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Serum biomarkers for evaluation of an adnexal mass for epithelial carcinoma of the ovary, fallopian tube, or peritoneum

Frederick Rand Ueland, MD
Andrew John Li, MD
Section Editor
Barbara Goff, MD
Deputy Editor
Sandy J Falk, MD, FACOG


Ovarian cancer is the second most common gynecologic malignancy and the most common cause of gynecologic cancer death in the United States [1]. Worldwide in 2008, ovarian cancer was the second most common gynecologic malignancy in developed countries and the third most common gynecologic malignancy (cervical cancer is the most common) in developing countries [2].

Epithelial ovarian cancer, the most common histologic type (95 percent of cases) of ovarian cancer (figure 1), typically presents at an advanced stage, which contributes to its poor prognosis [3]. In addition, a definitive diagnosis of ovarian cancer requires surgery; however, many procedures performed for a pelvic mass ultimately identify a benign adnexal mass.

Use of serum biomarkers for the diagnosis of epithelial ovarian cancer is an active area of investigation. Biomarkers or panels of biomarkers are generally used in combination with each other or with other findings (eg, ultrasound). Only a few biomarkers are commercially available. Cancer antigen 125 (CA 125) has been the focus of most investigations and is used most extensively. Other diagnostic tests for epithelial ovarian cancer include human epididymis protein (HE4), the OVA1 panel, and the Risk of Malignancy Algorithm (ROMA).

There is evidence that high-grade serous epithelial ovarian, fallopian tubal, and peritoneal carcinomas should be considered as a single clinical entity due to their shared clinical behavior and treatment. There is also accumulating evidence of a common pathogenesis for these carcinomas [4]. We will use the term epithelial ovarian cancer to refer to this group of malignancies in the discussion that follows. There is currently no serum biomarker that can distinguish between these types of carcinoma.

Use of serum biomarkers for the diagnosis of epithelial ovarian cancer in women who have an adnexal mass is reviewed here. Related topics are discussed separately, including:

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Literature review current through: Oct 2017. | This topic last updated: Apr 24, 2017.
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