Evaluation of CA125, physical and radiological findings in follow-up of ovarian cancer patients.

ABSTRACT

The majority of ovarian cancer patients will suffer from intraabdominal relapse within the first five years after surgery. Today various diagnostic tools, including ultrasound or CT, are available to detect an ovarian cancer recurrence. Radiological examinations at regular time-intervals may lead to the detection of tumor relapse, however these procedures have limited sensitivity and specificity. Moreover, imaging procedures are costly. CA125 is a tumor marker with high sensitivity in ovarian cancer patients. Tumor marker determination is a simple, reproducible technique, and may therefore be useful in routine follow-up in ovarian cancer patients, supplemented with additional imaging procedures. In a retrospective analysis of 58 patients with recurrent ovarian cancer, the sensitivity of clinical examination and tumor marker analysis was compared to radiological findings. Physical interview and physical examination were performed for all patients. CA125 levels were determined in 54 out of 58 patients at the time of diagnosis of recurrence. Forty-seven out of 58 patients received a vaginal ultrasound and 42 were examined by CT scan. In 45 out of 54 (83%) patients, CA 125 was elevated at the time of recurrence. In 45 out of the 58 (78%) patients, a tumor was detected by physical examination. Forty-two out of the 58 patients had CT scans. Pathological findings were seen in 33 out of these patients (80%) Ultrasound revealed tumor recurrence in 33 out of 47 patients (70%). By a follow-up based on physical examination and CA125 determination, 53 out of 54 (98%) patients with recurrences could be identified. In patients with a pelvic recurrence, vaginal examination had the highest sensitivity in comparison to vaginal ultrasound and CT scan. Imaging techniques did not add clinically relevant information during follow-up and should therefore only be performed prior to surgical or therapeutical intervention.