Due to hormonal changes in a woman’s body during menopause, the risk of cancer is increasing. Cancer diseases, as a rule, make themselves felt already in late stages, when recovery is almost impossible. The index Roma 1 in premenopausal can detect cancer education at the initial stage. Due to this increases the chance of recovery.
What is the index Roma 1 and why do it?
Index Roma 1 is designed for early detection of ovarian cancer. It is defined as a formula that calculates the percentage possibility of the formation of tumor processes in the ovaries and pelvic organs.
Ovarian cancer is a crafty disease. At the initial stage does not manifest itself. Some statistics: ovarian carcinoma is found in stage 3-4 in 70% of all episodes. In this scenario, the cure rate is only 20%. However, if you find a tumor in stage 1, then the chance to recover is 80%! Of course, it makes sense to diagnose the disease as early as possible.
Climax, though not the cause of the disease, but still contributes to its development. Therefore, it is during the premenopause period that the Roma 1 index is used for the early detection of cancer.
The Roma index is divided into two indicators:
- Roma 1 - for the determination of cancer in the premenopausal period.
- Roma 2 - for the determination of cancer in the period of menopause.
In this article we will take a closer look at the indicator index Roma 1, for women at the initial stage of menopause.
What does the indicator consist of?
The need to take this analysis occurs when a woman has a benign tumor in the ovaries, or there is a disease in which the risk of developing cancer is increased. The analysis involves the collection of blood from a vein. Before this, a woman should not eat for 8 hours. Blood is examined for the ratio of the two components. The study is conducted dynamically. Only joint indicators of the components can give an accurate result. So what does the rum index consist of?
This is a marker in the body that rises in the presence of cancer cells in the pelvic organs. When cancer develops, atypical cells are detected by blood tests. In fact, the presence of an ovarian tumor is indicated not by the presence of CA 125, but by its rapid growth in a short time. Increased concentration of the marker increases 10 months before the diagnosis. Therefore, if CA 125 is found in the blood, this does not mean that you have 100% cancer. Without correlation with the second component it is impossible to say for sure. Sometimes CA 125 may manifest due to:
- Pregnancy. If a woman is pregnant for up to 12 weeks, the CA 125 can detect itself.
- Endometriosis also reveals CA 125.
- Inflammations in the uterus and adhesions may manifest themselves as CA 125.
Therefore, for an accurate diagnosis, blood is examined for the presence of another substance.
Protein protein that is produced by the body in small doses, especially in the pelvic organs. The component is sensitive to atypical cells and an increase in its concentration indicates cancer. The number of NOT 4 rises about 3 years before an accurate diagnosis of ovarian cancer. Despite the accuracy of this marker, there is an error of false positive response when:
- inflammatory processes in the pelvic organs,
- renal failure
- sound education,
So, a joint study of these two indicators and is the basis for calculating the index of Roma 1. After calculating the indicators, the woman learns about the likelihood of ovarian cancer.
Calculation, decoding, rate and deviations
So, in order not to distort the testimony of the test, a woman must follow the rules:
- donate blood in the morning
- a couple of days before the test, do not drink alcohol, do not smoke, refuse junk food,
- avoid stress and heavy exercise
- Do not make diagnostics related to radiation (ultrasound, MRI, etc.).
After observing all the rules and taking blood in the laboratory, they proceed to the calculations.
The formula for calculating the Roma index is complex, therefore, without having a medical education, you should not count on it yourself.
roma = exp (PI) / [1 + exp (PI)] x 100
After the technicians have calculated the percentage ratio of the two indicators, a comparison with the norm occurs, and deviations are detected.
The rate for premenopausal patients is 7.39%. If the rate is more than normal, then the risk of ovarian cancer is high. If the indicator is less than the norm, then the woman has a small risk of ovarian cancer.
What does Roma consist of 1
To determine Roma 1, you need a blood test for the presence, concentration and ratio of two substances in it. Moreover, this is done in dynamics, since temporary changes in the indicator or their absence are important.
The need to determine it is caused by the presence of a benign neoplasm on the ovaries or other gynecological pathologies in which the likelihood of cancer is increased. In premenopausal sex hormones, a drop in the level of sex hormones can trigger cell degeneration if there is already a tumor, or there are other factors favorable for pathological changes. Blood for roma 1 is taken from a vein, the patient cannot be eaten for 8 hours prior to her collection.
Atypical cells that form in the healthy tissues of the ovaries, find themselves in the study of blood. The presence of a tumor marker CA 125 is read in a biological fluid. It is a substance that the body increases when cancer cells appear in the tissues of the gonads. It is dangerous in relation to the onset of ovarian cancer, not the presence, but an increase in the level of the indicator in a short time.
Its detection is not a 100% cancer detection method. Without an updated analysis of Roma 1, a calculation of CA 125 before menopause can give a false positive result in the following cases:
- Pregnancy up to 12 weeks. This is possible in the premenopausal period, when rare menstruation causes a woman to lose vigilance and be less carefully protected,
- The presence of inflammations of various kinds in the uterus, appendages,
- Adhesions in the pelvic area.
