Ovarian Cancer
- Key Points
- Diagnosis
- Screening
- Monitoring
- Background
- Lab Tests
- References
- Related Topics
- Videos
Use of Tumor Markers in Pelvic Masses: Cancer Antigen 125 (CA-125) and Human Epididymis Protein (HE4)
Biology
- CA 125 – glycoprotein antigen expressed in tissue derived from coelomic epithelial cells (ovary, fallopian tube, peritoneum, pericardium, colorectal, kidney, stomach)
- Frequency of elevation correlates with clinically detected stage of cancer, tumor burden, and type of tumor
- HE4 – secreted protein expressed in most epithelial ovarian tumors
- Marker of relapse
- Improves specificity of CA 125 if used in conjunction
Uses
- In general, the combination of CA 125 and HE4 provides the highest sensitivity and specificity
- Tumor markers in ovarian cancer and pelvic masses
| Ovarian Cancer |
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Screening
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Diagnosis
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Monitoring
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| Pelvic Mass |
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Premenopausal
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Postmenopausal
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Indications for Testing
- Individual with suspected ovarian cancer
Laboratory Testing
- Biomarkers
- Epithelial cell tumors
- Beta-hCG – consider this test in premenopausal females to rule out pregnancy
- CA 125
- Not recommended as a single initial diagnostic test (although results >65 U/mL are highly suggestive of malignancy)
- Recommended differential diagnosis of suspicious pelvic mass in postmenopausal females
- HE4 – combining with CA 125 decreases false positives
- Inhibin – complements CA 125
- Best performance in mucinous subtype
- Other markers currently available are not generally as useful
- Granulosa-theca tumors
- CA 125 – frequently normal (not useful if normal)
- Inhibin – alpha and beta (beta usually higher than alpha)
- Total inhibin – highly sensitive
- Estradiol – often elevated
- Germ cell tumors
- CA 125 – not useful (usually normal)
- Beta-hCG – elevated
- Alpha fetoprotein (AFP) – elevated
- Neuron-specific enolase (NSE) – elevated
- Lactate dehydrogenase (LD) – elevated
- Epithelial cell tumors
Histology
- Surgical biopsy to determine if ovarian mass is malignant (with planned surgical debulking if malignant)
- Avoid percutaneous biopsy – can cause tumor spillage into the pelvis
- All tumors require histologic confirmation for diagnosis
- Immunohistochemistry
- Epithelial
- Serous
- HGSC
- (+) p53, WT-1, p16, ER
- LGSC
- (+) WT-1, ER
- HGSC
- Mucinous
- (+) CK 7, CK 20 (weak, focal), CDX2 (weak, focal), SMAD4, DPC4
- (-) ER, WT-1 (not diffusely positive), beta-catenin-1, p16
- Endometrioid
- (+) ER, PR (nuclear), beta-catenin-1, vimentin, CK 7
- (+) p53 in some high-grade endometrioid – most lack p53, p16
- (-) WT-1 (not diffusely positive), calretinin, inhibin, CK 20, CEA (monoclonal or polyclonal)
- Clear cell
- (+) HNFI-beta, beta-catenin-1
- (-) ER, WT-1 – typically lack p53 unless high-grade
- Transitional cell
- (+) WT-1, ER, p53
- (-) p53 – typically lack p53 unless high-grade
- Serous
- Granulosa/Sertoli – (+) inhibin, WT-1, calretinin
- Germ cell – (+) CA 125, inhibin, AFP, beta-hCG
- Epithelial
- Molecular testing based on histology
- High-grade serous carcinoma (HGSC) – BRCA1 or BRCA2 gene mutations common
- BRCA1 and BRCA2 testing is recommended for all of these patients (NCCN, 2014)
- Low-grade serous carcinoma (LGSC) – BRAF or KRAS gene mutations
- Mucinous – KRAS gene mutations common
- Endometrioid – CTNNB1 and PTEN gene mutations common
- Clear cell – lacks BRCA1 or BRCA2 gene mutations
- Transitional cell
- If lacking Brenner component – BRCA1 or BRCA2 gene mutations common
- Granulosa cell – FOXL2 gene mutations
- High-grade serous carcinoma (HGSC) – BRCA1 or BRCA2 gene mutations common
Imaging Studies
- Ultrasound
- Transvaginal sonography (TVS) followed by CT/MRI if suspicious TVS findings
Prognosis
