What Happens Next?: How Ovarian Cancer Forces a Woman into a New Draft of Her Life Script

Objective To investigate the diagnosis significance of serum HE4 ,CYFRA21-1 , CA125 levels for the benign and malignant varian tumor,and evaluate the value of single detection and combined detection on judging the high risks of ovarian cancer. Methods A total of 45 patients with primary ovarian cancer and 56 patients with benign varian tumor and 50 healthy subjects admitted in Wendeng central hospital whose serum levels of HE4 ,CYFRA21-1 and CA125 were detected by electro-chemiluminescence（ ECL）,any index above the normal limit was setting for positive,the positive rate and coincidence rate of the three indexes in diagnosis of ovarian cancer was analyzed,and the diagnosis values of three indexes in the benign and malignant varian tumors were compared. Results HE4 and CYFRA21-1 levels of ovarian cancer group were significantly higher,compared with the benign tumor group,and healthy contol group and the differences were statistically significant（ P ﹤0. 05 ）,however there was no significant difference between benign tumor group and control group（ P﹥0. 05 ）,for the ma-lignant tumors the specificity and positive predictive value were very high[ HE4（ 100%,100%）,CY-FRA21-1（98. 2%,96. 7%）]and the diagnostic accuracy was relatively high（90. 1%,83. 2%）,com-pared with CA125 the difference was significant（ P﹤0. 05 ）,but both of them the sensitivity was lower than CA125. The CA125 levels were all increased in benign and malignant tumor,only the extent was different,there was significant difference between them（P﹤0. 05）and the difference was also statistical-ly significant in benign and control group（ P﹤0. 05 ）,which can simply distinguish benign and malignant tumors, however the specificity for the diagnosis of ovarian cancer is not very high （75%）and the positive predictive value and diagnostic accuracy was also relatively low（ 72%, 77. 2%）,The sensitivity and accuracy of diagnosis was improved by combining the three indexes and the clinical diagnosis was optimized. Conclusions HE4 ,CYFRA21-1 levels are only increased in malig-nant tumors,and they are mainly used for the diagnosis of ovarian cancer,CA125 levels are all in-creased in benign and malignant tumors,only the extent is different and it can be used for distinguis-hing and diagnosing of benign and malignant tumors. Combining the three indexes can improve the sensitivity and accuracy of the diagnosis of ovarian cancer,and it has important significance for the early diagnosis and treatment of ovarian cancer. Key words: Human epididymis protein 4 Cytokeratin 19 fragment antigen 21-1 CA125 Ovarian cancer Electrochemiluminescence

Objective: To look for the association of raised CA 125/ CEA ratio and positive ascitic fluid cytology with the diagnosis of epithelial ovarian cancer in patients with an adnexal mass. Study Design: Comparative Cross-sectional study. Setting: Department of Oncology and Gynecology, Sheikh Zayed Hospital Rahimyarkhan. Period: September 2021 to February 2022. Material & Methods: A total of three hundred patients presenting with adnexal mass were recruited for the study. All patients underwent detailed evaluation, including CA 125 levels, CEA levels and ascitic fluid cytology. After complete staging workup, they underwent surgery and histopathological analysis of adnexal mass. A consultant histopathologist made the diagnosis of ovarian cancer. Association of various factors, including raised CA 125/ CEA ratio and positive ascitic fluid cytology with the diagnosis of ovarian cancer, was established. Results: Out of 350 patients of adnexal mass included in analysis, 273 (88%) were diagnosed with ovarian carcinoma, while 77 (22%) were not diagnosed with ovarian cancer after the surgery and had a diagnosis other than ovarian cancer. 179 (51.2%) patients were post-menopausal whereas 171 (48.8%) were pre-menopausal. It was revealed that raised CA-125/CEA ratio and positive ascitic fluid cytology had a statistically significant association with the diagnosis of ovarian carcinoma on histopathology (p-value<0.001). Conclusion: Most patients who presented with adnexal mass were diagnosed with ovarian carcinoma in our study. Raised CA 125/ CEA ratio and positive ascitic fluid cytology at baseline predicted a histopathological diagnosis of ovarian cancer in our study participants.

