Ovarian Tumour Markers
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Direct answer
Ovarian tumour markers are serum proteins or hormones that help classify, monitor and sometimes suspect ovarian neoplasms, but none is diagnostic on its own. CA-125 tracks serous epithelial cancer, AFP points to yolk sac tumour, beta-hCG to choriocarcinoma, LDH to dysgerminoma and inhibin to granulosa cell tumour. Every result must be read against the histological type, the imaging and conditions such as pregnancy.
What you must remember
- CA-125: a glycoprotein raised in most serous epithelial cancers, but also in endometriosis, pelvic infection, menstruation and pregnancy.
- HE4: a second epithelial marker, used with CA-125 in the risk of malignancy algorithm (ROMA) for pelvic masses.
- AFP: raised in yolk sac tumour and embryonal carcinoma, and maternal AFP rises physiologically in pregnancy, so gestation-specific values matter.
- Beta-hCG: raised in choriocarcinoma and in some dysgerminomas, and a pregnancy test always comes first.
- LDH: raised in dysgerminoma, and its trend tracks disease burden, though it is not specific.
- Inhibin B and anti-Mullerian hormone: raised in granulosa cell tumour and useful for follow-up.
- CEA and CA 19-9: raised in mucinous tumours, although gastrointestinal cancers produce them too.
- Screening: no marker is effective as a population screen for ovarian cancer, because sensitivity in early disease is poor.
Matching each marker to its tumour
Each marker is useful for a specific histological group, and the table pairs it with the main caveat. The final column shows its usual clinical role, which is often what the exam asks about.
| Marker | Matched tumour | Main caveat | Main use |
|---|---|---|---|
| CA-125 | Serous epithelial carcinoma | Raised in endometriosis, infection and pregnancy | Monitoring response and relapse |
| HE4 | Epithelial ovarian cancer | Used with CA-125 in ROMA, not alone | Risk stratification of pelvic masses |
| AFP | Yolk sac tumour | Physiological rise in pregnancy | Diagnosis and follow-up |
| Beta-hCG | Choriocarcinoma | Pregnancy and gestational disease must be excluded | Diagnosis and monitoring |
| LDH | Dysgerminoma | Nonspecific and raised in many conditions | Tracking disease burden |
| Inhibin B | Granulosa cell tumour | Used mainly for monitoring | Detecting recurrence |
| CEA and CA 19-9 | Mucinous tumours | Raised in gastrointestinal cancers too, so origin is not certain | Supporting an ovarian mucinous origin |
A marker is most informative when its trend is followed on treatment, rather than read from a single value. Imaging and histology remain the reference standard, so markers support rather than replace them, and a normal marker does not exclude a tumour seen on imaging.
Marker traps in the exam
Marker questions usually test the matching of marker to histology and the confounders of pregnancy and benign disease.
- Trap: Using CA-125 as a screening test for ovarian cancer Correct: it is raised in many benign states and is often normal in early disease, so it cannot screen the population.
- Trap: Reading a raised hCG in a young woman as a germ cell tumour without testing Correct: pregnancy and gestational disease are excluded first, and only then is germ cell tumour considered.
- Trap: Interpreting maternal AFP without a gestational reference Correct: AFP rises physiologically in pregnancy, so gestation-specific values are used.
- Trap: Expecting LDH to be specific for dysgerminoma Correct: LDH supports dysgerminoma but is nonspecific, so its trend and histology guide treatment.
Frequently asked questions
Which tumour marker is raised in dysgerminoma?
LDH is commonly raised in dysgerminoma and correlates with tumour burden, which makes it useful for diagnosis and monitoring. Beta-hCG is raised only in a minority of dysgerminomas, typically those containing syncytiotrophoblast giant cells.
Why is CA-125 not used for screening for ovarian cancer?
CA-125 is not used for screening because it is raised in endometriosis, pelvic infection, menstruation and pregnancy, and it is often normal in early-stage ovarian cancer. These limitations give it poor sensitivity and specificity for population screening.
Which tumour marker is useful for granulosa cell tumour?
Inhibin B and anti-Mullerian hormone are the most useful markers for granulosa cell tumour, because they correlate with tumour burden and help detect recurrence. CA-125 is less reliable for this tumour type.
How is CEA useful in ovarian tumours?
CEA is raised in many mucinous ovarian tumours, and combined with CA 19-9 it can suggest a mucinous origin. It is not specific, because gastrointestinal cancers also raise these markers, so imaging and histology are still needed.