When a woman is found to have a mass on or near her ovary, referred to as a pelvic or adnexal mass, the primary concern is to determine if the growth is cancerous. Distinguishing between a benign, non-cancerous mass and a malignant one is a significant challenge that shapes all subsequent medical decisions.
The evaluation process involves a physical examination, a detailed medical history, and imaging studies, such as a transvaginal ultrasound. While certain features on an ultrasound might suggest one outcome over another, imaging alone often cannot provide a definitive answer. This ambiguity creates a need for additional methods to help predict the likelihood of cancer before any surgery is performed.
The ROMA Test Explained
The Risk of Ovarian Malignancy Algorithm, or ROMA, is a blood test designed to assess the probability that a pelvic mass is cancerous by measuring two protein biomarkers: Cancer Antigen 125 (CA 125) and Human Epididymis Protein 4 (HE4). CA 125 has long been associated with ovarian cancer, but its levels can also be raised by benign conditions like endometriosis or fibroids, making it less specific when used alone. HE4 is another protein associated with ovarian cancer, and its inclusion increases the overall accuracy of the prediction.
The ROMA test uses an algorithm that combines the concentrations of CA 125 and HE4. This calculation also incorporates a woman’s menopausal status, as this influences the interpretation of the biomarkers. The result is a single score representing a statistical estimate of malignancy risk.
Who Needs a ROMA Test
The ROMA test is not a general screening tool for ovarian cancer in women without symptoms. It is specifically for adult women who have already been identified as having a pelvic or adnexal mass and are scheduled for surgery to remove it.
In this pre-operative setting, the test is used to stratify patients based on their statistical risk of having a malignant tumor. This information is meant to be used in conjunction with other clinical and radiological evaluations, such as ultrasound findings, to create a more comprehensive risk profile.
Interpreting ROMA Score Results
The result of the ROMA test is a score that classifies a woman’s risk of having an epithelial ovarian cancer as either low or high. The interpretation of this score depends on the woman’s menopausal status, as different cutoff values are used for pre-menopausal and post-menopausal individuals. This distinction is necessary because the baseline levels of the biomarkers and the incidence of different types of pelvic masses vary between these two groups.
For pre-menopausal women, a ROMA score of less than 1.14 indicates a low risk of finding an epithelial ovarian cancer during surgery. A score of 1.14 or greater is considered high risk. It is important to understand that a high-risk result does not confirm a cancer diagnosis, but signifies an increased statistical probability that the mass is malignant.
For post-menopausal women, the threshold is different. A ROMA value of less than 2.99 suggests a low risk for malignancy, while a score of 2.99 or higher places the woman in the high-risk category. A low-risk score is reassuring but does not entirely eliminate the possibility of cancer. The score provides a standardized risk assessment that adds a layer of objective data to the physician’s evaluation, which also includes imaging results and the patient’s overall health and symptoms.
Role in Patient Care
The ROMA score plays a direct role in guiding patient care by influencing the plan for surgery. The main function of the risk score is to assist in patient triage, ensuring that women receive the appropriate level of specialized surgical care.
When a woman receives a high-risk ROMA score, clinical guidelines often recommend that she be referred to a gynecologic oncologist for her surgery. A gynecologic oncologist is a surgeon with specialized training in operating on cancers of the female reproductive system. Studies have indicated that patient outcomes are improved when a malignant mass is removed by one of these subspecialists.
Conversely, a low-risk ROMA score can provide support for the initial plan for a general gynecologist to perform the procedure. This helps to allocate specialized surgical services to the patients who are most likely to benefit from them.