Current clinical use of biomarkers for epithelial ovarian cancer

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Abstract
The majority of women diagnosed with epithelial ovarian cancer (EOC) will be diagnosed with advanced stage disease, a stage that is fundamentally incurable. Survival rates for this deadly disease have improved over the last 25 years secondarily to the advances in surgery and chemotherapeutics. Effective screening protocols are not currently available, and risk assessment protocols for the presence of EOC in women with an ovarian cyst need improvement. Earlier diagnosis may result in stage migration and decreased morbidity for women diagnosed with EOC. Better risk assessment will allow the triage of women to centers of excellence in the treatment and management of ovarian cancer with improved outcomes and survival rates. This review will focus on new biomarkers and algorithms for screening and risk assessment for ovarian cancer. The use of multiple biomarkers and statistical algorithms has been shown to be an accurate method for assessing the risk of ovarian cancer in women with ovarian cysts/masses preoperatively. Newer algorithms employing biomarkers to trigger ultrasound imaging for screening also show promise. The addition of novel biomarkers such as human epididymis protein 4 to the use of CA125 improves the sensitivity and specificity over that of either biomarker alone for the management of EOC. For more than 25 years CA125 has been the main biomarker for the management of women with EOC. Recently, novel biomarkers have become available clinically that improve upon the use of CA125 for the risk assessment and management of women with ovarian cancer.

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