Application of tumor markers in ovarian malignancies

Ovarian cancer is the fifth leading cause of death in women. The incidence of this malignancy increases in women over the age of 40. The overall five years survival is less than 30%, as most women present with advanced stage disease. Until recently, detection of early stage ovarian cancer has been difficult since it is usually nonpalpable and asymptomatic. The definitive diagnosis of an ovarian mass is a common problem in gynecologic patients with adnexal mass. The routine standard evaluation for adnexal masses includes patient's history, physical examination, ultrasound and histopathological examination. These parameters individually or in combination have little predictive value. The accuracy of diagnostic tools are of immense value and great concern to practicsing Gynecologists and Oncologists. The clinical application of serum concentration of CA 125, AFP and hCG is of great help not only as diagnostic aid but also in monitoring efficacy of any treatment modality like chemotherapy, radiotherapy or surgical resection. Additionally, evaluation of tumor marker concentration helps in predicting early biochemical recurrence and in prognostication in different types of ovarian malignancies. The ability to differentiate a malignant mass from a benign pelvic mass pretherapeutically could be enhanced optimally by additional use of tumor markers such as cancer antigen CA-125, alphafetoprotein and human chorionic gonadotrophin in pre-and postmenopausal women.