- p53 overexpression
- Correlates with poor survival, propensity for recurrence, and distant recurrence
- RAS dysregulation in serous subtype
- Associated with poor prognosis in patients with incomplete response to platinum-based therapy
- Beta-catenin-1 dysregulation in serous subtype
- Associated with poor prognosis in patients with incomplete response to platinum-based therapy
- EGFR overexpression
- Associated with platinum resistance and poor prognosis
- HER2 expression – in only 10% of patients
- Correlates with poor survival
- MMP-9 overexpression
- Associated with poor prognosis
Differential Diagnosis
- Abdominal pain
- Appendicitis
- Cholecystitis
- Peptic ulcer disease
- Other gastrointestinal malignancies – gastric, pancreatic, gallbladder
- Uterine fibroids
- Irritable bowel disease
- Metastatic disease from other tumors
- Pelvic inflammatory disease
- Endometriosis
- Diverticulitis
- Inflammatory bowel disease
- Abdominal girth enlargement
- Pregnancy
- Polycystic ovarian syndrome
- Uterine cancer
- Ovarian cysts
- Primary lymphoma – B-cell lymphoma
- Uterine fibroids
- Cirrhosis with ascites
- Metastatic disease from other tumors
- Genitourinary symptoms
- Uterine fibroids
- Endometriosis
- Pregnancy
- Urinary retention
- Polycystic kidney disease
- Endocrine symptoms
- Adrenal tumors
- Pregnancy
- Routine screening in general population is not currently recommended by any professional society
- Ongoing trials to evaluate multimodality screening (CA 125 and TVS)
- European Randomized Trial of Ovarian Cancer Screening (ERTOCS)
- United Kingdom Collaborative Trial of Ovarian Cancer Screening [UKCTOCS], 2009
- Multimodality screen shows significantly greater specificity and positive predictive value than TVS alone
- Completed trial
- Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial [PLCO], 2014
- Multimodality screening does not reduce ovarian cancer mortality and can lead to health issues
- No statistical difference in survival rates between screened and unscreened groups
- Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial [PLCO], 2014
- Ongoing trials to evaluate multimodality screening (CA 125 and TVS)
- Screening for specific syndromes
- BRCA – ovarian cancer risk >50%
- If patient chooses not to undergo total abdominal hysterectomy with bilateral salpingo-oophorectomy, begin screening at age 35, or 5-10 years before earliest age of diagnosis of ovarian cancer in family
- See NCCN Genetic/Familial High-Risk Assessment (Breast and Ovarian Oncology) 2014 screening guidelines
- Concurrent TVS and CA 125 – every 6 months
- TVS – preferably day 1-10 of menstrual cycle in premenopausal women
- CA 125 – preferably after day 5 of menstrual cycle in premenopausal women
- If patient chooses not to undergo total abdominal hysterectomy with bilateral salpingo-oophorectomy, begin screening at age 35, or 5-10 years before earliest age of diagnosis of ovarian cancer in family
- Lynch syndrome (HNPCC) – ovarian cancer risk 10%
- TVS – beginning at 30-35 years (for endometrial cancer screening)
- CA 125 – unproven efficacy due to inadequate trials
- BRCA – ovarian cancer risk >50%
- Hereditary breast and ovarian cancer (HBOC) genetic testing (National Cancer Institute)
- For individuals with a family history of a known pathogenic mutation previously identified in a relative – perform targeted mutation testing
- Epithelial
- CA 125
- Assess patient response to chemotherapy, detect early relapse, and predict prognosis
- Absolute serum value of CA 125 before third cycle of chemotherapy – most important factor for predicting progression at 12 months
- Suggested monitoring – every 2-4 months for the first 2 years
- Persistent postoperative elevation suggests poor prognosis
- Assess patient response to chemotherapy, detect early relapse, and predict prognosis
- HE4
- Relatively new marker in ovarian cancer monitoring
- Useful because not all patients with ovarian cancer have elevated CA 125 levels
- May be complementary when used with CA 125 for monitoring
- ≥25% change is considered significant
