Pelvic Endometrial and Ovarian cancer (ovarian-/tubal-/peritoneal cancer) is the sixth
and seventh most frequent type of cancer and ovarian cancer the fourth leading cause of
cancer related death among Swedish women. Endometrial cancer gives mostly early symptoms
but two thirds of patients with ovarian cancer are diagnosed with advanced stage of the
disease, and this is reflected in poor outcome. Early diagnosis is challenging especially
in ovarian cancer.
Plasma protein biomarker panels with improved diagnostic performance and predicting
survival in patients with ovarian tumors have been performed by several research groups.
The sensitivity is good, but specificity is today not good enough for screening purposes.
Several blood-based protein biomarker candidates for endometrial cancer detection have
been reported but the protein biomarkers have so far only clinical relevance in advanced
or recurrent endometrial cancers. However, there is a need for improved more specific
broader biomarker panels for discrimination between localized or metastatic disease and
preoperative risk stratification especially in endometrial cancer patients. Such improved
biomarker panels would be able to predict metastatic disease and guide adjuvant
chemotherapy treatment.
Endogenous volatile organic compounds (VOCs) are products of metabolic activity in the
body and changes to these VOCs can be characteristic of specific disease processes such
as cancer development. Analyses in plasma of VOCs such as triethylamine, pyridine,
toluene, etc. with Field-Effect-Transistor (FET) -based gas sensors have shown to be able
to measure VOCs very accurately in low concentrations (Bastuck thesis, 2009). The
metabolism in cancer cells vastly differs from that of healthy cells. Elevated glycolysis
leads to increases in lactate and fumarate metabolites resulting in altered VOC
abundances in exhaled breath. Experimental data indicate that the detection of VOCs
released by various cancer cells may be useful in early diagnoses of cancer. In patients
with ovarian cancer, analyzes of specific VOC: s in blood has shown promising results to
discriminate patient with ovarian cancer from healthy women (Horvath). The investigators
have very recently in 37 patients out 38 with ovarian cancer found VOC indicating cancer
which indicates a preliminary sensitivity of 97 %. In the total material of 68 analyzed
samples, 3 false positive results were found which indicates a specificity of 90 %. In a
population with 1 % malignancy the positive predictive value would be almost 10 % and
negative predictive value 99.9 %.
In the current study, samples from more ovarian cancer patients will be included, and
also samples from patients with other cancer types (totally 245 patients, of which 50
ovarian cancers). The aim will be to see if good sensitivity and specificity can be
achived with larger patient population (same or better values than in the previous
study). Special focus will be put on early stages of ovarian cancer, as well as
borderline tumours. The investigators aim also to see how distinct is VOC pattern for
ovarian cancer compared to the VOC patterns for the other cancer forms. Finally, the
study will give preliminary answer if VOC patterns for the other types of cancer (i.e.,
breast, colorectal, bladder, endometrie, cervix, ...) is specific so it could be used in
the future for development of dedicated diagnostic tools for those diseases.