الفهرس 
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Abstract
Ovarian cancer is the most lethal type of gynecological malignancy and the fifth leading cause of cancer deaths among women. Its high mortality rate is due to the difficulties in diagnosis and high recurrence rate. Patients with early-stage disease is commonly asymptomatic or presented with vague nonspecific symptoms, so most of patients are presented with advanced-stage (III/IV) tumors, which associated with extremely low survival rate, so ovarian cancer is the silent killer.
CA 125 is currently the serum marker most widely used to monitor therapeutic response and to detect disease recurrence in patients treated for epithelial ovarian cancer. The National Comprehensive Cancer Network (NCCN) recommends CA 125 measurement before each treatment cycle for women with elevated pretreatment levels. NCCN also recommends CA 125 measurement at each follow-up evaluation if the level was initially elevated. CA 125, however, is not elevated in all patients with epithelial ovarian cancer; thus, other markers have been sought.
Human epididymis protein 4 (HE4), a relatively new marker for ovarian carcinoma, it is the product of the WFDC2 (HE4) gene that is overexpressed in patients with ovarian carcinoma.
Elevated HE4 levels are associated with ovarian cancer but are not disease-specific. A change in HE4 level of ≥25% is considered significant. An increase of this magnitude suggests recurrence or disease progression, while a decrease of this magnitude suggests therapeutic response. Levels of HE4 within the reference range do not preclude the presence of cancer, nor are elevated results an absolute indication of malignancy.
An algorithm combining HE4, CA125, and menopausal status, the Risk of Ovarian Malignancy Algorithm (ROMA), is used now to improve triage of patients with pelvic tumors.
The aim of the present study was to evaluate the ability of ROMA, HE4 and CA125 to detect ovarian cancer in patients with pelvic mass.
The study included 100 women recruited from gynecological oncology clinic at El Shatby Maternity University Hospital and were treated surgically, after signing a written consent.
Patients were subdivided into two groups: Group Ι: Included 50 patients with suspicious adnexal masses. The criteria of the suspicious mass were; bilateral, fixed, variable in consistency, presence of papillae, in postmenopausal women and presence of ascites.
The patients of this group were randomly subdivided them into two subgroups: Group A; included 25 patients with suspicious adnexal masses. CA125 was done to all of these patients. Group B; included 25 patients with suspicious adnexal masses. ROMA & HE4 were tested for this group.
Group ΙΙ: Included 50 women with non suspicious adnexal masses. The patients of this group were randomly subdivided into two subgroups: Group C; included 25 patients, CA125 was tested for all patients in this group. Group D; included 25 patients. ROMA&HE4 were tested for patients in this group.
The appropriate surgical treatment was done to all patients in all groups, followed by histopathological diagnosis. Correlation of ROMA value, HE4 level, CA125 level, surgical findings and results of histopathological examination were performed to test the ability of ROMA, HE4 and CA125 to detect ovarian cancer.
In our study ROMA showed the higher sensitivity and specificity in comparison to HE4 & CA125 alone in detection of ovarian cancer. HE4 & CA125 levels were higher in malignant adnexal lesions than border line and benign lesions while ROMA was with the highest level when associated with border line tuomurs than malignancy or benign lesions.
Carcinosarcomas were associated with the highest levels of CA125, HE4 & ROMA while serous subtypes were the most common type among all patients with malignancy.
Presence of malignant cells in ascites, LN affection, omental affection and high grade tumour usually associated with higher levels of CA125, HE4 and ROMA in patients with ovarian cancer.