- Inhibin – most useful in monitoring of mucinous subtype tumors
- Other emerging markers, such as osteopontin, show promise but cannot be recommended
- CA 125
- Stromal tumors (including granulosa, granulosa-theca, and Sertoli-Leydig tumors)
- Inhibin levels – increased levels parallel tumor recurrence
- Germ cell
- Alpha fetoprotein (AFP), beta-hCG, lactate dehydrogenase (LD)
- Expect decrease after surgery
- Increasing levels may signal recurrence
- Alpha fetoprotein (AFP), beta-hCG, lactate dehydrogenase (LD)
Cancer Antigen 125 0080462
Method: Quantitative Electrochemiluminescent Immunoassay
Not a stand-alone test for ovarian cancer screening or diagnosis
Evaluate and monitor ovarian cancer, usually epithelial subtype
Monitoring requires elevated pretreatment value of CA 125
Combination with HE4 may enhance sensitivity
Not recommended for monitoring breast cancer or germ-cell tumors
Not recommended for screening general population for ovarian cancer
Elevated in other gynecological conditions
Higher rate of false positives than HE4
Patients with confirmed ovarian carcinoma may have pretreatment CA-125 value in the same range as healthy individuals
Test values for CA-125 are not interchangeable between different laboratories or test platforms – sequential monitoring should be performed at the same laboratory
Human Epididymis Protein 4 (HE4) 2003020
Method: Quantitative Enzyme Immunoassay
Not a stand-alone test for ovarian cancer screening or diagnosis
Use with CA 125 to monitor ovarian cancer, usually epithelial subtype, post therapy if pretreatment level was elevated
Not recommended for monitoring mucinous or germ cell ovarian cancer
Not recommended for screening general population for ovarian cancer
Not recommended for monitoring patients with known mucinous or germ cell subtype
Risk of Ovarian Malignancy Algorithm 2012618
Method: Quantitative Enzyme Immunoassay, Electrochemiluminescent Immunoassay
Use for assessment of cancer risk, particularly epithelial cell ovarian cancer, in pre- and postmenopausal women who present with an adnexal mass
Combines CA-125 and HE4, together with menopausal status, to classify adnexal mass patients into high- or low-risk epithelial ovarian cancer groups
Not intended as a screening, stand-alone, or tumor-monitoring test
Tumor monitoring using HE4 and/or CA 125 test should be ordered separately
Should not be used without an independent clinical/radiological evaluation and is not intended to be a screening test or to determine whether a patient should proceed to surgery
Total Inhibin, Serum 2014109
Method: Quantitative Enzyme-Linked Immunosorbent Assay
Aid in the detection and monitoring of granulosa cell tumors of the ovary
Inhibin B 0070413
Method: Quantitative Enzyme-Linked Immunosorbent Assay
Use to differentiate ovarian tumor with normal CA 125 as stromal or mucinous epithelial tumor
May be used for monitoring recurrence of stromal ovarian tumors
Estradiol, Adult Premenopausal Female, Serum or Plasma 0070045
Method: Quantitative Chemiluminescent Immunoassay
Evaluate suspected granulosa cell tumor
Alpha Fetoprotein, Serum (Tumor Marker) 0080428
Method: Quantitative Chemiluminescent Immunoassay
Evaluate suspected germ cell tumor
Monitor germ cell tumor during treatment (if level initially elevated)
Neuron Specific Enolase 0098198
Method: Quantitative Enzyme-Linked Immunosorbent Assay
Use as a tumor marker for evaluation of neuroendocrine tumors
Lactate Dehydrogenase, Serum or Plasma 0020006
Method: Quantitative Enzymatic
Evaluate suspected germ cell tumor
Use for problematic ovarian tumor identification
Beta-hCG, Quantitative (Tumor Marker) 0070029
Method: Quantitative Electrochemiluminescent Immunoassay
Evaluate suspected germ cell tumor
Cannot be interpreted as absolute evidence of the presence or absence of malignant disease
Result not interpretable as a tumor marker in pregnant females
Results obtained with different test methods or kits cannot be used interchangeably
Breast and Ovarian Hereditary Cancer Panel, Sequencing and Deletion/Duplication, 20 Genes 2012026
