CancerBro, what are the ovary cancer investigations required if suspected cancer?
To confirm the diagnosis of ovary cancer, we have to do some scans and blood tests.
The first step is to do transabdominao or transvaginal ultrasound, to look for the ovary mass and the rest of the pelvic structures.
CT scan of abdomen and pelvis or PET CT scan may be done if required.
Next step is to do blood tests, which will depend upon the sub-type of ovary cancer, as we have discussed previously.
CA-125 is the tumor marker for epithelial ovary cancer, which is elevated most commonly.
But CA-125 testing has some limitations. It may be false negative in some cases, that is negative when there is cancer. This could be seen in subtypes other than epithelial ovary cancer.
Even in some cases of an early-stage disease, it could be a false negative. Also, in the mucinous subtype of epithelial ovary cancer, it may be negative, and CA 19.9 or CEA may be elevated.
CA-125 may also be false positive, that is elevated in the absence of ovary cancer. Other cancers in which it may be false positive are breast, lung and GI cancer.
The non-cancerous conditions in which it may be false positive are PID, endometriosis, pregnancy, cirrhosis, peritonitis, pleuritis and pancreatitis.
The tumor marker for germ cell tumor is AFP, beta HCG, and LDH. Different sub-types of germ cell tumors have different combinations of this tumor marker elevated.
Most commonly elevated in dysgerminoma is LDH, and beta HCG may also be elevated in some cases, but AFP is never elevated in dysgerminoma.
In choriocarcinoma, beta HCG is very high and LDH may also be elevated.
In endodermal sinus or yolk sack tumors, AFP is high and LDH may also be elevated.
Inhibin A and inhibin B are the tumor markers for sex cord-stromal tumors, mainly granulosa cell subtype.
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