Ovarian and Endometrial Cancer Screening
Ovarian cancer is the fourth most common cancer in women with approximately 6,000 cancers diagnosed every year in the UK. Traditionally the survival rate of women with ovarian cancer is very poor with around 4,500 women dying annually. Women diagnosed in the early stages have the highest chance of being cured.
What is ovarian cancer?
Ovarian cancer is the abnormal growth and division of cells in the ovary. The tumour can invade local areas and spread to other areas of the abdomen.
Who is at risk?
Those with a family history of ovarian cancer and also those with a family history of some other cancers such as breast, bowel and endometrial.
How is ovarian cancer diagnosed?
Ovarian cancer is difficult to diagnose because the ovaries are an inaccessible organ hidden deep within the pelvis and because there are no symptoms until the later stage. At the later stage symptoms include abdominal discomfort, nausea, vomiting, constipation, diarrhoea or pain during intercourse.
Screening for ovarian cancer
There are two ways of looking for ovarian cancer:
- Blood test
Whilst neither of these tests alone or together are completely reliable, they can at least go some way to alleviating worry regarding problems with the ovaries, especially if repeated checks are performed for comparison (serial testing).
What happens if an abnormality is found?
The findings will be explained to you in your report. This report can be discussed with your GP for further management advice.
Who should have ovarian cancer screening?
- Women with family history of ovarian cancer and or related cancers such as breast, bowel and endometrial cancer.
- As there is increasing awareness of ovarian cancer, many women simply wish to have the reassurance of having their ovaries checked, especially if they have a friend who has developed the disease.
CA125, HE4 and ROMA (Risk of Ovarian Malignancy Algorithm)
CA125 is, to date, the best known test for ovarian cancer diagnosis, and is the serum marker most widely used to monitor therapeutic response and to detect disease, or disease recurrence, for epithelial ovarian cancer. Its recognised limitations have prompted the need to develop biomarkers with better sensitivity for early stage diagnosis, with the ability to differentiate women with ovarian cancer from those with benign ovarian conditions.
HE4 is a new marker for ovarian carcinoma, which is over-expressed in patients with ovarian and some other cancers. When combined with CA125, HE4 raises the potential to discriminate benign from cancerous ovarian masses and has the strongest correlation with endometrial cancer of all markers tested to date. HE4 is consistently expressed in patients with ovarian cancer and has demonstrated an increased sensitivity and specificity over that of CA125 alone.
High HE4 with High CA125 would suggest ovarian cancer whereas an elevated CA125 without an associated elevated HE4 indicate benign conditions. A raised HE4 and normal CA125 would suggest the presence of either ovarian or possibly other type of cancer (e.g. endometrial). It is promising as a marker for early detection by differentiating women with ovarian cancer from women with benign ovarian conditions
A Risk of Ovarian Malignancy Algorithm (ROMA) classifies patients as being at low or high risk for malignant disease using both the CA125 and HE4 results, and a woman’s menopausal status. This risk is reported with results for both CA125 and HE4. ROMA calculates a risk of finding ovarian cancer during surgery. ROMA classifies patients as being at low or high risk for malignant disease.