ROMA (Risk of Ovarian Malignancy Algorithm)

More About ROMA (Risk of Ovarian Malignancy Algorithm)

ΗΕ4
(Human epidydimis protein 4)
AND OVARIAN CANCER

Ovarian cancer represents the 4th mortality factor due to diseases related to cancer in women. It comprises about 20% of the cancers that affect the female reproductive organs.
It typically appears after the 50th year of age and it is characterised by high morbidity and mortality. Survival is a direct function of timely diagnosis and treatment. The best treatment outcome is achieved when the diagnosis occurs and treatment commences during the early stages of the disease. Timely diagnosis increases the chances of successful treatment. According to the data from the international literature, the five-year survival probability is estimated at 46%. Despite that, when the diagnosis takes place during the early stages, the above probability rate can approach 94%.
We note however that it is difficult to trace the disease during its early stages due to the lack of tell-tale symptoms.

HE4

This protein belongs to the WFDC protein family. It can be located in very low traces in the epithelium membrane tissue of the upper respiratory and reproductive system, including those of the ovaries. It is excessively present in these tissues in cases of ovarian cancer. High levels of HE4 are secreted into the serum of those women that suffer from ovarian cancer during the early and final stages of the disease. This protein is present independently of the cancer index CA-125. H4 is a new bio-index that is expected to contribute substantially to the estimation of the risk of developing epithelial ovarian cancer.

EARLY HIGHLY SENSITIVE INDICATOR
FOR THE DIAGNOSIS OF OVARIAN CANCER

The up to date current practice, both clinical and experimental, daily justifies, suggests and confirms the difficulty of diagnosis. Recent studies from the isolated use of this particular indicator (HE4) have proven that it is the most sensitive for the identification of ovarian cancer, particularly during stage I of the disease which is particularly devoid of symptoms. Measurements of indicators HE4 and CA-125 in combination have led to results of greater diagnostic sensitivity, offering more information in an effort towards the timely tracing of the disease, which is a fact of critical and decisive importance to the survival chances of the patient.

We note that indicator HE4 manifests greater sensitivity during the early stages of the cancer of the endometrium. Increased levels of HE4 in combination with normal levels of CA-125 would indicate traces of whatever other type of ovarian or other type of cancer, with the incidence of cancer of the endometrium being an indicative example.

INCREASED DISCRIMINATION IN THE EVALUATION
OF THE ORIGIN OF MALINGNANCY OF TUMORS AND CYSTS IN THE OVARIES.

According to recent epidemiologic data, about 20% of women are diagnosed with adnexal mass or cyst in the pelvic area. The simultaneous measurement of indicators HE4 & CA-125 in combination with the evidence suggested by the imaging methods, can aid in the ‘discrimination in the diagnosis between malignancy and non-malignancy’ in the cases of presence of adnexal mass in the pelvic area, in women at the pre and post menopause stage. This joint measurement offers a more precise prognostic indicator of malignancy.
International studies report final results of 78.6% (95% in specialised cases) sensitivity for ovarian cancer in cases of cysts in the endometrium.

Being able to exclude the possibility of malignancy represents another significant step in the progress of patient care.

NEW PROSPECTS IN THE MANAGEMENT AND MONITORING OF THE TREATMENT OF THE PATIENT!

Indicator HE4 is a useful tool for the selection of the control group with adnexal pelvic mass, offering clinicians help in their decision making regarding the most suitable treatment selection and monitoring schedule for their patient. The levels of the indicator are related to the clinical response to treatment as well as to the potential of relapse in women with already diagnosed ovarian cancer.

HE4 & CA-125: RISK ASSESSMENT

The number of women with potential ovarian cancer is, quite often, quite high. With the ovarian malignancy risk estimator (ROMA Algorithm) the stratification of the women under examination into low and high-risk groups for developing epithelial ovarian cancer (90% of all cancer cases in the ovaries) can be achieved. This particular algorithm controls for the menopause factor as well as for the HE4 and CA-125 indicator levels before the surgical intervention. The mathematical formula for the calculation of the algorithm is adjusted depending on whether the woman is at a pre or post-menopause stage.
According to the literature, using the ROMA algorithm has resulted in the correct categorisation of 94% of women with epithelial ovarian cancer.

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