Elivated CA125 during remmsion

Dr Goodman,

My mother was diagnosed with Stage IV Grade 3 OVC in Nov 2007.  At diagnosis her CA 125 was 4900.  She went through neo-adjuvant chemotherapy with IV taxol and carboplatin for 3 cycles and underwent complete debulking with no gross disease left behind.  She continued with 3 more IV cycles.  On completing her initial treatment her CA 125 was 17.  She was then given 3 additional IP cycles of cisplatin as consolidation.  At the end of that her CA was 14.

PET CT at end of consolidation came in clear

My mother has been having severe abdomen pain since 3 months after consolidation followed by nausea which resolves in a day.  The oncologist feels this could be due to adhesions after surgery and the last 2 CT scans have showed nothing.  She has it consistently once every 4-5 weeks.

3 Months after consolidation CA went down to 9.8 and CT came in clear
6 Months after consolidation CA was at 10.1 and CT came in clear
9 Months after consolidation CA came in at 27.

When we asked the oncologist if a CT or PET was required due to this spike he refused, he thinks it is too early and will now show anything.  He asked us to repeat a CA after 3 months and he will evaluate then.

We are all scared if this is an early sign of reoccurrence.  Should we repeat a CA every month instead of waiting for 3 more months

Thanks
OVCIndia

[Annekathryn Goodman, M.D.]

Hi There,

First of all, I would say that your mother has received excellent and aggressive care for her cancer. It is not inappropriate to suggest a watch and wait approach at this time. Ca 125 elevations can be due to other factors as you suggest. Unfortunately, just based on the extent of your mother's cancer at diagnosis, she has a very high risk for recurrence. Unfortunately, the time one sees a recurrence is 12 to 18 months after completion of therapy. So I completely understand your concern.

It is possible that the CA 125 value of 27 is an insignificant glitch or it could reflect the beginning of a recurrence.  Personally, I would repeat the value in a month as opposed to 3 months.

Now the abdominal pain may indeed be adhesions. IP chemo can add to the irritation in the abdominal cavity. I wonder whether she has a partial blockage of a loop of intestine so that she gets pain and then it is relieved when she vomits.  I would suggest a CT scan with oral contrast or an upper GI series with small bowel follow through at the time  of her pain to make the diagnosis.

Please let us know how your mother is doing.
best regards

[OVCIndia]

Dr Goodman,

A followup on my question.  We got the results from the lab today where the numbers came in at 27.  We noticed that the normal range in the report says 21.  When we spoke to the lab they said they have a new equipment where the normal now is 21.

Would it be worth waiting 2 weeks and repeating the test in a lab where the normal is 35.  Also my my mother has been taking medicated mushroom extracts every day for about a year now and from one of your posts you mentioned that this could also cause an elivation.

Also about 3 weeks back my mom had a minor accident where a scooter fell on her.  She said that she hurt her self where the IP port was in originally( Taken out after chemo).  That area was sore but now hurts when one puts preasure on it.

Could all these conditions in this test cycle cause a CA increase.

Thanks
OVCIndia