The ROMA test is a modern diagnostic tool that assesses the risk of ovarian epithelial cancer. In what cases is it performed and what is the ROMA test? How are the ROMA test results interpreted?
First of all, it should be emphasized that theROMA(Risk of Ovarian Malignancy Algorithm) test does not allow for diagnosis. We will not find out if we have a malignant tumor or not. In women with an already diagnosed adnexal tumor, the ROMA test only assesses the probability that a given lesion is malignant and that it is epithelial ovarian cancer.
In other words, it enables a mathematical, percentage estimation of the risk of developing epithelial ovarian cancer based on the concentration of CA 125 and HE4 markers, taking into account differences for pre- and postmenopausal women and several other factors.
Insidious ovarian cancer
About 3,500 women suffer from malignant ovarian cancer in Poland each year, and 2,500 women die from it, and for several years this number has remained more or less at the same level. When it comes to ovarian cancer mortality in Poland, it is 6% of cancer deaths among women.
The main reason why the diagnosis of ovarian cancer is delayed is that symptoms are very poorly expressed and are mostly non-specific. We go to the doctor only when we have been suffering from gastric problems for a long time: tiring flatulence, constipation, pain in the lower abdomen, feeling of fullness in the abdomen. Unfortunately, it often happens that doctors look for the cause of these ailments in diseases of the stomach and liver.
However, an insightful specialist will also take into account chronic fatigue, weakness, loss of appetite and general malaise of the patient, and after performing basic laboratory and imaging tests, he will refer her to a gynecologist.
Diagnosis of ovarian cancer
In the case of pain such as painful pressure on the bladder, pain when urinating, constipation, flatulence, pain in the lower abdomen, and sometimes vaginal bleeding, we are usually dealing with the advanced stage of the disease. Unfortunately, as many as 75 percent of ovarian cancer cases are diagnosed only in stage III and IV, when effective treatment is very difficult and sometimes impossible due to numerous metastases.
Of course notall ovarian tumors must be malignant. They can also be harmless cysts, but to find out, you need to perform a number of diagnostic tests.
The first is palpation (two-handed) through the vagina - it is often thanks to it that the presence of the lesion can be detected. In this way, the doctor can determine the position and size of the ovaries, the location of the tumor, its mobility and shape. The next step is to perform a pelvic ultrasound (USG) with both a vaginal and a transabdominal probe.
Thanks to the assessment of various ultrasound parameters and the use of calculators taking into account the patient's age and menopausal status, the doctor can determine with high probability whether the ovarian tumor is malignant. The ROMA algorithm further improves the ability to estimate the risk of malignancy of the detected lesion. Other tests that should be supplemented with diagnostics are computed tomography, colonoscopy, gastroscopy, and sometimes magnetic resonance imaging.
What is the ROMA test?
As already mentioned, the ROMA test correlates with each other the test results of two tumor markers: CA 125 and HE4.
- CA 125 - an increased level of this indicator occurs when a woman's body has a cancer condition related to the reproductive organs, but also in endometriosis, uterine fibroids, ectopic pregnancy and in inflammation of the small pelvis. So, based on this one figure, ovarian cancer cannot be diagnosed yet, only a suspicion of it.
- HE4 - Human Epididymis Protein 4 - subfraction 4 of the human epithelial epithelial cells protein. It is a new tumor marker that is more sensitive than CA 125. It helps to detect cancer even in stage I and stage II. Since a small percentage of patients with benign ovarian cancer have elevated levels of HE4, this study is more likely to differentiate between benign and malignant lesions. In small amounts, this protein is also produced by some breast cancers, pancreatic cancer, endometrial cancer, and urinary tract cancer. The HE4 marker is also used in disease monitoring, during treatment and for the assessment of tumor recurrence.
Combined determination of HE4 and Ca 125 proteins shows better diagnostic parameters than both results interpreted individually. However, the isolated determination of HE4 gives diagnostic possibilities that exceed the determination of Ca 125 alone.
In the diagnosis of ovarian cancer, in addition to the above-mentioned imaging tests and the ROMA test, medical history should be taken into account, such as:
- number of births (the more, the lower the risk);
- timebreastfeeding (reduces the risk);
- taking birth control pills (reduces the risk)
- infertility and ovulation stimulation
- a family history of ovarian and breast cancers (increases the risk);
- carrier of BRCA1 and BRCA2 mutations;
- diet (high fat, with lots of milk and dairy products increases the risk);
If a ROMA test in a premenopausal woman is below 11.4%, it means a low risk of cancer. A score greater than or equal to this value - high risk.
A postmenopausal woman is at high risk when the ROMA test is 29.9% or higher. Less is low risk.
Contraindications for the ROMA test
It is worth knowing that the ROMA test should not be performed on patients:
- under 18,
- undergoing chemotherapy,
- previously treated for cancer.