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CA-125 slightly elevated
In 2001 I had a CA-125 scan of 28. (I requested this because I don't know family history.) Had another CA-125 last week with a score of 40. I am 42 years old with 2 children, only been on birth control pills once in my life, and am premenopausal. Prior to test I didn't know all the factors that can elevate score. I started period 2 days after blood test, and I take primrose oil and vitamin E. I am not sure of any symptoms. (I am nervous so I really can't think objectively.) My family doctor scheduled CT pelvic but insurance denied. I am going to have CA-125 done again next week since period may have elevated results. Is this the appropriate action? Should I have an ultrasound regardless of what next CA-125 results show? Thank you.
I think it is important to get a second opinion whenever surgery is considered. It is difficult waiting for tests and reports, but you will have more information. I will keep you in my prayers.
A few weeks ago i had sever abd pain and went to the gyn...i had an ultrasound done and found an ovarian cyst I had was now 3 times the original size from 3 months prior (now 6cm by 5cm) and was partially solid. I had a CA 125 done and my level was 34 and my gyn said that was elevated and i should have surgery to remove my ovary because it MAY be cancerous. I read that "normal" levels are up to 35. I want to have laproscopy done to remove the cyst. Should i get a 2nd opinion? I work for the fire dept and would have to be out of work for 4 to 6 weeks as opposed to 1 week for laproscopy.
Thank you for your response and the attached report. I did have an ultrasound and everything looked fine. I had the repeat CA-125 and am waiting for the results. Thanks again.
MEDICAL PROFESSIONAL
Hi There,
Your plan is a good one. I would agree with the pelvic ultrasound. you may have developed fibroids in the past 6 years. A CA 125 is unreliable as a cancer screening test in premenopausal women. It can vary with your period and with inflammation. it can also be elevated with fibroids and endometriosis. There is information to suggest that a rising CA 125 over time (multiple checks) may be predictive of a malignancy. I have pasted a report below but this is for postmenopausal women.
Overall, if your CA 125 continues to be elevated, you should see a gyn oncologist. If your next value is below 40 and you have a normal ultrasound (ie: no scary looking ovarian growths), then there is nothing right now to suggest a laparoscopy.
best wishes
Preliminary results: individualize CA 125 levels for ovarian cancer risk assessment
OB/GYN News, April 15, 2004 by Kate Johnson
SAN DIEGO -- A prospective, multicenter screening trial is investigating whether a longitudinal pattern of CA 125 measurements, rather than a single measurement, offers better sensitivity for detecting ovarian cancer in women at high risk for the disease.
'The interpretation of a woman's CA 125 level involves looking for an elbow pattern rise, over time, rather than evaluating a single absolute level,' reported Dr. Steven Skates of Massachusetts General Hospital, Boston.
For further refinement of the measurement's sensitivity, variables such as menopausal status, race, bilateral salpingo-oophorectomy, and smoking also should be considered, because they can alter by at least 10% the critical cut point that indicates further investigation, he said at the annual meeting of the Society of Gynecologic Oncologists.
A total of 2,005 women from 23 U.S. academic medical centers have been enrolled in the trial to date. Of the five ovarian cancers that have been detected, four had levels commensurate with an elbow pattern of rising CA 125 levels. In general, approximately 15%-20% of ovarian cancers do not produce CA 125, Dr. Skates said.
Investigators in the study are using CA 125 levels, measured every 3 months as the first line of screening, followed by transvaginal ultrasonography (TVS) when indicated. Although they are mainly looking for an elbow pattern rise, they also have set cutoff levels to guide them in interpreting initial measurements before a pattern is evident. The cut point is chosen so that 10% of screened women are referred to CA 125 indicated ultrasound annually.
For postmenopausal women, that cut point is 34 U/mL, which is essentially the standard CA 125 cutoff of 35 U/mL.
Similarly, in premenopausal women, although the cut point was initially set at 40 U/mL, the preliminary results from the trial indicate the equivalent cut point is 53 U/mL. African American premenopausal women have a lower equivalent cut point of 39 U/mL, and for premenopausal smokers it's 44 U/mL.
