Scientific interpretation: How HE4 and CA125 improve the accuracy of ovarian cancer diagnosis

Author: Cui Liyan, Chief Physician, Peking University Third Hospital

Reviewer: Duan Hua, Chief Physician, Beijing Obstetrics and Gynecology Hospital, Capital Medical University

Ovarian cancer is a major killer that threatens women's health, and its early diagnosis has always been a challenge. Among the many tools used to assist in the diagnosis of ovarian cancer, tumor marker detection has become an important part of auxiliary examinations due to its convenience. Among them, CA125 and HE4, as two key markers, play an indispensable role in clinical practice. The following will explore in depth the characteristics, complementarity, and precautions of HE4 and CA125 in practical applications.

HE4, as a new ovarian cancer marker, has received widespread attention from researchers and clinicians since it was discovered ten years ago. HE4 is not only expressed in the reproductive system, but may also be expressed in the respiratory system to a certain extent. Therefore, its level may also increase when the respiratory system is diseased. However, for ovarian cancer, the increase in HE4 is particularly significant, making it a relatively specific marker. Studies have shown that HE4 shows a clear upward trend in both the early and late stages of ovarian cancer.

In contrast, CA125, as a traditional ovarian cancer marker, has been used clinically for many years. However, the sensitivity of CA125 has certain limitations. In particular, in certain types of ovarian cancer, such as serous ovarian cancer, CA125 levels may not increase. In addition, CA125 is also affected by a variety of benign diseases, such as inflammatory endometriosis, etc. These diseases may lead to an increase in CA125, thereby increasing the risk of false positives. Therefore, the limitations of CA125 in the diagnosis of ovarian cancer cannot be ignored.

To make up for the lack of sensitivity of CA125 in predicting ovarian cancer, the emergence of HE4 provides a new option for the diagnosis of ovarian cancer. Studies have found that in patients with ovarian cancer, HE4 levels are often significantly elevated, while in patients with benign ovarian lesions, HE4 levels usually remain normal. This characteristic makes HE4 important in the differential diagnosis of ovarian cancer.

Of course, no tumor marker can be used alone as a basis for cancer diagnosis. In the diagnosis of ovarian cancer, although the combination of CA125 and HE4 can play the complementary advantages of the two markers and improve the accuracy of diagnosis, the final diagnosis needs to be made in combination with the patient's symptoms, signs and imaging examinations.

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When testing for tumor markers for ovarian cancer, both patients and doctors need to pay attention to some things. First of all, a simple tumor marker test cannot confirm ovarian cancer, it can only serve as a basis for auxiliary diagnosis. Therefore, even if the tumor marker is elevated, there is no need to be too nervous. Under normal circumstances, if there are no uncomfortable symptoms, monitoring can be performed every six months to a year. If the tumor marker shows a trend of progressive increase, or the patient has related symptoms, it is necessary to go to the hospital in time for further examination.

Secondly, patients usually do not need to make special preparations before undergoing tumor marker testing. Most current detection methods are not affected by fasting, so patients can eat normally. However, it should be noted that certain interfering factors may affect the accuracy of the test results. Such as common interfering factors such as hemolysis, lipemia, jaundice, and the influence of certain therapeutic drugs. In addition, some special foods or health products may also cause a slight increase in tumor markers. Therefore, if the test results show a slight increase, the patient can be tested again after a period of time to rule out the influence of interfering factors.