In the female body there is another substance - HE 4, which is a protein of the epidermis. It is produced by the epithelium of the upper respiratory tract, the tissue of the reproductive organs in minimal quantities, but production increases in response to the appearance of atypical cells in certain areas of the body.
If elevated HE 4 values are detected, a false diagnosis is also possible, since this happens with a combination of benign ovarian neoplasm and renal failure, as well as:
- Inflammations in the pelvic area,
- Hepatitis or cirrhosis.
A mucinous tumor, on the contrary, does not cause an increase in the concentration of the protein compound. And relying only on it is easy to start the process of its development.
According to Roma 1
Using the properties of both these substances, doctors have derived a mathematical algorithm for calculating the probability of ovarian cancer in percent. For this, a special formula determines the prognostic index. Roma 1, the calculation of which before menopause is necessary with an increased risk of ovarian cancer, is its derivative.
If it matters more than the norm, but over time it remains at the same level or decreases, most likely, the neoplasm on any of the pelvic organs is benign. With a steady increase in the index, combined with the corresponding results of ultrasound, laparoscopy, doctors diagnose cancer.
Interpret information obtained after all surveys can only specialist. But it will be useful for women to know that when determining roma 1 (calculation before menopause) the rate is up to 7.4%. This means that at the time of the examination the malignant neoplasm is absent, and the probability of its appearance is minimal. If the figure is greater than or equal to this value, doctors have reason to suspect ovarian cancer.
We recommend to read an article about premenopause. You will learn about what it is, the onset of this period in a woman, the extinction of ovarian function, the use of hormonal therapy and other means.
Who should do the analysis of Roma 1
90% of ovarian cancers are epithelial. Roma indicator 1 reveals them. To stop the disease at an early stage means higher chances of a full recovery. The probability of getting it is high for those who are burdened by appropriate heredity.
The index of roma premenopause may require checking more than once. With it, not only detect cancer, but also determine the tactics of treatment of other diseases of the pelvic organs.
Index Roma, calculation before menopause: what it consists of. Causes and treatment of ovarian cysts during menopause.
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The test for menopause. The ability to determine the beginning of menopause in women. . The device has the name Frautest Menopause.
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Ovarian cancer and statistics
Ovarian tumors rank fourth among cancers that are fatal to women. This disease is difficult to detect, and can be cured only in the early stages of onset. Seventy percent of cases of tumor detection occurs in the third - fourth stages. 80 - 90% of patients survive after detection in the first stage, only 20% remain alive if a tumor is found later.
Climax is not the cause of oncology, but hormonal disruptions can cause cancer, and most often it occurs during menopause.
For the success of treatment, it is important to make a diagnosis at the initial stage of ovarian cancer. The roma index is a special blood test that detects the possible presence of ovarian cancer. This analysis is carried out for detected benign tumors or for female diseases that are a risk group for the occurrence of a malignant tumor.
The study of the Roma index divides patients into two groups:
- with a high chance of ovarian cancer,
- with a low chance of ovarian cancer.
The Pi index, which shows the possibility of a malignant ovarian tumor in determining the roma index, can be divided into groups of patients. In different stages of menopause index index is different: for women with premenopause - roma1, for postmenopausal women - roma2. In this article we are talking about the first case, premenopause.
A woman’s blood is examined to determine roma1, to find out, to find out the concentration, and to compare the number of two specific types of cells. Analyzes are taken repeatedly so that a change in their performance can be seen. Appoints a survey gynecologist, oncologist, or possible initiative of the patient.
With premenopause, a lack of sex hormones can cause the cells of the ovaries and other organs to degenerate, to mutate. The body is not able to control atypical cells. A healthy body is designed so that these mutants gradually self-destruct, but under adverse conditions they start to grow and become cancerous.
Oncomarkers are tumor secretions that appear in the blood of a woman who becomes ill with oncology, which include proteins, hormones, metabolic products and antigens.
The CA125 marker is an important type of marker that concentrates inside the ovaries. The blood of each person has this antigen, but its amount increases with cancer or for some other reason. This substance can be found in the uterus, ovaries, as part of the eye, but its amount increases when ovarian cancer cells or other diseases of the female organ appear.
This indicator is not very sensitive to the detection of tumors at an early stage: it is elevated when examining an early stage in only half of the cases of disease. Also, using the CA125 protein separately and in tandem with other markers, cancer is tested in the pancreas, mammary gland, rectum, stomach, liver, respiratory organs, appendages, uterine mucosa, serous tumor, in the presence of relatives of oncological problems.
In the absence of pathologies, the result of a blood test will reveal from 10 to 15 units / ml of CA125, although an increase in this protein to 35 units / ml is acceptable, and this is possible to the maximum in the absence of cancer.
Exceeding the value of the marker can talk about oncology. CA 125 grows for other reasons, leading to a false-positive result for cancer, the reasons are as follows:
- presence of pulmonary pleurisy,
- inflammations, infections of the female reproductive system,
- purulent appendicitis,
- diseases affecting the liver
- the presence of pregnancy, possible with premenopausal,
- menstrual bleeding
- cystic formation in the ovaries,
- thyroid problems,
- the presence of endometriosis.