Of the five cancers detected so far, one cancer was particularly worrisome, because the woman exhibited the typical elbow pattern rise in CA 125 levels but repeatedly had normal TVS findings, Dr. Skates said.
'One of the discussion points for the trial's surgical committee based on this case, which has just arisen, is going to be whether the guidelines on exploratory laparoscopy in such situations should be revised and more strongly encouraged, and whether we can calculate a risk beyond which, even with a negative ultrasound, we would encourage exploratory laparoscopy,' he said in an interview.
BY KATE JOHNSON
Contributing Writer
COPYRIGHT 2004 International Medical News Group
COPYRIGHT 2004 Gale Group
Your plan is a good one. I would agree with the pelvic ultrasound. you may have developed fibroids in the past 6 years. A CA 125 is unreliable as a cancer screening test in premenopausal women. It can vary with your period and with inflammation. it can also be elevated with fibroids and endometriosis. There is information to suggest that a rising CA 125 over time (multiple checks) may be predictive of a malignancy. I have pasted a report below but this is for postmenopausal women.
Overall, if your CA 125 continues to be elevated, you should see a gyn oncologist. If your next value is below 40 and you have a normal ultrasound (ie: no scary looking ovarian growths), then there is nothing right now to suggest a laparoscopy.
best wishes
Preliminary results: individualize CA 125 levels for ovarian cancer risk assessment
OB/GYN News, April 15, 2004 by Kate Johnson
SAN DIEGO -- A prospective, multicenter screening trial is investigating whether a longitudinal pattern of CA 125 measurements, rather than a single measurement, offers better sensitivity for detecting ovarian cancer in women at high risk for the disease.
'The interpretation of a woman's CA 125 level involves looking for an elbow pattern rise, over time, rather than evaluating a single absolute level,' reported Dr. Steven Skates of Massachusetts General Hospital, Boston.
For further refinement of the measurement's sensitivity, variables such as menopausal status, race, bilateral salpingo-oophorectomy, and smoking also should be considered, because they can alter by at least 10% the critical cut point that indicates further investigation, he said at the annual meeting of the Society of Gynecologic Oncologists.
A total of 2,005 women from 23 U.S. academic medical centers have been enrolled in the trial to date. Of the five ovarian cancers that have been detected, four had levels commensurate with an elbow pattern of rising CA 125 levels. In general, approximately 15%-20% of ovarian cancers do not produce CA 125, Dr. Skates said.
Investigators in the study are using CA 125 levels, measured every 3 months as the first line of screening, followed by transvaginal ultrasonography (TVS) when indicated. Although they are mainly looking for an elbow pattern rise, they also have set cutoff levels to guide them in interpreting initial measurements before a pattern is evident. The cut point is chosen so that 10% of screened women are referred to CA 125 indicated ultrasound annually.
For postmenopausal women, that cut point is 34 U/mL, which is essentially the standard CA 125 cutoff of 35 U/mL.
Similarly, in premenopausal women, although the cut point was initially set at 40 U/mL, the preliminary results from the trial indicate the equivalent cut point is 53 U/mL. African American premenopausal women have a lower equivalent cut point of 39 U/mL, and for premenopausal smokers it's 44 U/mL.
Of the five cancers detected so far, one cancer was particularly worrisome, because the woman exhibited the typical elbow pattern rise in CA 125 levels but repeatedly had normal TVS findings, Dr. Skates said.
'One of the discussion points for the trial's surgical committee based on this case, which has just arisen, is going to be whether the guidelines on exploratory laparoscopy in such situations should be revised and more strongly encouraged, and whether we can calculate a risk beyond which, even with a negative ultrasound, we would encourage exploratory laparoscopy,' he said in an interview.
BY KATE JOHNSON
Contributing Writer
COPYRIGHT 2004 International Medical News Group
COPYRIGHT 2004 Gale Group
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