The aim of this study was to detect the expressions of serum micro-ribonucleic acid (miR)-26b and miR-21 in ovarian cancer patients, and to explore their associations with the diagnosis, clinicopathological parameters and prognosis of ovarian cancer. A total of 86 patients diagnosed with ovarian cancer in our hospital from January 2014 to January 2015 were enrolled in the observation group. Meanwhile, another 86 subjects receiving physical examination in our hospital during the same period were enrolled in the control group. The expressions of serum miR-26b and miR-21 in both groups were detected via Real Time fluorescence-quantitative Polymerase Chain Reaction (RT-qPCR). Receiver operating characteristic (ROC) curves were plotted. Later, the clinical diagnostic value of combined detection of miR-26b and miR-21 in ovarian cancer was analyzed. Moreover, the associations of serum miR-26b and miR-21 expressions with clinicopathological characteristics and prognosis of ovarian cancer patients were explored. The expression of serum miR-26b in ovarian cancer patients was significantly lower than that of healthy subjects, while miR-21 expression was markedly higher in ovarian cancer patients (p<0.05). The area under the ROC curve (AUC), the sensitivity and specificity of miR-26b detection, miR-21 detection and combined detection in the diagnosis of ovarian cancer were 0.753 vs. 0.826 vs. 0.916, 47.2 vs. 76.3 vs. 87.6 and 78.5 vs. 85.6 vs. 90.4, respectively. Therefore, it could be observed that both the sensitivity and specificity of combined detection were remarkably higher than those of single detection (p<0.05). In addition, the expressions of serum miR-26b and miR-21 were associated with clinical stage and lymph node metastasis of ovarian cancer patients, whereas it was not correlated with age and histological type. The 3-year survival rate of patients with high expression of serum miR-26b was significantly higher than that in those with low expression of serum miR-26b. However, the 3-year survival rate of patients with low expression of serum miR-21 was higher than that in those with high expression. MiR-21 is highly expressed, while miR-26b is lowly expressed in the serum of ovarian cancer patients. Both of them may be involved in the incidence and development of ovarian cancer. Furthermore, combined monitoring of serum miR-26b and miR-21 has a certain value in the clinical diagnosis and treatment of ovarian cancer.

Diet and survival after a diagnosis of ovarian cancer: a pooled analysis from the Ovarian Cancer Association Consortium.

The United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) recently reported a reduction in the average overall mortality among ovarian cancer patients screened with an annual sequential, multimodal strategy that tracked biomarker CA125 over time, where increasing serum CA125 levels prompted ultrasound. However, multiple cases were documented wherein serum CA125 levels were rising, but ultrasound screens were normal, thus delaying surgical intervention. A significant factor which could contribute to false negatives is that many aggressive ovarian cancers are believed to arise from epithelial cells on the fimbriae of the fallopian tubes, which are not readily imaged. Moreover, because only a fraction of metastatic tumors may reach a sonographically-detectable size before they metastasize, annual screening with ultrasound may fail to detect a large fraction of early-stage ovarian cancers. The ability to detect ovarian carcinomas before they metastasize is critical and future efforts towards improving screening should focus on identifying unique features specific to aggressive, early-stage tumors, as well as improving imaging sensitivity to allow for detection of tubal lesions. Implementation of a three-stage multimodal screening strategy in which a third modality is employed in cases where the first-line blood-based assay is positive and the second-line ultrasound exam is negative may also prove fruitful in detecting early-stage cases missed by ultrasound.

Objective To investigate the diagnosis significance of human epididymis (HE4), cytokeratin-19-fragment (CYFRA21-1), carbohydrate antigen 199 (CA199) on the malignant ovarian tumor, and to evaluate the value of individual and combined detection in judging high risk ovarian cancer. Methods The serum HE4, CYFRA21-1, CA199 levels of 45 patients with primary ovarian cancer, 56 patients with benign ovarian tumor and 50 healthy check-up women in our hospital were detected by electrochemiluminescence immunoassay (ECL). The positive rates and coincidence rates of them were analyzed and the diagnostic value of them were compared. Results HE4 and CYFRA21-1 levels of ovarian cancer group were significantly higher compared with the benign tumor group and healthy control group and the differences were statistically significant (Z=-8.61, P<0.001; Z=-8.39, P<0.001; Z=-8.60, P<0.001; Z=-8.39, P<0.001), however there is no difference between benign tumor group andcontrol group(Z=-1.31, P=0.189; Z=-1.29, P=0.191). The difference of CA199 between benign tumor group and control group was statistically significant (Z=-8.79, P<0.001). For the malignant tumors, the specificity and positive predictive value of HE4 (99.8%, 99.7%), CYFRA21-1 (99.0%, 96.7%) were very high and the diagnostic accordance rates were relatively high (93.4%, 88.7%), but the sensibilities of them were lower compared with CA199.CA199 was increased both in benign and malignant ovarian tumors with different degrees, but the specificity was not very high (85.8%), and the positive predictive value and the diagnosis accordance rate were low (70.6%, 84.1%). The combined detection of HE4, CYFRA 21-1 and CA199 could improve the sensitivity and of the diagnosis of ovarian cancer (100%) and accuracy (89.4%). Conclusions HE4 and CYFRA21-1 only increas in malignant ovarian tumors, and they are mainly used for the diagnosis of ovarian cancer; CA199 level is increased both in benign and malignant ovarian tumors, but the extent is different and it can be used for distinguishing and diagnosing of benign and malignant ovarian tumors. Combining the three indexes can improve the sensitivity and accuracy of the diagnosis of ovarian cancer, and has an important significance for the early diagnosis and treatment of ovarian cancer. Key words: Ovarian neoplasms; Keratins; Antigens, tumor-associated, carbohydrate; human epididymis protein 4