Therefore, the increase in CA125 is not an accurate indicator of an ovarian tumor. But with careful examination by MRI, ultrasound, gastroscopy, blood and urine tests it is possible to accurately determine why there is a large jump in CA125.
An antigen index of 120 to 160 u / ml indicates ovarian cancer. To ensure that the result is accurate, the test is combined with determining the level of another antigen - HE4.
This protein is based inside the appendages of the ovaries, on the mucous membrane, in the respiratory organs. This protein is very sensitive to oncological cells and grows strongly in quantitative terms as soon as cancers appear. Among the many markers, HE4 is most suitable for the diagnosis of ovarian tumors. In 96% of cases, an increase in the level of this protein is seen at stage 1 of the tumor, and its level of sensitivity to cancer cells is 80%.
The growth of the HE4 marker indicates the appearance of an ovarian tumor (even an early stage is found) of endometrial uterine cancer, breast cancer, carcinoma and transitional cell carcinoma.
It should be added that an increase in the values of the HE4 marker is not always associated with oncology. This may indicate a false-positive diagnosis of cancer in the following diseases:
- benign ovarian tumors,
- renal failure
- inflammation of the female organs,
- cirrhosis of the liver.
The appearance of a mucinous tumor does not affect the growth of the HE4 marker, and this makes it difficult for the analysis to find the disease. The result is such that the cancer can be started up inoperable.
This protein is recognized as an accurate marker for cancer in the ovaries.
Blood for this analysis is taken from a vein, on an empty stomach. The doctor prescribes the order of repeat tests, because the definition of the disease must be in the dynamics of time. The analysis of blood serum is carried out by any gynecology laboratory. The exact test result requires you to follow the rules before blood collection:
- morning time: from seven to eleven o'clock,
- Do not eat until the analysis of 8 hours
- eliminate alcohol, smoking, fried and fat in food,
- be calm, not nervous
- strongly not physically strain
- the doctor should know about the medications taken by the patient,
- ultrasound examination, X-ray, magnetic resonance imaging, all these conditions for a few days are excluded.
Research analysis is carried out quickly - for a day, in some clinics - for three days.
Norm roma index before menopause
- The rate of this result is the index roma1 for premenopause — less than 7.4 percentThis figure indicates the absence of cancer and the minimum possibility of its occurrence. When the test detects a digital rate of 7.4 percent or more, suspected cancer in the ovaries.
- AT postmenopausal norm index roma2 -24.7 percentIf the number is greater, the risk of a cancer is great. When the figure is more than the norm, but with time, after the newly made analysis, it remains the same and does not increase or decrease, this may indicate that there is a benign tumor in the female organs.
The fact of an increase in HE4 three years before the patient finds out that she has ovarian cancer is important, and the CA125 level becomes higher eight to ten months before the diagnosis is made.
The calculation of the roma index is necessarily accompanied by other analyzes and surveys. This helps doctors accurately find tumors in the early stages, when there is a high probability for healing from this terrible disease. There are cases of getting rid of this problem and much later, but these facts can be considered a miracle - the probability of survival under these circumstances is so low.
Roma index analysis is not carried out:
- people under the age of 18,
- cancer patients who are treated with chemotherapy.
Venues, prices for roma1 and roma2
Tests are done in diagnostic centers, cancer centers, biochemical laboratories. The immunoelectrochemiluminescent method is used, which precisely determines the concentration of a substance, is very advanced and popular in 21st century medicine for diagnosing various health problems.
The price of the survey is from 1,500 rubles or more, starting from the price list of various clinics.
Добавим в заключение, что нормы анализов не абсолютны, поскольку зависят от возрастных особенностей женщин и сопутствующих отклонений здоровья, но опытный врач справится с расшифровкой без труда. Дорогие дамы, вовремя посещайте докторов, от этого зависит ваша жизнь. Be healthy!
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Types of female tumor markers and indications for examination
Cancer of the uterus or ovaries in addition to instrumental methods of diagnosis is determined using a blood test. It should contain markers - specific compounds secreted as a response to the aggression of the cancer. These substances are huge molecules, in the center of which the protein with an attached carbohydrate or lipid is localized.
Markers for ovarian cancer are produced by malignant cells after their metaplasia occurs. A certain amount of these substances enters the body fluids. The larger the tumor, the more glycoprotein is produced. For accurate diagnostics, only 2-3 tumor markers are usually taken:
- The main ones: CA 125, CA 19-9.
- Secondary: NOT 4.
- Additional: AFP and REA.
Table of norm and pathology markers in ovarian cancer
An analysis of the level of hCG is also needed to determine ovarian cancer. It is on the basis of the level of the main tumor markers that a woman is made the final diagnosis. Other studies only confirm it. Although CA 125 is not able to detect cancer at an early stage, as it is less sensitive. There already have to use additional markers.
Naturally, such an analysis is not always carried out. It is shown only in such cases:
- to confirm ovarian or endometrial cancer,
- to predict the course of the pathology and the probability of its reappearance after undergoing a course of treatment,
- to track the effectiveness of the chosen therapy,
- to see if the cancerous tumor was completely removed.
