ROMA index: what it shows and how the result is read

The ROMA index is a calculated indicator rather than a separate blood test — it is obtained from a formula that combines the results of two tumour markers (HE4 and CA 125) together with information about whether the woman is before or after the menopause. The result is given as a percentage and shows an approximate likelihood that, when a pelvic mass (a mass in the lesser pelvis) has been found, it may be malignant. According to MedlinePlus, CA 125 can also rise for non-malignant reasons (for example endometriosis, pelvic inflammation, a uterine fibroid). However, some studies show that both markers together, often by calculating the ROMA index, give more accurate information than either of them separately. ROMA is used as an additional tool before surgery, when deciding whether a woman with such a finding should be referred to a gynaecological oncologist, and not as a diagnosis in its own right or as a screening test for healthy women without symptoms.

• When a suspicious pelvic mass (a mass in the lesser pelvis) has been found on an imaging test (for example an ultrasound) — to weigh the likelihood of malignancy before deciding on further steps
• Before planned surgery for an ovarian or pelvic mass — when deciding whether the patient should be referred to a gynaecological oncologist
• When there are symptoms that raise a suspicion of ovarian disease (bloating, pelvic pain, feeling full quickly, a frequent need to pass urine), together with imaging tests

How to prepare

• No special preparation is usually needed for the HE4 and CA 125 tests from which the ROMA index is calculated
• It is worth telling your doctor your menopausal status, the phase of your menstrual cycle and any possible pregnancy, as they can affect the values of the component markers (particularly CA 125) and the result of the calculation

Reference limits

There is no unified international ROMA cut-off: it depends on the method the laboratory uses and on the woman's menopausal status, so we do not give a general number here. The exact value and how to interpret it are explained by a doctor, taking into account the methodology stated on the result report.

A higher ROMA value

A higher ROMA value is regarded as a greater likelihood of malignancy when a pelvic mass has been found, but it is not a diagnosis. The value is raised by the component markers — HE4 and CA 125; CA 125 can rise not only because of ovarian cancer but also because of endometriosis, pelvic inflammatory disease, a uterine fibroid or liver disease (MedlinePlus). The result is always discussed together with imaging tests and the doctor's assessment.

Possible causes of a higher value

• Epithelial ovarian cancer or another malignant pelvic mass
• Non-malignant conditions that raise the CA 125 value, for example endometriosis, pelvic inflammatory disease or a uterine fibroid
• Liver disease, which can affect the CA 125 value
• Natural physiological changes — menstruation or pregnancy, which can temporarily raise CA 125

Symptoms that may go with a higher value

• Bloating or an enlarged abdomen
• Pain or tenderness in the lower abdomen or the pelvis
• Feeling full quickly or a loss of appetite
• A frequent or urgent need to pass urine
• Tiredness
• Weight loss with no clear cause

What a doctor usually assesses next

• The result is always assessed together with imaging tests (ultrasound and others), rather than on its own
• Whether a known non-malignant condition (endometriosis, a fibroid), the phase of the menstrual cycle or pregnancy could have affected the CA 125 value
• A referral to a gynaecological oncologist for further assessment and a decision on the extent of surgery
• Whether the symptoms (bloating, pain, feeling full quickly, frequent passing of urine) last longer than a few weeks

ROMA is neither a diagnosis nor a screening test

A higher value is regarded as a greater likelihood of malignancy, not as a diagnosis. CA 125 can also rise for non-malignant reasons, for example endometriosis, pelvic inflammation or a uterine fibroid, so further tests are needed. The ROMA index is not used as a screening test in women without symptoms — it is used purposefully, when a pelvic mass has been found, before deciding on further steps.

Related pages

• CA 125
• HE4
• CA 15-3
• CA 19-9
• CEA
• AFP