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 (β-hCG) – consider this test in premenopausal females to rule out pregnancy
- Cancer antigen 125 (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
- Human epididymis protein 4 (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 cell tumors
- CA 125 – frequently normal (not useful if normal)
- Inhibin – A and B (B usually higher than A)
- Total inhibin – highly sensitive
- Estradiol – often elevated
- Germ cell tumors
- CA 125 – not useful (usually normal)
- β-hCG – elevated
- Alpha fetoprotein (AFP) – elevated
- Neuron-specific enolase (NSE) – elevated
- Lactate dehydrogenase (LDH) – 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
- High-grade serous carcinoma (HGSC)
- (+) p53, Wilms tumor (WT-1), p16, estrogen receptor (ER)
- Low-grade serous carcinoma (LGSC)
- (+) WT-1, ER
- (+) SALL4, PAX8
- High-grade serous carcinoma (HGSC)
- Mucinous
- (+) CK 7, CK 20 (weak, focal), CDX2 (weak, focal), PAX8, SMAD4, DPC4 (testing for DPC4 not offered at ARUP Laboratories)
- (-) ER, WT-1 (not diffusely positive), beta-catenin-1 (β-catenin-1), p16
- Endometrioid
- (+) ER, progesterone receptor (PR) (nuclear), β-catenin-1, vimentin, CK 7, PAX8
- (+) p53 in some high-grade endometrioid – most lack p53, p16
- (-) WT-1 (not diffusely positive), calretinin, inhibin, CK 20, carcinoembryonic antigen (CEA) (monoclonal or polyclonal)
- Clear cell
- (+) HNF1-beta (HNF1β) (testing for HNF1β not offered at ARUP Laboratories), β-catenin-1, PAX8
- (-) 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, β-hCG
- Epithelial
- Molecular testing based on histology
- HGSC – BRCA1 or BRCA2 gene mutations common
- 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 (test not offered at ARUP Laboratories)
Imaging Studies
- Ultrasound
- Transvaginal sonography (TVS) followed by computed tomography (CT)/magnetic resonance imaging (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
- β-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
- SALL4 overexpression
- Associated with poor prognosis
- PD-L1 overexpression
- Associated with poor prognosis
Differential Diagnosis
- Abdominal pain
- Appendicitis
- Cholecystitis
- Peptic ulcer disease
- Other gastrointestinal malignancies – gastric, pancreatic, gallbladder
- Uterine fibroids
- Irritable bowel syndrome
- Metastatic disease from other tumors
- Pelvic inflammatory disease
- Endometriosis
- Diverticulitis
- Inflammatory bowel disease (IBD)
- 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 (cancer antigen 125 [CA 125] and transvaginal sonography (TVS)
- United Kingdom Collaborative Trial of Ovarian Cancer Screening [UKCTOCS]
- Multimodality screen shows significantly greater specificity and positive predictive value than TVS alone
- United Kingdom Collaborative Trial of Ovarian Cancer Screening [UKCTOCS]
- Completed trial
- European Randomized Trial of Ovarian Cancer Screening (ERTOCS)
- Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial [PLCO], 2015
- 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
- Ongoing trials to evaluate multimodality screening (cancer antigen 125 [CA 125] and transvaginal sonography (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 30
- See National Comprehensive Cancer Network (NCCN) Genetic/Familial High-Risk Assessment (Breast and Ovarian Cancer) 2017 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 30
- Lynch syndrome (hereditary nonpolyposis colorectal cancer [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 recommendations, based on personal and family history (NCCN, 2017)
- For individuals with a family history of a known pathogenic mutation previously identified in a relative – perform targeted mutation testing
- Epithelial
- Cancer antigen 125 (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
- Human epididymis protein 4 (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
- Cancer antigen 125 (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 (β-hCG), lactate dehydrogenase (LDH)
- Expect decrease after surgery
- Increasing levels may signal recurrence
- Alpha fetoprotein (AFP), beta-hCG (β-hCG), lactate dehydrogenase (LDH)
Cancer Antigen 125 0080462
Method: Quantitative Electrochemiluminescent Immunoassay
Evaluate and monitor ovarian cancer, usually epithelial subtype
Monitoring requires elevated pretreatment value of CA 125
Combination with human epididymis protein 4 (HE4) may enhance sensitivity