General description of the glycoprotein CA 125 and HE 4
The ovarian cancer marker CA 125 is the main analysis that makes it possible to determine the presence of a malignant disease.
It is produced by cells of the epithelial tissue. Moreover, it is produced not only by the ovary, but also by the pancreas, gall bladder, stomach, bronchi and intestines. However, most often analyzes are used to diagnose cancer of the reproductive organs. That is, the specificity of tumor markers is important.. To achieve the most accurate result, the study is combined.
This tumor marker can be detected not only in endometrial cells, but also in serous uterine fluid. The analysis does not always indicate the presence of a cancer process in the ovaries. Often, a change in the level of CA 125 on ovarian cancer is observed in the presence of the usual inflammatory processes in the body.
It is detected mainly in those patients who develop a serous type cancer pathology. Such a study is mandatory in women with a history of pain. The fact is that malignant tumors in a large number of cases are due to genetic predisposition.
This tumor marker has certain features:
- Low sensitivity. That is, in the early stages of the disease, it is practically not detected. Its level increases about 8 months before diagnosis.
- Not very good specificity. That is, protein is produced by the epithelium of both the ovaries and other organs.
For the most accurate result, it is necessary to analyze two tumor markers at the same time: CA 125 and NOT 4. The latter is considered more sensitive at the early stage of development of the pathology, and rises sharply, even if there are no symptoms. Its level changes even 3 years before the final diagnosis. An additional advantage of such a tumor marker is high specificity. It does not respond to inflammation in the uterus or ovaries. That is, with its help it is determined malignant process.
What diseases does an increase in the level of a substance indicate
If the presented substance is found in excess in the patient's blood, then the pathological process develops in her body. Moreover, it is not always malignant. For example, with its help it is determined:
- ovarian cancer (especially its epithelial form),
- cancer of the uterus,
- swelling of the fallopian tubes,
- cancer of the rectum, stomach, liver,
- oncology of the pancreas, as well as other organs: lung, endometrium, chest.
In addition, cancer tumor markers speak not only about malignant disease. They often indicate the presence of inflammation or a benign lesion in the uterus, fallopian tubes, ovaries. The level of the substance increases in systemic lupus erythematosus, rheumatoid arthritis and other autoimmune pathologies.
Norm and pathology of the result
In healthy people, the indicator of this substance almost never goes beyond 35 U / ml. Not a very large increase in the number of CA 125 in serum may appear during pregnancy, menstruation.
The average normal value is 11-13 U / ml. If there is a constant increase in the level, it means that the oncological process develops in the body. If the number of tumor markers has increased after the treatment of ovarian cancer, then there may have been a relapse of the pathology.
As for the non-4 tumor marker, the rules here are as follows:
Roma1 - analysis results
The study using the tumor marker Roma1 is prescribed for suspected cancer and the presence of tumors in the pelvic area. The algorithm of the tumor marker Roma1, the result of the indicator (PI index) of the test, is calculated using a special formula. Separately calculated PI for women in premenopausal and postmenopausal women. PI index for Roma1:
PI for premenopause: PI = -12.0 + 2.38 * LN [HE4] +0.0626 * LN [CA125]
Then the predictive value of the index (PI) is entered into the equation of Roma:
ROMA (%) = exp (PI) / [1 + exp (PI)] • 100
After obtaining the index by calculation, patients are divided into high and low risk groups. Roma1 in premenopausal women: a value of less than 7.4% is considered normal, indicating a low risk. Equal and more than 7.4% meaning indicates the high risk of epithelial cancer in a patient.
Where can I make Roma1
The Roma1 test is carried out in medical centers for diagnosis and prevention, in the laboratories of cancer centers, in laboratories conducting biochemical studies. For analysis, blood is drawn from a fasting vein. The test is carried out on serum, immunoelectrochemiluminescent method. This is the most sensitive method for determining the concentration of substances. With its help, diagnostic tests for cancer and many other diseases are carried out.
The cost of analyzing Roma1 starts from 1550 rubles and higher. The cost depends on the clinic where the study will be conducted. The result of the analysis you can get in 1-2 days.
How do oncomarkers work
Oncomarker is a protein indicator in the human body, showing the probability with which a person has the possibility of developing cancer. With its help, the structure of the neoplasm and the approximate stage of its development are also determined.
Roma tumor marker is essentially a kind of index, which is calculated based on the results of the calculation of 2 CA 125 and HE 4 protein proteins and their ratios. The index thus determined makes it possible to estimate the percentage probability of the presence of a malignant ovarian tumor.
When using this method, women can be divided into a group with a low risk and a group with a high risk of a malignant neoplasm in the female genital glands of the pelvic cavity.
The basis of this unit is taken as a prognostic index. With its help, when calculating the Roma index, it is possible to determine what the risk is in the development of epithelial ovarian cancer.
Organisms in women of old age and young girls are very different, in this regard, menopause in women is divided into two stages. Depending on this, the prognostic index is calculated: for postmenopause and premenopause. Therefore, the existence of two algorithms is distinguished: Roma 1 (for patients in pre-menopausal status) and Roma 2 (if the woman is in post-menopausal status).
