Management of asymptomatic patients on follow-up for ovarian cancer with rising CA-125 concentrations

Goonewardene, T.I.; Hall, Marcia; Rustin, G. J. S.

doi:10.1016/s1470-2045(07)70273-5

Cited by 86 publications

(59 citation statements)

References 48 publications

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“…A longstanding and ongoing controversy in the treatment of advanced ovarian cancer concerns use of the CA125 test (Rustin, Nelstrop, Bentzen, Piccart & Bertelsen, 1999;Goonewardene, Hall & Rustin, 2007;Gadduci & Cosio, 2009). CA125 is a serum marker produced by ovarian cancers and by irritation of the body's internal surfaces.…”

Section: Introductionmentioning

confidence: 99%

Cancergazing? CA125 and post-treatment surveillance in advanced ovarian cancer

Jordens

Morrell

Harnett

et al. 2010

Social Science & Medicine

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Post-treatment surveillance of advanced ovarian cancer involves regular testing of asymptomatic patients using the CA125 test. This practice is based on a rationale that is not supported by evidence from clinical trials. This paper aims to stimulate critical reflection concerning the effect of investigative tests on clinical decisions and interactions, and the experience of illness, particularly in the context of advanced malignant disease. Drawing on the idea of the "medical gaze", and building on previous health communication research, we present an analysis of in-depth interviews and psychometric tests collected in a prospective study of 20 Australian women with advanced ovarian cancer conducted between 2006 and 2009. We describe the demands placed on patients by the use of the CA125 test, some hazards it creates for decision-making, and some of the test's subjective benefits. It is widely believed that the CA125 test generates anxiety among patients, and the proposed solution is to educate women more about the test. We found no evidence that anxiety was a problem requiring a response over and above existing services. We conclude that the current debate is simplistic and limited. Focussing on patient anxiety does not account for other important effects of post-treatment surveillance, and educating patients about the test is unlikely to mitigate anxiety because testing is part of a wider process by which patients become aware of a disease that -once it has relapsed -will certainly kill them in the near future.

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Section: Introductionmentioning

confidence: 99%

Cancergazing? CA125 and post-treatment surveillance in advanced ovarian cancer

Jordens

Morrell

Harnett

et al. 2010

Social Science & Medicine

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show abstract

“…2,3 For anaplastic astrocytomas (AAs) and anaplastic oligoastrocytomas (AOAs), there is no molecular marker for diagnosis, treatment evaluation, and prognosis. Decreased expression of the gene O 6 -methylguanine-DNA methyltransferase by methylation of its promoter was recently reported to confer a favorable response to temozolomide chemotherapy and longer survival in GBM patients, 4 but this analysis requires tumor tissues that are often unavailable.…”

mentioning

confidence: 99%

“…For prostate and ovarian cancer, serum prostate-specific antigen and cancer antigen 125 markers are often used clinically for diagnosis. 5,6 No such blood markers have been identified for glioma patients, although a few candidate proteins (cathepsin D, low-molecular-weight caldesmon, YKL-40, matrix metalloproteinase-9, and glial fibrillary acidic protein) have been recently reported. [7][8][9][10] In this study, we tested the potential use of measuring plasma insulin-like growth factor binding protein 2 (IGFBP-2) levels in the setting of glioma.…”

mentioning

confidence: 99%

Plasma IGFBP-2 levels predict clinical outcomes of patients with high-grade gliomas

et al. 2009

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Insulin-like growth factor binding protein 2 (IGFBP-2) is a malignancy-associated protein measurable in tumors and blood. Increased IGFBP-2 is associated with shortened survival of advanced glioma patients. Thus, we examined plasma IGFBP-2 levels in glioma patients and healthy controls to evaluate its value as a plasma biomarker for glioma. Plasma IGFBP-2 levels in 196 patients with newly diagnosed glioma and 55 healthy controls were analyzed using an IGFBP-2 ELISA kit. Blood was collected before surgery, after two-cycle adjuvant chemotherapy, and at recurrence. Plasma IGFBP-2 levels were correlated with disease-free survival (DFS) using Cox regression analyses. We found that preoperative plasma IGFBP-2 levels were significantly higher in high-grade glioma patients (n 5 43 for grade III glioma; n 5 72 for glioblastoma multiforme [GBM]) than in healthy controls (n 5 55; p , 0.001) and low-grade (grade II) glioma patients (n 5 81; p , 0.001). No significant differences in preoperative plasma IGFBP-2 levels were observed between grade III glioma and GBM patients or between grade II glioma patients and healthy controls. After recurrence, plasma IGFBP-2 levels were significantly increased in GBM patients (n 5 26; p , 0.001). Preoperative plasma IGFBP-2 levels were significantly correlated with DFS in GBM patients (hazard ratio, 1.404; 95% confidence interval, 1.078-1.828; p 5 0.012). We conclude that preoperative plasma IGFBP-2 levels are significantly higher in high-grade glioma patients than in low-grade glioma patients and healthy subjects, and are significantly correlated with recurrence and DFS in patients with GBM. Longitudinal studies with a larger study population are needed to confirm these findings.

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“…CA-125 is a high-molecular weight glycoprotein that is expressed at the cell-surface of epithelial cells from where it is actively secreted into the lumen and subsequently drained into the bloodstream [37,38]. Immunohistochemical analyses have shown that 80 % of serous ovarian cancers will express CA-125, while fewer than 30 % of mucinous-, clear-cell-, and endometrioid cancers are positive for this surface antigen [39].…”

Section: Ovarian Cancermentioning

confidence: 99%

Serum tumor markers and PET/CT imaging for tumor recurrence detection

et al. 2012

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When confronted with a suspicious rise in CA 15.3 in asymptomatic breast cancer patients following primary treatment and negative or equivocal conventional imaging findings, FDG PET/CT allows assessment of the site and extent of the recurring disease with an accuracy of 83 %. Both FDG PET and FDG PET/CT are superior when compared to CT alone for the purpose of recurrence detection in patients suffering from ovarian carcinoma who have completed primary therapy but demonstrate a rising serum CA-125 level. As the global accuracy of CT alone for detection of recurrence of ovarian cancer approximates 80 %, CT scan should be performed upfront to identify the site of recurrence. When confronted with negative or equivocal CT findings, FDG PET alone or FDG PET/CT should be added. In patients with rising erum CEA levels that have undergone primary treatment for a colorectal carcinoma, both FDG PET and FDG PET/ CTs allow detection of tumor recurrence with an accuracy of 95 %, well above that of CT and MRI. Available studies further suggest that FDG/PET findings will affect treatment management in 28-50 % of these patients. The detection rate of both 11C-choline and 18F-choline PET and PET/CT for local, regional, and distant recurrence in prostate carcinoma patients with a biochemical recurrence increases with rising PSA value at the time of imaging and reaches about 75 % in patients with PSA [3 ng/mL. Furthermore, PET and PET/CT with [11C]-and [18F]-choline derivates may be helpful in the clinical setting for optimization of individualized treatment.

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Management of asymptomatic patients on follow-up for ovarian cancer with rising CA-125 concentrations

Cited by 86 publications

References 48 publications

Cancergazing? CA125 and post-treatment surveillance in advanced ovarian cancer

Cancergazing? CA125 and post-treatment surveillance in advanced ovarian cancer

Plasma IGFBP-2 levels predict clinical outcomes of patients with high-grade gliomas

Serum tumor markers and PET/CT imaging for tumor recurrence detection

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