Method: Massively Parallel Sequencing/Exonic Oligonucleotide-based CGH Microarray
Preferred first-tier genetic test to diagnose a hereditary cancer syndrome related to breast and ovarian cancer, including HBOC, if a known familial variant has NOT been previously identified
When a relative has been previously tested, see familial mutation targeted sequencing test
Highest detection rate for HBOC syndrome but also highest likelihood of identifying variants of unknown significance
Genes tested – ATM, BARD1, BRCA1, BRCA2, BRIP1, CDH1, CHEK2, EPCAM, MEN1, MLH1, MSH2, MSH6, MUTYH, NBN, PALB2, PTEN, RAD51C, RAD51D, STK11, TP53
Refer to Additional Technical Information document for further content
Clinical sensitivity – unknown
Deep intronic and regulatory mutaitons, breakpoints for large deletions/duplications, sequence changes in EPCAM (exons 11-15 of CHEK2 will not be evaluated with the exception of the c.1100delC mutation), and deletions/duplications (exon 1 in CDH1, MSH2, and RAD51D; exons 4,6, 7 in STK11; exon 8 in PTEN; exon 12 in ATM) will not be determined or evaluated
Small deletions or insertions may not be detected
Diagnostic errors can occur due to rare sequence variations
Breast and Ovarian Hereditary Cancer Syndrome (BRCA1 and BRCA2) Sequencing and Deletion/Duplication 2011949
Method: Polymerase Chain Reaction/Sequencing/Multiplex Ligation-dependent Probe Amplification
Acceptable first-tier genetic test to confirm HBOC syndrome
Only the BRCA1 and BRCA2 genes are assayed
When a relative has been previously tested, see familial mutation targeted sequencing test
Clinical sensitivity – ~20-60% sensitivity for HBOC syndrome
Analytical sensitivity and specificity of sequencing – 99% and 96%, respectively
Rare diagnostic errors can occur due to primer or probe site mutations
Regulatory region mutations and deep intronic mutations will not be detected
Genes causing HBOC syndrome, other than BRCA1 and BRCA2, are not tested
Deletion/duplication breakpoints will not be determined
p53 with Interpretation by Immunohistochemistry 0049250
Method: Immunohistochemistry
Aid in histologic diagnosis of ovarian cancer
Stained and resulted by ARUP
Wilms Tumor (WT-1), N-terminus by Immunohistochemistry 2004184
Method: Immunohistochemistry
Aid in histologic diagnosis of ovarian cancer
Stained and resulted by ARUP
p16 by Immunohistochemistry 2004064
Method: Immunohistochemistry
Aid in histologic diagnosis of ovarian cancer
Stained and returned to client pathologist; consultation available if needed
Estrogen/Progesterone Receptor with Interpretation by Immunohistochemistry 0049210
Method: Immunohistochemistry
Aid in histologic diagnosis of ovarian cancer
Stained and resulted by ARUP
Cytokeratin 7 (CK 7) by Immunohistochemistry 2003854
Method: Immunohistochemistry
Aid in histologic diagnosis of ovarian cancer
Stained and returned to client pathologist; consultation available if needed
Cytokeratin 20 (CK 20) by Immunohistochemistry 2003848
Method: Immunohistochemistry
Aid in histologic diagnosis of ovarian cancer
Stained and returned to client pathologist; consultation available if needed
CDX2 by Immunohistochemistry 2003821
Method: Immunohistochemistry
Aid in histologic diagnosis of ovarian cancer
Stained and returned to client pathologist; consultation available if needed
Beta-Catenin-1 by Immunohistochemistry 2003454
Method: Immunohistochemistry
Aid in histologic diagnosis of ovarian cancer
Stained and returned to client pathologist; consultation available if needed
Vimentin by Immunohistochemistry 2004181
Method: Immunohistochemistry
Aid in histologic diagnosis of ovarian cancer
Stained and returned to client pathologist; consultation available if needed
Calretinin by Immunohistochemistry 2003490
Method: Immunohistochemistry
Aid in histologic diagnosis of ovarian cancer
Stained and returned to client pathologist; consultation available if needed
Inhibin by Immunohistochemistry 2003969
Method: Immunohistochemistry
Aid in histologic diagnosis of ovarian cancer
Stained and returned to client pathologist; consultation available if needed