He 4 protein is produced by the epidermis. The cells of certain organs, including the ovaries, produce NO 4 in small quantities. Therefore, a low concentration of it is considered the norm for humans. But NO 4 is highly sensitive to the cells that the tumor produces.
Therefore, if there is a significant increase in this protein, then this indicates a tumor in the ovaries, and the tumor may be malignant or benign.
In addition, the level of HE 4 may increase if a person has a tumor that has a malignant character:
- in the pancreas,
- in the mammary gland
- in the lungs.
CA 125 is a specific substance that appears in the bloodstream as a result of pathological changes in the ovaries. CA 125 is not particularly sensitive in the early stages of the formation of a malignant tumor, less than half of women have a high CA 125 index. In the later stages of cancer, more than 80% of women increase its value and some CA 125 may not show anything at all. The level of CA 125 rises as well in the following cases:
- in the presence of inflammation in the pelvic organs and abdominal cavity,
- with cyst formation in the ovaries,
- if a person has developed peritonitis, endometriosis, pleurisy,
- during menstruation,
- at the beginning of pregnancy.
If there is a deviation of CA 125 from the normal level of more than 5 times, then this indicates the presence of cancer in the ovaries. CA 125 is used as the main and additional test:
- when testing the presence of serous cancer and a malignant tumor in the pancreas,
- with hereditary ovarian and breast cancer,
- with the prediction of the possibility of recurrence of a malignant disease and metastases,
- for the presence of cancer of the liver, rectum, lung, uterus of the fallopian tube, stomach,
- to monitor the effectiveness of therapeutic therapeutic course.
If you examine the marker NOT 4 and CA 125 separately, then you will not get a clear picture of the state of health of the woman. Only in the aggregate analyzes of CA 125 and HE 4 indicators can a base be obtained that will allow the calculation of the Roma index.
The study of these two substances helps to determine a woman's susceptibility to a malignant ovarian tumor, or even to determine the presence of this disease.
The important point is that the growth rate of HE 4 is observed for 3 years after the presence of a malignant tumor in the ovaries is established, and the growth of CA 125 is observed 8-10 months before the diagnosis of this dangerous disease.
When and how is the research carried out?
Basically, the study is assigned to diagnose ovarian cancer at an early stage of development. The death rate from this disease is high due to the fact that too late the disease finds itself. With this method and additional research, a tumor can be detected when it is treatable.
To conduct research on this marker, additional training is not needed. To pass the analysis, venous blood is needed. The main condition is that nothing can be eaten before the blood is taken for 8 hours. The result can be found in a day, maximum two. According to various sources, ovarian cancer using this analysis is determined from 75% to 94%.
When decoding is done, it must be borne in mind that a small concentration of the studied proteins may be in the human body. If it does not exceed a certain value, then this is considered normal. But indicators may be absent during the development of a malignant tumor in the early stages of its development. In this regard, it is necessary to be examined in the same way with the help of other methods: MRI, ultrasound, CT, etc. When calculating the Roma index, a complex formula is used, so this should be done by a specialist. The outcome will depend on the age of the woman.
In the following table you can see the values of the Roma index corresponding to the norm:
What is the ROMA index?
Ovarian cancer is one of the most dangerous cancers in women. As a rule, it does not have specific symptoms and is often diagnosed in the later stages, which significantly reduces the chances of successful therapy and 5-year survival rates.
The name of the calculation algorithm is an abbreviation ("Risk of Ovarian Malignancy Algorithm"), literally meaning "algorithm for calculating the risk of ovarian cancer". The calculation of the probability of occurrence of malignant neoplasia with the help of two ovarian oncology markers is applied both to patients from risk groups and in standard diagnostic packages and oncological panels of laboratories.
One of the tumor markers used in calculating ROMA is CA 125. It is the main ovarian neoplasia antigen. Its sensitivity in the early stages of gonadal cancer is not high enough for an unambiguous diagnosis, so it is often combined with a more specific and accurate tumor marker, HE 4.
The normal concentration of CA 125 does not reach 35 U / ml (the results of patients during pregnancy or menstruation may approach the reference values). With most inflammatory diseases and benign neoplasms, its level does not exceed 100 U / ml.
The normal concentration of NOT 4 depends on the patient's menopausal status: before menopause, it does not exceed 70 pmol / ml, after it it increases twice. The second tumor marker is more specific for malignant neoplasms, although it can also give a false positive result in endometriosis and benign tumors.
The total sensitivity of the double test, taking into account the hormonal status of a woman, reaches 96% of cases of epithelial cancer of the genital glands, which occurs in 8-9 out of 10 patients with ovarian cancer.
The combination of two antigens reduces the likelihood of inaccuracy due to inflammatory processes in the small pelvis and menopause.
Indications for analysis
The calculation of the ROMA index is used not only to assess the effectiveness of treatment and monitor the patient in remission, but also for screening ovarian cancer. The use of antigens separately is not recommended by experts as an accurate test, especially if a woman is at risk for this disease.
