Ovarian Cancer Algorithm
The objective of the program is to help in the management of patients with abdominal masses, the differential diagnosis with benign gynecological pathology and the monitoring of patients with ovarian neoplasms. It has two complementary and related parts:
First:
First of all, the application of the criteria and experience in the differential diagnosis in women of the abdominal masses, and of the benign gynecological pathology of ovarian cancer. This malignant tumor is a silent neoplasm, with few symptoms and that is usually diagnosed in advanced stages, with a high mortality.
It is usually presented as an abdominal mass, frequent pathology. One in five women will have an abdominal mass throughout their lives. The 10% must go to surgery to perform a differential diagnosis with 15% of these malignancies. Due to its high mortality it is important to make an early diagnosis. Vaginal ultrasound is one of the main diagnostic methods, but it is not conclusive in more than 30% of cases.
In recent years, various methods have appeared to support the diagnosis of ovarian cancer. They mainly consist of tumor markers such as CA 125, HE4, alone or in an algorithm called ROMA (Risk of ovarian carcinoma).
This last algorithm has been criticized for subdividing patients in relation to functional ovarian status (premenopause or menopause) and not age. Recently another algorithm called Copenhagen has been published that takes into account age. The publications made have a great disparity of results, which makes difficult the correct evaluation of the results.
Second:
The second part of the program uses tumor markers in the therapeutic monitoring of ovarian cancer. Ovarian cancer is diagnosed late and is often treated by combining chemotherapy and surgery. It is a tumor that is sensitive to chemotherapy, so survival is linked to the response and rapid and efficient assessment of therapeutic results is fundamental. To give an ineffective treatment, only gets to increase the toxicity, with a high cost and time lost that could be used trying a second treatment could be applied, allowing the tumor to grow. The algorithm incorporates the monitoring of therapeutic response through the serial evaluation of markers and the study of criteria to assess the response in an early and cost-effective manner. These results will be perfectly validated in relation to the usual radiological evaluation criteria, RECIST v1.1: if there is response, progression or stabilization of the disease.
The patients included in the study are preferably the clinical routine of the Hospital Clinic, obtained for more than 10 years, but there have been collaborations from other Spanish, European and Asian centers.
This collaboration with other centers, allows to avoid the possible bias of results from single-center studies. This information is of great importance since important differences have been described between serum concentrations of HE4 and CA 125 in women of Asian origin and in women of color , in relation to Caucasian women.
The variability between the results of the analytical results, the incorporation of the differences in the numerical concordance between them and their possible influence on the approach to the diagnosis through the study of tumor markers has also been evaluated.
BIBLIOGRAPHY
REFERENCES related to this topic from members of the team or collaborators.
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Spanish
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