| CA 125 >= 30 (U/mL or kU/mL) ? | Yes No |
| ~If any of the following symptoms are reported >12 times per month, occurring only within the past 12 months. | |
| Bloating or increased abdominal size | Yes No |
| Abdominal or pelvic pain | Yes No |
| Difficulty eating or feeling full quickly | Yes No |
Ovarian cancer is the second most common gynecologic malignancy in the U.S., with >70% of women being diagnosed with advanced stage disease. In advanced cases, cure rates of just 20-30% are expected.
This study, authored by Andersen MR, et al., dichotomizing Cancer Antigen 125(CA 125) and a symptom index as a first-line screening process for prediction of ovarian cancer. It is important to note that the patients being evaluated were healthy women who were at high risk of ovarian cancer due to a positive family history.
Results of the study suggested there is improved sensitivity associated with using a combination of both CA 125 and a symptom index. Their conclusions were that if either is positive, immediate further evaluation with transvaginal ultrasound (TVS) is indicated.
In this cohort, the combination of CA 125 and the symptom index identified 89.3% of women who had cancers (80.6% of early cancers and 95.1% of late stage cancers). The symptom index identified presence of cancer in 50% of the women who had cancer, but had normal CA 125 levels. A positive symptom index score was also noted in 11.8% of these high risk women who did not have ovarian cancer.
In conclusion, the combination of CA 125 and the symptom index worked significantly better used together than either item independently in identifying which patients may need further evaluation for ovarian cancer.
Scoring:
#1: Positive CA 125: >=30 U/mL (kU/L)
[or at the 95
th
percentile at a given laboratory]
#2 Positive symptom index: If any of the following symptoms are reported >12 times per month, occurring only within the past 12 months.
TVS (Trans Vaginal Sonography) is generally used as a second screening step to identify women with false-positive marker results before surgical referral.
* Note: There are certain limitations to the current study and any recommendations regarding usage of the symptom index as a potential screening tool should be approached with caution.
Reference:
Andersen MR, Goff BA, Lowe KA, et al. Combining a symptoms index with CA 125 to improve detection of ovarian cancer. Cancer . 2008; 113(3):484-9.