The main indications for the delivery of the analysis on the tumor marker ROMA include:
- early diagnosis of malignant tumors of the ovary (the index increases due to the growth of HE 4, whereas with benign tumors the concentration of CA 125 or both tumor markers increases)
- predicting the degree of malignancy of the tumor in the pelvic area (in case of benign tumors, the ROMA index does not exceed the reference values, stably increased slightly or decreases with time in the absence of therapy),
- determination of the effectiveness of surgical treatment of malignant ovarian tumors (in combination with other tests).
To check the effectiveness of the treatment course, one of the indicators is monitored for the dynamics, but in some cases a full-fledged study and calculation of the ROMA is applied. A decrease in this index demonstrates the effectiveness of the chemotherapeutic course.
The ROMA test is not conducted for patients under 18 years of age or previously undergoing treatment for cancer.
How is the result calculated?
The formula for calculating the result and the name of the test (ROMA 1, ROMA 2) differs depending on the menopausal status of the woman. The indicator ROMA is calculated based on the prognostic index, which, in turn, depends on the concentration of the CA 125 and HE 4 tumor markers.
PI 1 (before menopause) = - 12 + 2.38 * Ln (concentration NO 4) + 0.0626 * Ln (concentration CA 125), where Ln is the natural logarithm (degree of exponent construction to obtain the specified value).
PI 2 (after menopause) = - 8.09 + 1.04 * Ln (HE concentration 4) + 0.732 * Ln (CA concentration 125).
The calculation of the final index for the tumor marker ROMA 2 and ROMA 1 occurs according to a single formula:
ROMA = (exp (PI1, 2) / [1 + exp (PI1, 2)]) * 100, where exp is raised to the power of the predictive index.
In premenopause, the ROMA index should not exceed 11.4%. After menopause, the reference value increases to 29.9%. Depending on the used limits for the concentration of each of the tumor markers, the norm for the ROMA index can vary from 7.39% (25.29) to 12.9% (24.7). Reference values are indicated in a special column of analysis results.
When these parameters are exceeded, the question of a more detailed diagnosis, which includes ultrasound of the pelvic organs, CT scan, MRI and a biopsy of the tumor tissue in case of a neoplasm on a hardware study, becomes.
An additional and less common (due to greater complexity) cancer risk calculation algorithm is OVA1. To determine it, 5 indicators are needed: the concentration of tumor marker CA 125, transferrin, alipoprotein A1, microglobulin B2 and prealbumin. As a rule, a comprehensive comprehensive assessment is used after surgery for ovarian cancer.
Determination of the concentration of tumor markers is made by immunoelectrochemiluminescent method. The reliability of the analysis depends entirely on the characteristics of the test systems and the correct implementation of the study protocol by staff. It is very important to carry out the analysis in the same laboratory, since a change in the average level of errors may be reflected in the dynamics of the index.
Правила сдачи анализа
Как и при других видах исследований, для которых берётся венозная кровь, пациенткам запрещено употреблять любую пищу в течение 8 часов до забора биоматериала и рекомендуется сообщать обо всех принимаемых лекарствах. В случае, если они не являются жизненно необходимыми медикаментами, нужно полностью исключить их употребление за 2 суток до проведения теста.
For a few days, a woman should stop using alcohol and eating foods that irritate the digestive tract (spicy, fried and fatty foods, smoked foods). Immediately before the study, you can drink only water without gas. 3 hours before blood sampling, stop smoking.
Taking analysis should occur in a state of physical and psycho-emotional peace. For 1-3 days it is recommended to eliminate heavy physical exertion and stress.
Despite the fact that the analysis of ROMA is often carried out after the discovery of neoplasia in the pelvic area, in parallel with other clarifying studies, it is necessary to allocate a break for the test. MRI, CT, ultrasound, x-rays and physiotherapy procedures cannot be performed for 1-3 days before laboratory diagnosis.
Timely diagnosis using the high-precision ROMA algorithm is a chance to detect a malignant tumor at an early stage and increase the chances of patient survival. The task of a woman is to regularly undergo preventive examinations (studies) and comply with all the rules for preparing for them.
Published at Tue, 07 Nov 2017 16:31:10 +0000
The Roma index (roma) is a complex indicator determined on the basis of the CA125 and HE4 tumor markers.
Used for more detailed definition the presence of ovarian cancer in the early stages of its occurrence. This also takes into account the age of the woman (as in the postmenopausal period).
Previously, doctors used to diagnose ovarian cancer several combinations of tumor markers, but the combination of CA125 and HE4 gives the most accurate result according to clinical trials.
The tumor marker CA125 - just allows you to determine the presence of ovarian cancer. But this figure is not accurate, and is relevant only at the 3rd and 4th stages of the disease.
HE4 marker is a group of glycoproteins and allows you to establish the presence of a malignant tumor depending on changes in hormonal levels (therefore, the rate changes not only in ovarian cancer, but also in the presence of malignant neoplasms of the respiratory and pancreas).
In the event that only one tumor marker is deviated from the norm (exceeding the permissible limit), then an analysis is also appointed to determine S100. In most cases, this is enough not only to determine the exact status of the disease, but also to calculate the risk of its occurrence (meaning, in the presence of a cyst of unknown etiology).
What ovarian cysts are found here.
