Screening for ovarian cancer: imaging challenges and opportunities for improvement

Abstract

The United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) recently reported a reduction in the average overall mortality among ovarian cancer patients screened with an annual sequential, multimodal strategy that tracked biomarker CA125 over time, where increasing serum CA125 levels prompted ultrasound. However, multiple cases were documented wherein serum CA125 levels were rising, but ultrasound screens were normal, thus delaying surgical intervention. A significant factor which could contribute to false negatives is that many aggressive ovarian cancers are believed to arise from epithelial cells on the fimbriae of the fallopian tubes, which are not readily imaged. Moreover, because only a fraction of metastatic tumors may reach a sonographically-detectable size before they metastasize, annual screening with ultrasound may fail to detect a large fraction of early-stage ovarian cancers. The ability to detect ovarian carcinomas before they metastasize is critical and future efforts towards improving screening should focus on identifying unique features specific to aggressive, early-stage tumors, as well as improving imaging sensitivity to allow for detection of tubal lesions. Implementation of a three-stage multimodal screening strategy in which a third modality is employed in cases where the first-line blood-based assay is positive and the second-line ultrasound exam is negative may also prove fruitful in detecting early-stage cases missed by ultrasound.

MicroRNA-1179 regulates proliferation and chemosensitivity of human ovarian cancer cells by targeting the PTEN-mediated PI3K/AKT signaling pathway

“…Obstetrics and gynecology been reported that in the United States alone more than 22 000 new ovarian cancer cases and 14 000 ovarian cancer deaths are recorded annually [3]. The main hurdles in the treatment of ovarian cancer are its late diagnosis and dearth of therapeutic targets.…”

Great Role in Gynecological Cancer Prophylaxis of a Unique Health Check-Up Institute, Ningen Dock in Japan (Review)

“…Many previous trials demonstrated a reduction in the average overall mortality among ovarian cancer patients screened with an annual sequential, multimodal strategy that tracked biomarkers CA125 over time, where increasing serum CA125 levels prompted ultrasound [20][21][22][23]. A critical factor which could contribute to false negatives is that many aggressive ovarian cancers are believed to arise from epithelial cells on the fimbriae of the fallopian tube, which are not readily imaged.…”

“…The ability to detect ovarian carcinomas before they metastasize is critical and future efforts toward improving screening should focus on identifying unique features specific to aggressive, early stage tumors, as well as improving imaging sensitivity to allow for detection of tubal lesions. So far, multimodal screening strategy in which blood-based assay is positive, and subsequent imaging examination may prove useful in detecting early stage cases [20][21][22]25].…”

miR-200b/200a/429 Cluster Stimulates Ovarian Cancer Development by Targeting ING5

“…e 5-year survival rate of earlystage ovarian cancer patients is more than 92%; however, the 5-year survival rate of late-stage ovarian cancer patients is only 29%, suggesting that early diagnosis is crucial for patient survival [2]. Unfortunately, only approximately 20-25% of patients with ovarian cancer are diagnosed at an early stage [3] due to a lack of early diagnostic markers [2]. Additionally, the molecular mechanism of ovarian cancer development is not fully understood.…”