IntroductionMutations in Breast Cancer Susceptibility Genes (BRCA) are associated with an increased risk of both breast and ovarian cancer. In previous studies, about 20% of ovarian cancer patients reported a...

Comparison of CA125, HE4, and ROMA index for ovarian cancer diagnosis

Disparities in Oncofertility: Assisted reproductive technology utilization and fertility-sparing oncology care in women with a history of breast, ovarian, cervical or endometrial cancer (094)

Objective To prepare monoclonal antibodies and immunoradiometric assay kit against human epididymis protein 4 (HE4) and study its clinical value in diagnosis of ovarian cancer. Methods BALB/c mice were immunized with recombinant HE4 antigen, 2 paired monoclonal antibodies were generated through splenic cell and myeloma cell fusion and screening. The detection antibody was labeled with 125 Iodine and immunoradiometric assay kit for HE4 was developed. The detect sensitivity of the kit was determined, and its clinical sensitivity and specificity in diagnosis of ovarian cancer was evaluated. Results Two paired monoclonal antibodies with high affinity and specialty were generated. The detect sensitivity of this immunoradiometric assay was 3.65 pmol/L, and the clinical sensitivity and specificity in diagnosis of ovarian cancer was 90.83% and 99.17% respectively. Conclusions This study was prepared by a high affinity monoclonal antibodies against HE4, and the technical indexes of HE4 immunoradiometric assay kit were rather good. So it could be used in early diagnosis and curative effect observation of ovarian cancer, and reduce its lethality rate. Key words: Human epididymis protein-4; Ovarian neoplasm, antibodies Monoclonal; Immunoradiometric assay

Ovarian cancer ranks seventh worldwide and is the third most common type of cancer diagnosed in women in India. Numerous studies have demonstrated that the number of people affected by ovarian cancer is expected to rise significantly in the future. Proactive measures for early cancer detection are essential to prevent death and recurrence. This paper attempts to review the various deep learning (DL) models in ovarian cancer diagnosis, including detecting risk factors, analyzing genomic data sets, predicting disease progression, recurrence, and mortality rates, and identifying correlations and patterns. The patient's electronic health records contain effective analytics on imaging and other types of data that may open the door to more accurate or early identification of ovarian cancer. The taxonomy of the several ways that DL aids in the diagnosis, early detection, and treatment of ovarian cancer will be compiled in this review article. As per the reviews, more research studies have examined the Convolutional Neural Networks (CNNs) approach for the Early Detection and Diagnosis of Ovarian Cancer. This is because CNNs are a popular and potent architecture for image classification tasks because of their capacity to learn spatial and hierarchical features from images effectively. The review article seeks to give future research topics and assess the state-of-the-art application of DL algorithms for ovarian cancer diagnosis.

Ovarian cancer: role of ultrasound in preoperative diagnosis and population screening

Earlier studies regarding the risk of colorectal cancer (CRC) in women with a prior diagnosis of gynecologic malignancies have revealed conflicting results. We sought to further clarify this association. A retrospective cohort study was performed using the General Practice Research Database of the United Kingdom. Patients with a prior diagnosis of ovarian, uterine, or cervical cancers were compared with control patients without a prior gynecologic malignancy. The primary outcome was a diagnosis of CRC. Poisson regression analysis was used to assess the effects of potential confounders. The study included 1995 ovarian, 1348 uterine, and 1101 cervical cancer patients and 7980, 5392, and 4404 matched control patients, respectively. The adjusted incidence rate ratio (IRR) of CRC among ovarian cancer patients was 2.90 [95% confidence intervals (CI) 1.45-5.82]. Five of 10 cases of CRC in ovarian cancer patients were diagnosed within 6 months of the cancer diagnosis with an adjusted IRR of 8.0 (95% CI 1.9-33.6). Excluding the initial 6 months of follow-up after the diagnosis of ovarian cancer, the adjusted IRR was 1.6 (95% CI 0.76-5.03). The adjusted IRR of CRC in patients with a prior diagnosis of uterine and cervical cancer was 0.79 (95% CI 0.24-2.61) and 1.50 (95% CI 0.43-5.21), respectively. Women with a prior diagnosis of ovarian cancer are at an increased risk of CRC. The risk of CRC was not increased among patients with a prior history of uterine and cervical cancer.

