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OVARIAN CYSTS & CANCER
Background

Many women with ovarian cysts will have some concerns about the risk of ovarian cancer.

The risk of ovarian cancer is generally low. This low risk appears to be the same worldwide.

The quoted risk is 1.3% in a women's lifetime. It is generally lower (eg 0.2%) in young women and higher (eg 1.2%) in women above 60 years old.

Women with ovarian cysts from endometriosis, family history of cancers or BRCA1 gene mutation can have a higher risk of ovarian cancer (eg>1.9-30%).

Pregnancy, breastfeeding, taking birth-control pills and removal of fallopian tubes all reduce the risk of ovarian cancer.

Ovarian Marker CA125

CA125 or Cancer-Antigen-125 was identified in the 1980s as a test for ovarian cancer. It is not the best test to diagnose ovarian cancer because many non-cancerous conditions can have a high CA125.

It is more effectively used to monitor treatment of certain cancers.

The normal CA125 is <35 U/ml. In the general population, there are healthy women with high CA125. The common benign, non-ovarian cancer conditions that increase CA125 are:-

  • Menstruation & Pregnancy
  • Endometriosis & Adenomyosis
  • Uterine fibroids
  • Pelvic Inflammatory Disease
  • Liver Cirrhosis
  • Pancreatitis

CA125, by itself, is not accurate enough to screen for ovarian cancer. Hence none of the major health professional organisations recommend using CA125 as a screening test for ovarian cancer in the general population.

Even when ovarian cancer is present, the CA125 can be normal. In a study (Skates 2003) of 9233 women, it was found that:

  • 50% of early ovarian cancer can have a normal CA125.
  • 20% of advanced ovarian cancer can have a normal CA125.

A recent study of CA125 and ovarian cancer (Funston 2019) found that CA125 may be detecting more ovarian cancers than thought.

Funston studied 50780 women and found 0.9% of them had ovarian cancer.

By age group, 0.4% of women <50 years and 1.2% of women >50 years had ovarian cancer.

In these 50780 women, CA125>76 in women <50 years and CA125>41 in women >50 years seem to predict the possibility of ovarian cancer.

Funston advised that these women should ideally have an urgent specialist referral for detailed assessment.

Ultrasound Features of Ovarian Cancer

The International Ovarian Tumour Analysis (IOTA) Group has formulated ultrasound features suggestive of ovarian cancer. Based on these ultrasound features, the detection of ovarian cancer can be 95% sensitive and 91% specific. (Timmerman 2010)

Features of Benign Non-Cancerous Ovarian Cysts:

Features of Malignant Cancerous Ovarian Cysts:

Risk of Malignancy Index (RMI) & ROMA Test

The Risk of Malignancy Index (RMI) uses CA125 and clinical features to assess the chance of ovarian cancer.
It cannot be used to diagnose ovarian cancer.
It is used to plan the detail treatment of ovarian cyst.

RMI = CA125 x U x M
  • CA125 = serum level in IU/ml
  • U= 0 (for ultrasound score 0)
  • U= 1 (for ultrasound score 1)
  • U= 3 (for ultrasound score 2-5)
  • M=1 for premenopausal women
  • M=3 for postmenopausal women
Ultrasound Score
  • Multilocular cysts
  • Solid areas
  • Bilateral lesions
  • Ascites
  • Metastases
RMI > 200 requires specialist consultation.

At RMI 200, 78% of ovarian cancer can be detected and it is 87% accurate.

(RCOG Guideline 62)

ROMA test is a computer calculation involving clinical factors (age >18yrs) and blood values of HE4 (Human Epididymis Protein 4) and CA125. ROMA test assesses the possibility of finding cancer in an existing ovarian cyst. It is not meant to be used as a screening test for ovarian cancer. ROMA test carries the following FDA Black Box Warning:-

ROMA should not be used without an independent clinical /radiological evaluation.
ROMA is not intended to be a screening test.
ROMA cannot determine whether a patient should proceed to surgery.
Who Needs Screening for Ovarian Cancer?

Women with strong family history of cancer and women with BRCA-1 or BRCA-2 gene mutation are advised to have ovarian screening. Strong family history refers to the following relations:

  • 2 or more 1st degree relatives with ovarian cancer
  • 1 relative with ovarian cancer and 1-2 relatives with breast cancer
  • 2-3 relatives with colon, stomach, ovarian, endometrium, urinary tract or small bowel cancer.

Screening for ovarian cancer involves CA125 and pelvic ultrasound every 4-6 months. Although screening cannot prevent ovarian cancer, they can possibly diagnose ovarian cancer earlier, hopefully at Stage 1. You can read more about ovarian cancer screening by downloading this article "Cancer and the Ovaries. Understanding ovarian cancer and screening methods"

OUR CLINIC'S EXPERTISE
  • Over 20 Years’ Experience in Ovarian Cyst Management
  • Internationally-Trained Laparoscopic Gynaecological Surgeon
  • Strong Advocate of Laparoscopic Surgery for Ovarian Cyst
  • Specialised in Single Incision Laparoscopy
  • Fast Recovery, Minimal Pain, Almost Scarless
Contact Our Clinic For Enquiries on Ovarian Cyst Screening, Diagnosis & Treatment
ASC Clinic for Women Pte Ltd
Gleneagles Medical Centre #05-04
6 Napier Road,
Singapore 258499

Appointments : +65 6479 9555
Email : surgery@anthonysiow.com
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