What tests need to pass and how to prepare for them?
To determine the rate of tumor markers blood is being taken (necessarily on an empty stomach). The optimal time for this is from 7 to 11 am. No specific preliminary preparation is required. It is enough to follow generally accepted recommendations:
- 5 days before the scheduled analysis, do not drink alcohol,
- 12 hours before analysis - do not drink herbal teas, give up nicotine,
- 24 hours before the analysis - refuse to have sex,
- during the period of drug therapy in the treatment of diseases of the reproductive system, the analysis is not carried out (you must notify the attending physician),
- 72 hours prior to the scheduled analysis there should be no MRI, ultrasound, x-rays.
Also, before passing the analysis, it is recommended to consult with a psychotherapist, since the psycho-emotional factor has a significant impact on the final result.
ROMA index for women, table and transcript
According to the current instructions of the World Health Organization, the ROMA index is deciphered as follows:
- Roma index 1 - premenopause (age of reproductive activity) - the allowable rate is up to 7.39%,
- Roma 2 index - postmenopause (after extinction of reproductive activity) - the permissible rate is up to 25.29%.
That is, with premenopausal, the index below 7.39% indicates low risk epithelial (superficial) ovarian cancer, above 7.39% - increased risk.
Similarly, in postmenopausal disorders, an indicator of up to 25.29% indicates a low risk, above 25.29% - a high one. Naturally, these indicators are not a reason for making a final diagnosis, but in 90% of cases the preliminary result is subsequently confirmed.
(The picture is clickable, click to enlarge)
How to calculate - an example of the formula
The index is calculated from two indicators - this is the so-called “prognostic index” (PI) and the rate of tumor markers. The traditional formula is as follows:
roma = exp (PI) / [1 + exp (PI)] x 100.
Forecast Index calculated by the formulas:
- premenopause: (—12.0 + 2.38 x HE4 + 0.0626 x CA125),
- postmenopause: (—8.09 + 1.04 x HE4 + 0.732 x CA125).
It is quite difficult to carry out the calculation yourself, therefore, experts recommend use special online calculators (they are often published on the websites of private clinics dealing with problems of oncology). And for correct calculation it is necessary to have valid values of HE 4 and CA 125.
The Roma index is a kind of averaged value based on the indicator of tumor markers and the productivity of the reproductive system.
How is the calculation made and what formula to use if the woman has a reproductive age, but in fact - menopause? The analysis in this case is not carried out until the cause of the hormonal failure is established and eliminated.
Total, the ROMA index is complex indicator based on data from two tumor markers (CA 125 and NOT 4). In gynecology, it shows the likelihood of ovarian cyst mucinization, as well as the stage of the disease (if the diagnosis is confirmed).
The necessary tests to obtain an index are the delivery of blood from a vein on an empty stomach. The calculation is made by a special formula. Her performance differs significantly depending on the woman's age (premenopause or postmenopause).
On the diagnosis of cancer by blood, see the video:
What is the Roma index
Early diagnosis of ovarian cancer is of great importance due to the risk of increased mortality due to the late detection of the disease. Recall that for the diagnosis used blood test for tumor markers.
Among the most commonly identified oncomarkers, CA 125 is indicated, which is precisely a marker of ovarian cancer. Yes, this is a working marker, since its level is elevated in more than 80 percent of patients who develop epithelial ovarian cancer.
However, the effectiveness of CA 125 applies only to the 3rd and 4th stages. But in the early stages of its sensitivity is quite low - it allows you to determine the problem no more than half the patients. This is due to the fact that the level of CA 125 may increase in other diseases besides ovarian cancer. In the medical community they say that such a marker is not strictly specific for this disease.
As a result, the question arose: “what to do with the diagnosis of ovarian cancer in the first and second stages?”. To solve it, they tried to use both individual markers and their combinations. For example, CA 72-4, SMRP, CA 125 + SMRP, HE4, HE4 + SMRP, and so on.
It turned out that the marker HE4 (with the English Human epididymis protein 4) proved to be the most suitable for the purposes of early diagnosis. It is this protein that showed the greatest sensitivity in the early stages of ovarian cancer. The focus on this disease reaches 96%, and the sensitivity is close to 80%. What was needed.
Thus, it turned out that the CA 125 operates in the final stages, and HE4 - in the initial stages. An idea emerged to create an indicator that would assess the risks of ovarian cancer, and in the pre- and post-menopausal periods.
The formulas are quite complex and we will use only the results and estimate the numerical values.
The results of the data obtained allow us to divide patients into two groups:
- High risk of ovarian cancer.
- Low risk of developing malignant damage to the ovaries.
Depending on the onset of menopause, the tumor marker Roma (after all, in fact, the index serves as a tumor marker) is divided into 2 groups:
- Roma 1 - an assessment of the risk of premenopausal women.
- Roma 2 - Risk assessment for postmenopausal women.
The Roma index is most often used to diagnose ovarian cancer, but can also be used to assess the risk of the following cancer processes, in particular cancer:
- Mammary gland.
The successful application of such a study allows even in the early stages, when clinical manifestations are still absent, to reveal cancer of the ovary, one of the most dangerous malignant neoplasms.
