# Ovarian Tumour Markers

> CA-125, AFP, hCG, LDH, inhibin and CEA matched to ovarian tumour types with caveats in pregnancy, for NEET-PG Obstetrics and Gynaecology preparation.

- Canonical URL: https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/ovarian-tumour-markers
- Exam / course: NEET-PG · Subject: Obstetrics and Gynaecology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-08
- Last updated: 2026-10-08
- Reference basis: Williams Gynecology; Dutta's Textbook of Gynecology; Shaw's Textbook of Gynaecology
- How to cite: "Ovarian Tumour Markers", PrepElephant, https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/ovarian-tumour-markers

## 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.