This is especially true in menstruating females, since false-positive results have been reported with endometriosis, benign ovarian cysts, pregnancy, and pelvic inflammatory disease. Pancreatic cancer and cirrhosis may also result in elevated CA-125 levels [18]. However, with stage II or greater ovarian cancer, the true-positive rate is as high as 80% [16]. There is a very high correlation between CA-125 levels and the clinical course of the patient during chemotherapy. CA-125 levels also can be used to predict tumor recurrence in patients who are clinically tumor free [19]. Oftentimes, other epithelial and nonepithelial tumor markers are ordered to differentiate tumor histology preoperatively. CA19-9 and carcinoembryogenic antigen (CEA) can also be elevated with epithelial ovarian neoplasms, but have limited specificity individually, and a high CA125-to-CEA ratio has been shown to optimize specificity for ovarian versus gastrointestinal primary neoplasms [20,21]. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Staging and Follow-up of Ovarian Cancer The decision regarding initial treatment for ovarian cancer depends on accurate staging. CT, FDG-PET/CT, and MRI have been used to assess the resectability of tumors, the candidacy of patients for effective cytoreductive surgery, the need for postoperative chemotherapy if debulking is suboptimal, and the need for referral to a gynecologic oncologist [5,34-36,39-45]. Referral to a gynecologic oncologist for optimal staging and debulking is the second most important determinant for survival after tumor stage in patients with ovarian carcinoma.
Staging and Follow up of Ovarian Cancer. This is especially true in menstruating females, since false-positive results have been reported with endometriosis, benign ovarian cysts, pregnancy, and pelvic inflammatory disease. Pancreatic cancer and cirrhosis may also result in elevated CA-125 levels [18]. However, with stage II or greater ovarian cancer, the true-positive rate is as high as 80% [16]. There is a very high correlation between CA-125 levels and the clinical course of the patient during chemotherapy. CA-125 levels also can be used to predict tumor recurrence in patients who are clinically tumor free [19]. Oftentimes, other epithelial and nonepithelial tumor markers are ordered to differentiate tumor histology preoperatively. CA19-9 and carcinoembryogenic antigen (CEA) can also be elevated with epithelial ovarian neoplasms, but have limited specificity individually, and a high CA125-to-CEA ratio has been shown to optimize specificity for ovarian versus gastrointestinal primary neoplasms [20,21]. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Staging and Follow-up of Ovarian Cancer The decision regarding initial treatment for ovarian cancer depends on accurate staging. CT, FDG-PET/CT, and MRI have been used to assess the resectability of tumors, the candidacy of patients for effective cytoreductive surgery, the need for postoperative chemotherapy if debulking is suboptimal, and the need for referral to a gynecologic oncologist [5,34-36,39-45]. Referral to a gynecologic oncologist for optimal staging and debulking is the second most important determinant for survival after tumor stage in patients with ovarian carcinoma.