”

Tumor burden is a potential marker of PARP inhibitor effects in ovarian cancer: a head-to-head observational series

“…Ovarian cancer is the highest mortal gynecological malignant tumor, while the five-year survival rate has long been teetering at 30% [1]. Currently, the standard treatment for ovarian cancer is maximal cytoreductive surgery and platinum-based chemotherapy [2].…”

Modulation of non-coding RNAs by resveratrol in ovarian cancer cells: In silico analysis and literature review of the anti-cancer pathways involved

“… 2 In most cases, surgery and chemotherapy elicit an initial good response, which however is followed by relapse of chemoresistant clones that inevitably lead to death the patient. 3 , 4 The tumor microenvironment, with its unique composition in stromal- and immune cell-derived cytokines and of blood and lymphatic vessels that determine the availability of nutrients, growth factors and oxygen, plays a pivotal role in ovarian cancer cell metabolism and progression. 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 …”