Not recommended for monitoring breast cancer or germ cell tumors
Not a stand-alone test for ovarian cancer screening or diagnosis
Not useful in cancer screening
Individuals with confirmed ovarian carcinoma may have pretreatment CA 125 values in the same range as healthy individuals
May be elevated in patients with nonmalignant disease
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
Use with CA 125 to monitor ovarian cancer, usually epithelial subtype, posttherapy if pretreatment level was elevated
Not recommended for monitoring mucinous or germ cell ovarian cancer
Not a stand-alone test for ovarian cancer screening or diagnosis
Not useful in cancer screening
Not recommended for monitoring patients with known mucinous or germ cell subtype
Risk of Ovarian Malignancy Algorithm 2012618
Method: Quantitative Enzyme Immunoassay, Electrochemiluminescent Immunoassay
Assess cancer risk, particularly epithelial cell ovarian cancer, in pre- and postmenopausal women 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 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
Suitable for measurement of estradiol in adult premenopausal women
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 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, if a known variant has NOT been previously identified in the family
When a relative has a previously identified pathogenic variant, see familial mutation targeted sequencing test
Highest detection rate for a hereditary syndrome related to breast and/or ovarian cancer, but also highest likelihood of identifying variants of uncertain 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 variants, 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 variant), 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
Preferred first-tier genetic test to confirm hereditary breast and ovarian cancer (HBOC) syndrome (BRCA1 and BRCA2 genes only)
When a relative has a previously identified pathogenic BRCA1 or BRCA2 variant, see familial mutation targeted sequencing test
Up to 99% sensitivity for BRCA1 and BRCA2 variants
~20-60% sensitivity for hereditary breast and ovarian cancers, in general
Deep intronic and regulatory variants will not be detected
Breakpoints for large deletions/duplications will not be determined
Small deletions or insertions may not be detected
Diagnostic errors can occur due to rare sequence variations
Genes causing HBOC syndrome, other than BRCA1 and BRCA2, are not tested
Breast and Ovarian Hereditary Cancer Syndrome (BRCA1 and BRCA2) Sequencing 2011954
Method: Polymerase Chain Reaction/ Sequencing
Acceptable first-tier genetic test to confirm HBOC syndrome
Up to 90% sensitivity for BRCA1 and BRCA2 variants
~20-60% sensitivity for hereditary breast and ovarian cancers, in general
When a relative has a previously identified pathogenic BRCA1 or BRCA2 variant, see familial mutation targeted sequencing test
Deep intronic and regulatory variants will not be detected
Breakpoints for large deletions/duplications will not be determined
Small deletions or insertions may not be detected
Diagnostic errors can occur due to rare sequence variations
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 returned to client pathologist; consultation available if needed
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
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
Aid in histologic diagnosis of ovarian 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): 742-746. 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: May 2017]
NCCN Clinical Practice Guidelines in Oncology: Ovarian Cancer, Including Fallopian Tube Cancer and Primary Peritoneal Cancer. National Comprehensive Cancer Network. Fort Washington, PA [Accessed: Jul 2017]
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
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Miller RE, Rustin GJ. How to follow-up patients with epithelial ovarian cancer. Curr Opin Oncol. 2010; 22(5): 498-502. PubMed
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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
Hamanishi J, Mandai M, Iwasaki M, Okazaki T, Tanaka Y, Yamaguchi K, Higuchi T, Yagi H, Takakura K, Minato N, Honjo T, Fujii S. Programmed cell death 1 ligand 1 and tumor-infiltrating CD8+ T lymphocytes are prognostic factors of human ovarian cancer. Proc Natl Acad Sci U S A. 2007; 104(9): 3360-5. PubMed
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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: September 2017