Elevated CA-125 and shrinking cyst

[Julie*]

Hello,

I had an IUD placed 10 weeks ago and had some irregular bleeding that prompted my doctor to do a transvaginal u/s to make sure the IUD was in place.  At the time they found a 3.5cm cyst on my right ovary.  I was scheduled for a repeat u/s for 6 weeks later to track it.
At that appt the cyst had grown to 5cm and the CA-125 test showed a number of 73.
I had another follow up last week and the cyst has shrunk back to 3.5cm but the CA-125 number is now 94.
I was given the option of lap surgery now or to wait 3 more weeks and do another CA-125 and ultrasound.

Does this sound like it could be ovarian cancer?

Thanks,
Julie

[Annekathryn Goodman, M.D.]

Hi There,
The IUD may cause enough inflammation to raise the CA 125. I would still want to keep an eye on the  CA 125 and the cyst. Say get a repeat CA 125 and ultrasound in 3 months
take care

[Julie*]

Hi again,

I wanted to update and ask one more question.
I had my follow up CA125 and u/s last week.

The CA-125 was back down to 74.
The cyst on my right ovary was about the same at 3.5cm but now I have another one on my left ovary that is about 3.5cm.  

My gyno said that I don't need anymore follow up unless I get uncomfortable or my periods worsen.  I have an IUD so I don't know if that affects any of this.  She also thinks I have endometriosis which is causing the elevation of the CA-125.   I also have PCOS but she said that these are not the same type of cysts you get from PCOS.

Do some women just get cysts that come and go?  Do you agree that a wait/see approach makes sense in my case?

Thanks,
Julie

[Annekathryn Goodman, M.D.]

Dear Julie,
there are many benign reasons for an elevation in CA 125. I agree with Linda F. However, you should ask your doctor about the option of looking laparoscopically to be sure that the cyst is benign. I agree that it is reassuring that it has reduced in size.
best wishes

[LindaF]

That's a good reduction in the cyst. The CA-125 isn't terribly accurate for what they are using it for since it will elevate when the abdomen is irritated, which would occur when a cyst is resolving. What did they say about the cyst? Was it simple? Complex? To be honest, three more weeks won't make a difference and were I you, I'd wait unti the 6th as you are doing. A cyst that's shrinking is a very good sign. Cancerous cysts do not shrink.

If the cyst continues to shrink, even if the CA-125 is elevated, I wouldn't panic. It's really only reliable when they are looking at tracking a re-occurance. My doc at Johns-Hopkins told me he had a freaked out patient call because her CA-125 at the ER was 350. Turned out to be not from her ovarian cyst but from a gall bladder that needed to come out. He said for that reason, unless a biopsy of the cyst showed cancer, he doesn't like the test. Too much can affect it.

Hope that helps!! If you want my 2 cents, my guess is you'll be fine!

[Julie*]

I hope that someone will be able to answer this but in the meantime thought I would update that I have another CA-125 test being done on Friday, August 31 and another transvaginal u/s scheduled for September 6th.

Julie