Rai Talapadi, Nirmala (2021). Biochemical markers and combination testing for the diagnosis of ovarian cancer in women with symptoms or signs suspicious of ovarian cancer. University of Birmingham. M.D.
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RaiTalapadi2021MD.pdf
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Abstract
Ovarian cancer (OC) has the highest mortality of all gynaecological cancers. A significant contributing factor to the high mortality in OC is delayed diagnosis. Currently, there is no consensus regarding the best test for early diagnosis.
A review of existing systematic reviews about symptoms, biochemical markers and US test used alone or in combination for the diagnosis of OC in symptomatic women demonstrated that existing reviews were variable in quality, applicability and limited by poor reporting. I attempted to address these deficiencies in two reviews on the accuracy of biomarkers alone and symptoms, biomarkers or US in combination for the diagnosis of OC in symptomatic women in generalist settings in pre and postmenopausal women separately.
My thesis finds key methodological issues, e.g., literature is not applicable to generalist settings as studies included women typical of tertiary healthcare settings, some studies excluded borderline tumours which inflates estimates of sensitivity, important differences exist in test performance between pre and postmenopausal women. Main results are 1) reviews not applicable to primary care settings – more research is needed. 2) for biomarkers i) HE4 at the threshold of 60-80pMol/L and 130-150pMol/L is recommended in pre and postmenopausal women for low prevalence settings ii) ROMA or LR2 in premenopausal women to replace RMI in secondary/tertiary setting; continue with RMI for postmenopausal women as it shows comparable accuracy to ROMA and LR2.
| Type of Work: | Thesis (Doctorates > M.D.) | |||||||||
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| Award Type: | Doctorates > M.D. | |||||||||
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| Licence: | All rights reserved | |||||||||
| College/Faculty: | Colleges (2008 onwards) > College of Medical & Dental Sciences | |||||||||
| School or Department: | Institute of Cancer and Genomic Sciences | |||||||||
| Funders: | National Institute for Health Research | |||||||||
| Subjects: | R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer) | |||||||||
| URI: | http://etheses.bham.ac.uk/id/eprint/11145 |
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