To the Editor: The article by Dr Kim and colleagues1 raises the false hope of finding "tumor markers
that could be used to detect the early stages of the disease." It is not at
all clear, and certainly not proved, that advanced stage ovarian carcinoma
begins as a disease confined to the ovary (stage I). Frequently, patients
with disseminated disease have relatively small tumor deposits in the ovaries
and the primary tumor may have been on adjacent or distant peritoneal surfaces,
or there may have been a multifocal origin.2
The extreme cases are those referred to as "peritoneal carcinoma" in which
the ovaries seem uninvolved or have demonstrable secondary implants only.
Finding stage I ovarian carcinoma early is a laudable ambition, and sensitive
and specific tumor markers may be useful in this pursuit. However, the rapid
progression of the disease and the multifocal nature suggest that efforts
and money would best be directed to more effective and specific treatment
rather than chasing the possibility of "early" disease. Experience with the
CA125 marker, which is quite useful for measuring and following advanced disease,
demonstrates that the likelihood of a sensitive marker improving survival
is remote or nil. Also, it is to be expected that fearful patients and physicians
will request the results for the marker in inappropriate situations as they
currently do for CA125.
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