Carcinoembryonic Antigen, Monoclonal (CEA M) by Immunohistochemistry 2003824
Method: Immunohistochemistry
Aid in histologic diagnosis of ovarian cancer
Stained and returned to client pathologist; consultation available if needed
Carcinoembryonic Antigen, Polyclonal (CEA P) by Immunohistochemistry 2003827
Method: Immunohistochemistry
Aid in histologic diagnosis of ovarian cancer
Stained and returned to client pathologist; consultation available if needed
Cancer Antigen 125 by Immunohistochemistry 2003478
Method: Immunohistochemistry
Aid in histologic diagnosis of ovarian cancer
Stained and returned to client pathologist; consultation available if needed
Sal-like 4 (SALL4) by Immunohistochemistry 2005432
Method: Immunohistochemistry
Aid in histologic diagnosis of ovarian cancer
Stained and returned to client pathologist; consultation available if needed
Smad4 by Immunohistochemistry 2006403
Method: Immunohistochemistry
Stained and returned to client pathologist; consultation available if needed
PAX8 by Immunohistochemistry 2010787
Method: Immunohistochemistry
Distinguish ovarian cancer from breast cancer
Stained and returned to client pathologist for interpretation; consultation available if required
PD-L1 by Immunohistochemistry 2011158
Method: Immunohistochemistry
Aid in histologic diagnosis of ovarian cancer
Stained and returned to client pathologist for interpretation; consultation available if needed
Guidelines
American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. Committee Opinion No. 477: the role of the obstetrician-gynecologist in the early detection of epithelial ovarian cancer. Obstet Gynecol. 2011; 117(3): 742-6. PubMed
BRCA-Related Cancer: Risk Assessment, Genetic Counseling, and Genetic Testing. U.S. Preventive Services Task Force. Rockville, MD [Accessed: Nov 2015]
Breast Cancer Risk Assessment Tool. National Cancer Institute. Bethesda, MD [Accessed: Feb 2017]
Hampel H, Bennett RL, Buchanan A, Pearlman R, Wiesner GL, Guideline Development Group, American College of Medical Genetics and Genomics Professional Practice and Guidelines Committee and National Society of Genetic Counselors Practice Guidelines Committee. A practice guideline from the American College of Medical Genetics and Genomics and the National Society of Genetic Counselors: referral indications for cancer predisposition assessment. Genet Med. 2015; 17(1): 70-87. PubMed
NCCN Clinical Practice Guidelines in Oncology, Breast and Ovarian Cancer Genetic/Familial High-Risk Assessment: Breast and Ovarian . National Comprehensive Cancer Network. Fort Washington, PA [Accessed: Apr 2017]
NCCN Clinical Practice Guidelines in Oncology, Ovarian Cancer. Epithelial Ovarian Cancer (including Fallopian Tube Cancer and Primary Peritoneal Cancer). National Comprehensive Cancer Network. Fort Washington, PA [Accessed: Nov 2015]
Protocol for the Examination of Specimens From Patients With Primary Tumors of the Ovary or Fallopian Tube. Based on AJCC/UICC TNM, 7th ed., and FIGO 2014. Protocol web posting date: Jan 2016. College of American Pathologists (CAP). Northfield, IL [Published Jan 2016; Accessed: Jun 2015]
Salani R, Backes FJ, Fung MF, Holschneider CH, Parker LP, Bristow RE, Goff BA. Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations. Am J Obstet Gynecol. 2011; 204(6): 466-78. PubMed
Sturgeon CM, Duffy MJ, Stenman U, Lilja H, Brünner N, Chan DW, Babaian R, Bast RC, Dowell B, Esteva FJ, Haglund C, Harbeck N, Hayes DF, Holten-Andersen M, Klee GG, Lamerz R, Looijenga LH, Molina R, Nielsen HJ, Rittenhouse H, Semjonow A, Shih I, Sibley P, Sölétormos G, Stephan C, Sokoll L, Hoffman BR, Diamandis EP, National Academy of Clinical Biochemistry. National Academy of Clinical Biochemistry laboratory medicine practice guidelines for use of tumor markers in testicular, prostate, colorectal, breast, and ovarian cancers. Clin Chem. 2008; 54(12): e11-79. PubMed
General References
