Rome Ca125 He4 Blog

HE4 + CA125 + ROMA Score Combined Interpretation – Comprehensive Guide

Why Are Tumor Markers Used Together?

A single tumor marker is often not sufficient. Therefore, HE4 and CA125 are used together, and the risk of ovarian cancer is more accurately assessed with the ROMA score.

What is CA125?

CA125 is a marker used in many gynecological conditions, especially ovarian cancer. However, it can also be elevated in benign conditions such as endometriosis and menstruation.

What is HE4?

HE4 is considered a more specific marker for ovarian cancer. It is less elevated in benign gynecological conditions.

What is the ROMA Score?

ROMA (Risk of Ovarian Malignancy Algorithm) calculates the risk of malignancy by evaluating HE4 and CA125 values together with menopausal status.

Pre- and Post-Menopausal Difference

The ROMA score uses different threshold values depending on menopausal status. Therefore, the patient's menopausal status is critically important in the assessment.

How is Combined Interpretation Performed?

If CA125 is high but HE4 is normal, benign conditions (e.g., endometriosis) are generally considered. If both HE4 and CA125 are high, the risk of malignancy increases. The ROMA score mathematically evaluates this combination.

Clinical Scenarios

In a young patient, high CA125 and normal HE4: endometriosis is more likely.
In a postmenopausal patient, both markers are high: further evaluation for malignancy is required.

Usage in the Diagnostic Process

These tests do not provide a diagnosis on their own. They should be evaluated together with ultrasound, MRI, and clinical findings.

When Should Suspicion Arise?

In the presence of high and increasing marker values, a suspicious mass, and high values in postmenopausal women, malignancy should be carefully considered.

Conclusion

When used together, HE4, CA125, and ROMA are a powerful tool in ovarian cancer risk assessment. However, they must always be interpreted in conjunction with clinical and imaging findings.