Marker HE4 - what is it? Ovarian cancer is a very insidious cancer because it initially produces non-specific symptoms and is therefore diagnosed too late in its advanced stage. A blood test for the HE4 marker can help in the early diagnosis of this cancer and enable a more effective treatment.

Marker HE4(Eng.human epididymis protein 4)as subfraction 4 of the human epithelial epithelial cell protein more widely known isa protein used in the diagnosis and monitoring of ovarian cancer . The HE4 marker isencoded by the WFDC2 gene located on chromosome 20 .

The marker HE4 was first describedas a protease inhibitor involved in sperm maturation . Its role as a potential marker in ovarian cancer has been proposed after it has been observed that in some types of ovarian cancer there is an increased production of HE4 protein relative to normal tissues. The HE4marker is highly sensitivebecause its increase is already observed with slight neoplastic changes.

Marker HE4: who to test?

The indications for the examinationof the HE4 marker are symptoms that may indicate ovarian cancer:

  • pain in the lower abdomen and pelvis
  • constipation
  • flatulence
  • feelings of fullness
  • abdominal size increase
  • pressure on the bladder

Epithelial ovarian cancer is the most common type of cancer.It comes from the cells that cover the outside of the ovaries and accounts for up to 90 percent of the cancer. ovarian cancer cases. There are several different types of epithelial ovarian cancer:

  • serous
  • endometrioid
  • slime
  • light cell

It has been shown that the level of the HE4 marker iselevated in over 90%. epithelial ovarian carcinomas of the serous and endometrial typeand in about 50 percent. clear-cell carcinomas. On the other hand, in the case of mucinous carcinomas, the HE4 marker is usually not elevated. Hence, the HE4 marker is not used in the diagnosis of all types of ovarian cancer.

Read also: Cancer markers (cancer indicators): types and results of tests

Marker HE4: ROMA algorithm

The HE4 marker together with the CA 125 marker is part of the ROMARisk of Ovarian Malignancy Algorithmalgorithm, which assesses the risk of existence malignant cancer of the ovary. The determination of both markers simultaneously increases the effectiveness of the risk assessment. The ROMA algorithm allows the division of patients into those with low or high risk of ovarian cancer and, on this basis, adjusting the appropriate treatment.

Marker HE4 and CA 125 areordered prior to treatmentto establish a baseline value and periodically thereafter to monitor for cancer recurrence or disease progression.

Read also: Cancer cell

Marker HE4: what is the test and how much does it cost?

The test of the HE4marker is performed from venous blood taken from the elbow bend . Before the examination, the patient should be fasting. Then the blood is transported to the laboratory, where the HE4 marker is determined using immunochemical methods, e.g. ECLIA.

The price of testing the HE4 marker in a commercial laboratory isabout PLN 90 .

Marker HE4: what's the standard?

Standards for the HE4 marker may differ depending on the laboratory . This is because medical laboratories may use a variety of reagents and methods to measure the HE4 marker. In case of regular monitoring of the HE4 marker, it is recommended that all tests be performed in the same laboratory. This ensures that the test results can be compared with each other and correctly interpreted.

Additionally, the norms for the HE4 marker may depend on the age of the patient . Exemplary standards for the HE4 marker are presented below:

  • under 40: 60.5 pmol / l
  • 40 - 49 years old: 76.2 pmol / l
  • 50 - 59 years old: 74.3 pmol / l
  • 60 - 69 years old: 82.9 pmol / l
  • over 70: 104 pmol / l

Read also: Blood test - how to prepare for it

HE4 marker: what does wrong result mean?

Too high level of the HE4 marker may indicate ovarian cancer,but its normal level will not necessarily exclude it, especially when other tests indicate it. In women with ovarian cancer with high levels of the HE4 marker at baseline after treatment, if levels remain the same, the tumor is unlikely to respond to treatment. On the other hand, an increase in the level of the HE4 marker compared to the baseline value after treatment may indicate recurrence of ovarian cancer. Conversely, if the level of the HE4 marker is initially elevated and then declines after treatment, this indicates thatthat ovarian cancer has responded to the therapy.

Patients who have been diagnosed with ovarian cancer and have a normal baseline HE4 marker level should not be used for disease monitoring.

It is worth knowing thatsmall amounts of the HE4 marker can be produced by he althy tissues throughout the body , and a slight increase in its level may occur in people with various non-cancerous conditions. The level of the HE4 marker may also fluctuate throughout the menstrual cycle.

In he althy people the HE4 marker increases:

  • with age
  • u smokers
  • oral contraception

In addition, research has shown thatelevated levels of the HE4 marker may accompany other diseasessuch as:

  • non-small cell lung cancer
  • cancers of the gastrointestinal tract
  • breast cancer
  • heart failure
  • chronic kidney disease (CKD)
  • kidney fibrosis
  • endometriosis

Due to this, the elevated level of the HE4 marker should always be interpreted together with other laboratory and imaging tests and a detailed clinical interview.

Bibliography :

  • Granato T. et al. HE4 in the differential diagnosis of ovarian masses. Clin Chim Acta. 2015 Jun 15; 446: 147-55.
  • Maksimiuk M. et al. HE4 - not only an ovarian cancer biomarker - a brief review. TUMORS J Oncol 2022; 69, 3-4: 142-145.

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  • Lobular breast cancer - what type of breast cancer is it? Symptoms, diagnosis, treatment
  • Cervical cancer: causes, symptoms, treatment
  • Removal of the uterus and ovaries - life after a difficult surgery for a woman

Category:

Oncology