Buys SS, Partridge E, Black A, Johnson CC, Lamerato L, Isaacs C, Reding DJ, Greenlee RT, Yokochi LA, Kessel B, Crawford D, Church TR, Andriole GL, Weissfeld JL, Fouad MN, Chia D, O'Brien B, Ragard LR, Clapp JD, Rathmell JM, Riley TL, Hartge P, Pinsky PF, Zhu CS, Izmirlian G, Kramer BS, Miller AB, Xu J, Prorok PC, Gohagan JK, Berg CD, PLCO Project Team. Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. JAMA. 2011; 305(22): 2295-303. PubMed
Clarke-Pearson DL. Clinical practice. Screening for ovarian cancer. N Engl J Med. 2009; 361(2): 170-7. PubMed
Gilks B, Prat J. Ovarian carcinoma pathology and genetics: recent advances. Hum Pathol. 2009; 40(9): 1213-23. PubMed
Jayson GC, Kohn EC, Kitchener HC, Ledermann JA. Ovarian cancer. Lancet. 2014; 384(9951): 1376-88. PubMed
Köbel M, Gilks B, Huntsman DG. Adult-type granulosa cell tumors and FOXL2 mutation. Cancer Res. 2009; 69(24): 9160-2. PubMed
Leung F, Diamandis EP, Kulasingam V. Ovarian cancer biomarkers: current state and future implications from high-throughput technologies. Adv Clin Chem. 2014; 66: 25-77. PubMed
Miller RE, Rustin GJ. How to follow-up patients with epithelial ovarian cancer. Curr Opin Oncol. 2010; 22(5): 498-502. PubMed
Moore RG, Maclaughlan S. Current clinical use of biomarkers for epithelial ovarian cancer. Curr Opin Oncol. 2010; 22(5): 492-7. PubMed
Robertson DM, Pruysers E, Jobling T. Inhibin as a diagnostic marker for ovarian cancer. Cancer Lett. 2007; 249(1): 14-7. PubMed
Roett MA, Evans P. Ovarian cancer: an overview. Am Fam Physician. 2009; 80(6): 609-16. PubMed
Schorge JO, Modesitt SC, Coleman RL, Cohn DE, Kauff ND, Duska LR, Herzog TJ. SGO White Paper on ovarian cancer: etiology, screening and surveillance. Gynecol Oncol. 2010; 119(1): 7-17. PubMed
Walsh T, Casadei S, Lee MK, Pennil CC, Nord AS, Thornton AM, Roeb W, Agnew KJ, Stray SM, Wickramanayake A, Norquist B, Pennington KP, Garcia RL, King M, Swisher EM. Mutations in 12 genes for inherited ovarian, fallopian tube, and peritoneal carcinoma identified by massively parallel sequencing. Proc Natl Acad Sci U S A. 2011; 108(44): 18032-7. PubMed
Zagouri F, Dimopoulos MA, Bournakis E, Papadimitriou CA. Molecular markers in epithelial ovarian cancer: their role in prognosis and therapy. Eur J Gynaecol Oncol. 2010; 31(3): 268-77. PubMed
References from the ARUP Institute for Clinical and Experimental Pathology®
Cho S, Sun Y, Soisson AP, Dodson MK, Peterson M, Jarboe EA, Kennedy AM, Janát-Amsbury MM. Characterization and evaluation of pre-clinical suitability of a syngeneic orthotopic mouse ovarian cancer model. Anticancer Res. 2013; 33(4): 1317-24. PubMed
Grenache DG, Heichman KA, Werner TL, Vucetic Z. Clinical performance of two multi-marker blood tests for predicting malignancy in women with an adnexal mass Clin Chim Acta. 2015; 438: 358-63. PubMed
Jarboe EA, Folkins AK, Drapkin R, Ince TA, Agoston ES, Crum CP. Tubal and ovarian pathways to pelvic epithelial cancer: a pathological perspective. Histopathology. 2009; 55(5): 619. PubMed
Kushnir MM, Naessén T, Kirilovas D, Chaika A, Nosenko J, Mogilevkina I, Rockwood AL, Carlström K, Bergquist J. Steroid profiles in ovarian follicular fluid from regularly menstruating women and women after ovarian stimulation. Clin Chem. 2009; 55(3): 519-26. PubMed
Mongia SK, Rawlins ML, Owen WE, Roberts WL. Performance characteristics of seven automated CA 125 assays. Am J Clin Pathol. 2006; 125(6): 921-7. PubMed
Shaaban AM, Rezvani M, Elsayes KM, Baskin H, Mourad A, Foster BR, Jarboe EA, Menias CO. Ovarian malignant germ cell tumors: cellular classification and clinical and imaging features. Radiographics. 2014; 34(3): 777-801. PubMed
Medical Reviewers
Hereditary Breast and Ovarian Cancer and Genetic Testing - Rong Mao, MD, and Gwendolyn A. McMillin, PhD, DABCC (CC, TC) (FREE CME credit) (23 min)
Molecular Oncology: The Role of Next-Generation, Sequencing-Based Gene Panels in Solid Tumors - Allie Grossmann, MD, PhD (60 min)
Spotlight on Testing: Genetic Testing for Hereditary Breast and Ovarian Cancer Syndrome - Hunter Best, PhD (4 min)
Utility of Whole Genome Arrays for the Detection of Clinically Relevant Imbalances and Homozygosity in the Constitutional and Hematologic Malignancies Setting - Sarah South, PhD, FACMG (50 min)
Last Update: July 2017