The value of cancer antigen-125 as a tumor marker in malignant germ cell tumors of the ovary

doi:10.1016/0090-8258(86)90096-X

Gynecologic Oncology

Volume 25, Issue 2, October 1986, Pages 150-159

https://doi.org/10.1016/0090-8258(86)90096-X Get rights and content

Abstract

The value of cancer antigen-125 (CA-125) as a tumor marker for malignant germ cell tumors (MGCT) of the ovary was investigated and compared with the other recognized tumor markers (human chorionic gonadotrophin (hCG), alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA)) and lactate dehydrogenase (LDH) isoenzymes. In the 10 months following June 1984, 4 new cases with MGCT and 1 patient with active disease on treatment were evaluated. In all cases prior to planned surgery the levels of CA-125 were significantly elevated. The serum values ranged from 154 to 617 U/ml (normal < 20 U/ml). In 1 case (pure dysgerminoma) CA-125 was the only tumor marker. In 3 patients (2 mixed germ cell tumors and 1 immature teratoma) serum LDH (LD 1, 2, and 3) was elevated, and AFP was elevated in 1 of these. In the fifth case (mixed germ cell tumor), on treatment, serum AFP was used to monitor the disease. Four patients underwent cytoreductive surgery followed by combination chemotherapy. The changes in the serum levels of CA-125 paralleled those of the other tumor markers while on therapy. In our experience CA-125 is an invaluable indicator of the clinical status of the patient and could be a new tumor marker in patients with MGCT.

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Cited by (20)

