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Today's Date: November 18, 2000

New Blood Test for Ovarian Cancer Shows Promise

Ovarian cancer is often described as a "silent" cancer because it typically causes no symptoms until it has spread quite extensively. The outlook for women who have localized ovarian cancer is very good, but only 24 percent of the cases are detected at this stage. Now, a new test for ovarian cancer may provide doctors with the ability to detect these cancers much earlier, giving women with the disease a better chance at successful treatment.

The new test measures the levels of lysophosphatidic acid (LPA) in the blood. Since LPA stimulates the growth of ovarian cancer cells, researchers speculated its presence in the blood may provide a good marker for the presence of ovarian cancer.

"We believe the most important finding of this study is elevated plasma LPA levels were detected in patients with early-stage ovarian cancer compared with controls," noted the authors in the August 26, 1998 edition of the Journal of the American Medical Association (JAMA).

Finding early-stage cancers would be a great step forward. The five-year survival rate for women with distant spread of ovarian cancer is about 25 percent. The outlook for women with localized ovarian cancer is much better-a 95 percent rate of survival beyond five years.

To perform the study, the researchers enrolled 165 women -- 48 with ovarian cancer, 48 with no cancer, and 69 with other cancers or benign gynecological diseases, and measured their LPA levels.

The researchers found the LPA blood levels of patients with ovarian cancer were significantly higher than those of the healthy control group. The LPA levels were elevated in 9 of 10 patients with stage I ovarian cancer and all patients with stages II, III, and IV ovarian cancers. However, among the healthy control groups, elevated LPA blood levels were found in 5 of 48 cases. Patients with other gynecological cancers also had higher LPA levels, as did some participants with benign gynecological diseases, such as fibroid tumors.

Comparison with CA125
The CA125 blood test is currently used to help in diagnosis of ovarian cancer and in detecting recurrence after treatment. However, CA125 is not always elevated in patients with early-stage disease and may be elevated in certain benign conditions, so it is not considered useful as a routine screening test.

In this study, researchers compared CA125 and LPA levels in the patients with ovarian cancer. They found that LPA levels were more accurate in finding ovarian cancers than were CA125 levels. For example, 8 of 9 stage I ovarian cancers had elevated LPA levels; only 2 of these patients had elevated CA125 levels. Among the 24 patients with stages II, III, and IV ovarian cancer, 100% (24) had elevated LPA levels compared to 54% (13) with elevated CA125 levels. Of women with recurrent ovarian cancer, 100% (14/14) had elevated LPA levels, compared to 86% (12/14) with elevated CA125 levels.

Overall 98% (47/48) patients with ovarian cancer had LPA levels above the cut-off compared to 57% (28/47) who had elevated CA125 levels.

Issues to be addressed
While these early findings are promising, the researchers cautioned that further studies will be needed to determine the general usefulness of LPA as a marker for ovarian cancer.

The current study examined only a small number of women; future studies will need to incorporate many more. Additionally, there was a high rate of false positive tests. Future studies will therefore need to identify which other medical conditions may affect the levels of LPA and devise strategies will need to be devised for reducing the false positive rate before this test can be used routinely. Finally, additional studies should be performed to assess how well LPA levels correlate with stage of disease and disease status to determine if it is a good marker for monitoring treatment, progression, and recurrence of disease.

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