Current clinical application of serum biomarkers to detect and monitor ovarian cancer - update.

In recent decades many potential serum biomarkers have been assessed in the diagnosis of ovarian cancer. Except cancer antigen 125 (CA125) and human epididymis protein 4 (HE4), none of them have been applied to everyday clinical practice. Based on extensive scientific evidence, CA125 combined with HE4 to form the risk of ovarian malignancy algorithm (ROMA), have become widespread in clinical practice in the evaluation of adnexal masses. Early ovarian cancer is often asymptomatic, so it remains challenging to develop even more effective methods for early diagnosis and screening. Among others, OVA1 is tested as a potential tool to improve the stratification of the risk of ovarian cancer. Also, a lot of effort is being made to develop suitable methods to monitor ovarian cancer patients. Serum CA125 already plays an established role in monitoring the treatment (except targeted therapies) and relapse setting in ovarian cancer patients, with a more limited role in subtypes other than in high-grade serous carcinoma, and always in correlation with imaging and clinical assessment. Human epididymis protein 4 (as well as circulating tumour DNA - ctDNA) is not recommended for monitoring at that timepoint, although encouraging newly published studies might influence their role in the future.