Multidisciplinary management of malignant ovarian germ cell tumours
2011, Gynecologic Oncology
Citation Excerpt :
Nevertheless, it can be useful in some cases to assess the response to the treatment and detect recurrence in patients with elevated LDH at diagnosis [6]. Similarly, CA-125 levels, although non-specific may be elevated in germ cell tumours and have been used to reflect patient progress [7,11]. Use of tumour markers in pregnancy for diagnosis and detection of relapse can be problematic due to physiological rises in these proteins.
Malignant ovarian germ cell tumours (MOGCT) are rare cancers of young women. Limited prospective trials exist from which evidence-based management can be developed. This review summarizes the available literature concerning MOGT in order to provide the clinician with information relevant to their multidisciplinary management.
MEDLINE was searched between 1966 and 2010 for all publications in English where the studied population included women diagnosed with malignant ovarian germ cell tumours.
The majority of patients can be cured with fertility-preserving surgery with or without combination chemotherapy. Long term survival approaches 100% in early stage disease and is approximately 75% in advanced stage disease. Most studies suggest that the treatment has little, if any, effect on future fertility and limited data suggest that there is no adverse effect on the future quality of life.
MOGCTs are rare tumours of young women the majority of which can be successfully treated with fertility-preserving surgery with or without chemotherapy with preservation of reproductive function. Minimisation of chemotherapy in good prognostic groups and improved treatment in resistant and relapsed MOGCT are important goals for the future. Further studies are needed to quantify the late adverse effects of treatment in long term survivors.
A systematic review of lactate dehydrogenase isoenzyme 1 and germ cell tumors
2001, Clinical Biochemistry
Objectives: To evaluate lactate dehydrogenase isoenzyme 1 (LD-1) as a tumor marker of germ cell tumors.
Methods: A literature search included a CancerLit and Medline computer search of articles regarding germ cell tumors and LD-1 published between 1963 to 99 and a manual search of reference lists, theses, and textbooks. Forty articles, letters to the editor, and abstracts on testicular germ cell tumors and 10 articles on ovarian germ cell tumors fulfilled inclusion criteria.
Results: Of 696 patients with testicular germ cell tumors, 423 (61%) had a raised serum LD-1 catalytic concentration (S-LD-1). Patients with seminoma have a raised S-LD-1 more often (63%) than those with nonseminoma (60%). S-LD-1 was raised less often in patients with stage I (48%) than in those with stage II (50%) and stage III (67%). S-LD-1, serum alpha fetoprotein concentration (S-AFP), and serum human chorionic gonadotropin concentration (S-hCG) were discordant. S-LD-1 predicted outcome in four studies: one study regarding relapse in patients with nonseminomatous testicular germ cell tumors stage I, and three studies regarding survival of patients with metastatic testicular germ cell tumors. In two of three studies, S-LD-1 was a better prognostic predictor for patients with metastatic testicular germ cell tumors than S-LD. Of 40 patients with ovarian germ cell tumors, thirty-five (88%) had a raised S-LD-1.
Conclusions: S-LD-1 is a useful serum tumor marker of testicular germ cell tumors. For patients with ovarian germ cell tumors, S-LD-1 was raised more often than for patients with testicular germ cell tumors. Further studies are required for a general recommendation regarding the use of S-LD-1 for germ cell tumors.
Diagnosis and management of malignant germ cell ovarian tumors in young females
1996, International Journal of Gynecology and Obstetrics
Germ cell tumors (GCT) compose most of the preadolescent malignant ovarian tumors; dysgerminoma being the most common (48%), followed by endodermal sinus tumor, immature teratoma, mixed GCT and embryonal carcinoma. The percentage of malignant epithelial ovarian tumors rises with increasing age, while that of the GCT tumors declines. Of all tumor markers discussed, only AFP ang hCG are being routinely monitored. Their most effective use is in monitoring response to therapy and detecting recurrences early. The current therapeutic regimens are presented, among them bleomycin, etoposide and platinol (BEP) and other new regimens; their influence on the patients' fertility is discussed. Further improvement in the prognosis of these young patients will hopefully follow development of new surgical and chemotherapeutic approaches.
α-Fetoprotein in malignant germ cell tumors of the ovary
1990, Gynecologic Oncology
To investigate the clinical significance of α-Fetoprotein (AFP) in malignant germ cell tumors of the ovary, we studied 46 patients who were treated by the Tokai Ovarian Tumor Study Group. The 46 patients had the following tumors: immature teratoma (IT), 17 cases; endodermal sinus tumor (EST), 16 cases; mixed germ cell tumor containing EST, 11 cases; embryonal carcinoma, 1 case; polyembryoma, 1 case. In all 29 non-IT cases, AFP was positive, and in 27 cases (93%) the level was above 1000 ng/ml. In 11 of 17 cases of IT (64.7%), AFP levels were elevated and in 1 case the level was above 1000 ng/ml. Elevation of the AFP level above 1000 ng/ml suggested the presence of EST. AFP levels were monitored in 27 of 29 cases without IT during treatment and follow-up. It was found that AFP levels should be monitored closely for at least 1 year after induction of remission. No recurrence was observed when AFP continued to be negative longer than 1 year. The mean interval to clinical recurrence from the reelevation of AFP was 4 months (1.4–9 months). An increase in the AFP to a positive level, even without clinical signs of recurrence, should be regarded as a recurrence. AFP was found to be a useful tumor marker for the diagnosis and management of malignant germ cell tumors of the ovary.
Ovarian yolk sac tumor arising from an endometrioid carcinoma
1987, Human Pathology
A yolk sac tumor that arose within an ovarian endometrioid adenocarcinoma in a 50-year-old woman is described. The tumor had typical microscopic features, stained immunohistochemically for α-fetoprotein, and was, associated with an elevated serum α-fetoprotein level when metastases appeared. This is the fourth case in which a yolk sac tumor has been reported to develop from a somatic carcinoma and the second in which this tumor has been associated with epithelium of endometroid type. Tumor heterogeneity or neometaplasia may account for the origin of a tumor of germ cell type from a carcinoma of somatic origin.
Gonadal and Extragonadal Germ Cell Tumors, Sex Cord Stromal and Rare Gonadal Tumors
2022, Pediatric Oncology

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The value of cancer antigen-125 as a tumor marker in malignant germ cell tumors of the ovary

Abstract

Clin. Obstet. Gynaecol.

Amer. J. Obstet. Gynecol.

J. Urol.

Gynecol. Oncol.

Advances in chemotherapy for gynecological cancer

Cancer

Germ cell malignancies of the ovary

Obstet. Gynecol.

Combination chemotherapy in the management of ovarian germ cell malignancies

Obstet. Gynecol.

Reactivity of a monoclonal antibody with human ovarian carcinoma

J. Clin. Invest.

Immunopathologic characterisation of a monoclonal antibody that recognises common surface antigens in human ovarian tumors of serous, endometrioid and clear core type

Amer. J. Clin. Pathol.

Tissue distribution of a coelomic epithelium related antigen recognised by the monoclonal antibody OC 125

Lab. Invest.

The value of CA 125 as a tumor marker in malignant germ cell tumours of the ovary

Brit. Med. J.