The timely recognition and diagnosis of this pathology makes it possible to predict the survival rate within 5 years up to 90% of cases.
The method of early diagnosis
The speed of recognition of the malignant process in a woman’s body is the key to saving her life. Thanks to the method of calculating the level of the Roma index, it is possible to carry out earlier diagnostics of such a terrible disease as ovarian cancer.
Using the results of the CA 125 + HE4 analysis and the predictive index (PI) calculation algorithm, it is possible to assess the risk of ovarian epithelial cancer.
The components included in the index calculation formula are responsible for each of their functions:
- HE4 - this tumor marker is synthesized in the body of a healthy person in such structures as epithelial cells of the upper respiratory tract, tissue elements of reproductive organs, in the ovaries as well. According to its structure, it refers to epidermal proteins. The substance has a high sensitivity to the cellular elements that the tumor produces. Accordingly, an increase in the specified tumor marker indicates a high risk of developing ovarian lesions. Definition HE4 is invaluable, as its levels rise 2-3 years before the diagnosis of ovarian cancer.
- CA125 - these are atypical cells that are synthesized in the tissues of a healthy ovary; they are not very sensitive in the early stages of the tumor process. More than 80% of cases there is an increase in its concentration levels in the later stages. Indicators of this marker increase approximately 8 to 10 months before the definition of the disease.
It is the combination and evaluation of indicators such as HE4 and CA125 levels that are the basis for obtaining the Roma index, the most successful method for early diagnosis.
Analysis and rate
To assess the risk of developing malignant tumors, venous blood is collected. Blood test carried out on an empty stomach in the morning; all research methods are canceled; it is recommended that you follow the diet.
Index Roma norm. The data obtained are interpreted according to the established norms:
- During the premenopause:
- An index of less than 11.4% indicates a low risk of developing ovarian cancer.
- An index of more than 11.4% indicates a high risk of developing epithelial ovarian cancer.
- During the postmenopausal period:
- An indicator of less than 29.9% indicates a low risk of developing a malignant tumor.
- A score of more than 29.9 indicates a high risk of ovarian cancer.
It is important to know that at any stage of the process, the calculation of the Roma index is extremely important because of the results of which it is possible to predict the course of the disease, prescribe the correct treatment and evaluate the effectiveness of the therapy.
Roma Index in Gynecology
In any branch of medicine, the most successful are those diagnostic methods, the results of which make it possible to determine the disease in its early stages or even in the preclinical period.
As mentioned above, such an index is a measure of the risk of ovarian cancer. But besides this, the oncomarkers that are included in the index calculation formula also allow us to determine such changes in the body:
- CA125 - an increase in such an indicator may additionally indicate the presence of the following states:
- Infectious processes of the reproductive system in women.
- Appendicitis purulent nature.
- Affection of baking.
- Menstrual bleeding.
- Cystic transformation of the ovaries.
- The defeat of the thyroid gland.
- HE4 - in more than 90% of cases, the analysis indicates a tumor process, but a change in its indicators is also possible if the following pathologies are present:
- Endometrial cancer of the uterus.
- Malignant neoplasms of the mammary glands.
- Benign ovarian disease.
- Kidney failure.
- Cirrhosis of the liver.
In the diagnosis of ovarian cancer, the greatest importance is attached not to each indicator separately, but to their combinations.
The value of the analysis
The value of research index Roma is great. Since in 70-75% of cases a malignant tumor in the ovaries is diagnosed late,
it is imperative to conduct an effective diagnosis in a timely manner. Indeed, according to WHO, only up to 30% of women live more than a year.
Despite advances in medicine, the prognosis of ovarian cancer remains sad:
- Stage 1 - revealed a maximum of 30% of cases, has the most favorable prognosis for five-year survival - up to 90%.
- Stage 2 - determined up to 10% of cases, the forecast is up to 70%.
- Stage 3 - almost 60% of patients are treated during this period, when it is often already late. Survival rate is not even 40%.
- Stage 4 - makes up to 17% of cases of detection and the sad forecast of five-year survival - less than 25%.
Only an early diagnosis will allow you to start an effective and efficient treatment, because the calculation of the Roma index determines the process:
- Which in the early stages can not be any diagnostic methods.
- In women who have a history of malignant neoplasms.
- Evaluation of the treatment.
When using indicators of the Roma index, the sensitivity of the study is almost 93%, and the specificity is 76% in postmenopausal women.
During premenopause, sensitivity is 100%, and specificity is up to 75%.
It should be borne in mind that such indicators are characteristic only when determining epithelial ovarian cancer.
Only thanks to the data obtained in the study of blood for tumor markers, it is possible to assess the degree of threat and the risk of developing the disease.
Index Roma 1
The period of premenopause in women is characterized by an increased risk of malignant tumors of the reproductive system.
Determination of the index of Roma 1 in premenopausal disease is an important diagnostic criterion that makes it possible to determine the risk of a pathological condition so early that recovery occurs in almost 100% of cases.
And only by analyzing the determination of the Roma 1 index in the blood, it is possible to prevent and timely detect a pathological condition that is extremely dangerous for life.