Early detection of ovarian cancer has been a challenge to manage the high mortality rate caused by this deadly disease. The trends in mortality have been reduced by the scientific contributions from the corners across the globe, however accounting for the fifth leading cause of gynecological mortality. The complexities in the clinical presentation, origin of tumor, and gene expression profiles had added to much difficulty in understanding and diagnosis of the disease. Stage 1 diagnosis of ovarian cancer improves the 5-year survival rate to around 92%. Cancer antigen-125 (CA-125) is the gold standard tumor marker found at abnormally high levels in the blood of many women in ovarian cancer. However, many non-cancerous conditions exhibit high levels of CA-125 and several women have normal CA-125 level in the early stage of ovarian cancer, suggesting CA-125 biomarker is not specific enough for the screening of early stage ovarian cancer. In addition, several other biomarkers, including HE4 have been added in the diagnostic field for higher sensitivity and specificity in the diagnosis and progression of ovarian cancer. HE4 is a prospective single serum biomarker which has been approved by the FDA to monitor the disease progression in epithelial ovarian cancer. However, owing to low sensitivity and specificity, combination of a panel of biomarkers has been proposed in the diagnosis of the disease. Based on extensive biomarkers research findings, here we discuss current trends in diagnostic approaches and updated potential several panels of cancer biomarkers for early detection of ovarian cancer. It has been recently reported that CA125 in combinations with two or more biomarkers have outperformed single biomarker assays for early detection of the disease. Moreover, CA-125 with CA 19–9, EGFR, G-CSF, Eotaxin, IL-2R, cVCAM, MIF improved the sensitivity with 98.2 % and specificity of 98.7% in early stage detection of ovarian cancer. Overall, this review demonstrates a panel of biomarkers signature as the potential tool for prototype development in future and other advanced approaches for early diagnosis of ovarian cancer to avoid false-diagnosis and excessive cost.

We sought to determine the validity of cancer antigen 125 (CA-125) and the risk of malignancy index (RMI) in the diagnosis of ovarian cancer in women presenting with adnexal lesions of various histopathology types. This retrospective cross- sectional study included all women with adnexal lesions who were evaluated at the Royal Hospital, Oman, between January 2012 and December 2014. The inclusion criteria included women who underwent surgical intervention and who had preoperative CA-125 testing and pelvic ultrasound in the work-up plan of their management. The surgical intervention was usually followed by a histopathological diagnosis of the nature of the lesion, which was used as the gold standard for the evaluation of both CA-125 and RMI. The cohort included 361 women who had serum CA-125 and pelvic ultrasound prior to the surgical intervention of the adnexal lesion. Of these women, 61 (17%) had malignant ovarian lesions. Using the proposed cut-off 35 U/ml for CA-125 and 200 for RMI, the CA-125 test was more sensitive for detecting the majority of malignant ovarian tumors compared to the RMI (69% vs. 57%). Both tests were more sensitive in detecting epithelial ovarian cancer compared to other ovarian cancers. However, RMI was more specific in excluding benign ovarian lesions compared to CA-125 (81% vs. 68%). Additionally, RMI had a better area under the curve compared to CA-125 (0.771 vs. 0.745; p<0.005). Lowering the RMI cut-off to 150 resulted in a better sensitivity (62% vs. 57%) and had an acceptable specificity (78% vs. 81%) compared to a cut-off of 200. Both CA-125 and RMI have good validity in the diagnosis of ovarian tumors. CA-125 has higher sensitivity; however, RMI has higher specificity. In combination, CA-125 might be more valid for the diagnosis of malignant ovarian cancer while RMI is more valid for excluding the diagnosis of these tumors. Differential use of these two tools will improve the triage of women with suspected ovarian tumors since both are measured in their work-up. We recommended the use of both tools in primary care to reduce referral to gynecology or oncology units.