Signaterra testing

We've discussed Signatera recently in this conversation:
https://connect.mayoclinic.org/discussion/post-treatment-follow-up-for-clear-cell-endometrial-cancer/
It's also been discussed in many of the other cancer forums. Use the search function (click on the magnifying glass icon).

Was your CA-125 elevated when your cancer was still present? If so, it's unlikely that Signatera will be better than the CA-125 test, and will probably be less sensitive. (The people on the pancreatic cancer forum tend to see tumor markers go up before Signatera.)

I am a year post chemo for stage 3 ovarian cancer and requested the Signatura test to monitor for recurrence. My test came back positive but my CA 125 was only 10. My oncologist/surgeon immediately ordered scans even though I was not due for the screening for a couple months. CT showed enlarged lymph node so Pet scan was ordered and the node showed possible recurrence so I had robotic surgery to have node removed with in two weeks of scans. Now waiting for pathology report to determine what next. I definitely will be requesting follow up Signatura testing to see if it is still positive since the node removal. Had I not gotten the testing I would not have gotten the early scans. Lessons learned. Needless to say I am a huge advocate of the testing.

Good to know. What was the lowest (or highest) your CA-125 ever measured? Was 10 higher (or lower) than it had been previously?

I've only had CA-125 tests when I also had visible tumors, so I don't know what it would be if I were NED. I suspect in the 5-7 range. But when mine went from 14 to 16, that was definitely a sign that the drug I was on wasn't working, even though the "normal range" goes up to 35. For me, very small changes in CA-125 are very meaningful. The highest mine has ever been is 77 (and that was with a lot of cancer), so my cancer doesn't produce as much CA-125 as many ovarian cancers do.

Both of your responses are very helpful and I thank you. My CA-125 was 268 at the highest with extensive cancer, then went down dramatically after surgery and again with each chemo treatment. This last time it went to 18 from 14 three months earlier and I was concerned but the oncologist wasn't. Now I'm thinking I want to have the Signaterra testing in case the CA-125 isn't reflecting signs of a recurrance. Does insurance cover the testing for ovarian cancer? And what is NED?

No Evidence of Disease. (This means they can't detect your cancer on a CT/PET scan, but doesn't imply that you're cancer-free.)

@juliejane on the "Has your doctor..." thread said her insurance paid for it. I was under the impression that insurance didn't pay.

Definitely seems worth doing, as long as it doesn't cost an arm and a leg. Sequencing tests like that have the potential to generate monster bills. So I'd definitely try to check beforehand.

I had Caris DNA testing done over a year ago. The insurance company wouldn't pay and declared that I owe Caris $21,000. I've done a lot of complaining to Caris, and they still haven't tried to bill me for this. I'm starting to wonder if they're hoping to get it out of my estate, since they know I'm going to cause trouble if they send me a huge bill. I'm sort of afraid to ask about it, in case they've just forgotten.

My CA 125 was steady at 10 since completing chemo in March of 2024. Prior to surgery it was 460. So Signatura being positive at 10 was very interesting. None the less scans were ordered and there it was in one lymph node. Again I feel it should be routinely done from the start just after surgery and again after finishing chemo and then every three months. It appears it may be far better than CA 125 in detecting recurrence. Medicare covers it so why not? Only problem is that it is either positive or negative. There are no numbers to guide you on some kind of scale.

It clearly worked very well for you. But the jury is still out on how consistent it is between different cancer types and between different people's tumors of the same cancer type. Some tumors shed more DNA than others.

I had a different ctDNA test done at a time when I had several sizable tumors detectable by CT scan. It didn't detect my cancer at all.

I just messaged my oncologist to find out if I'm a candidate for Signaterra testing. I'm really anxious about the CA-125 going from 14 to 18. From what I've read this is not a good prognostic sign even though it's only a 4 point increase. Ugh....yes, I'm grateful for so much but this diagnosis is lousy.