Elevated CA 19-9 prompts concern for hysterectomy

[SMPRENTISS]

I was told that I had cancerous cells in my cervix along with fibroid tumors and heavy bleeding back in 1997. I was told after having a colposcopy test, that I was not bleeding from a menstrual period but the cervix.  I had a hysterectomy 11 years ago but my ovaries were left due to my age.  Now I am being told that I have complex cysts showing on my ovaries. The CA-125 test was preformed and was negative (6), however I was sent to a gyne specialist who also took a CA-19-9 test, and I was recently told it was high (52%) and that my ovaries will need to come out as a result. My question is: The doctor says I have ovarian carcinema (spelling?) Why is the CA-19-9 test done as we are talking about my ovaries. IF the CA-125 test for ovarian cancer is negative, why did the CA-19-9 test now suggest that my ovaries should be removed.

Any help you could provide is greatly appreciated.

Thanks
SMPRENTISS

[Annekathryn Goodman, M.D.]

Hi There,
CA 19-9 is a marker of pancreatic cancer. In looking through the literature most sites are similar to this link that I have pasted here.It is not a screening test.

http://cancer.about.com/od/pancreaticcancer/p/CA19tumormarker.htm

I did find an abstract from China combining CA 19-9 with CA 125 for mucinous tumors of the ovary. I have pasted that below as well.

As a general comment, I would say that the diagnosis of malignancy comes after the tissue is removed and analyzed under the microscope.It may be that removing your ovaries is reasonable.The decision to intervene surgically for ovarian cysts depends on several factors:

-size (greater than 4-5 cm)
-complexity
-persistence
-symptoms

best wishes

Zhonghua Fu Chan Ke Za Zhi. 2008 Jan;43(1):5-8.Links
[Clinical value of serum CA19-9, CA125 and CP2 in mucinous ovarian tumor: a retrospective study of 273 patients][Article in Chinese]


**** L, Cui H, Li XP, Sun LF, Chang XH, Liang XD, Zhu HL.
Gynecologic Oncology Center, Peking University People's Hospital, Beijing 100044, China.

OBJECTIVE: To evaluate the diagnostic and prognostic value of serum CA19-9, CA125 and CP2 in mucinous ovarian tumors. METHODS: In this retrospective study, the serum CA19-9, CA125 and CP2 levels of 273 hospitalized patients with ovarian tumors of either mucinous or non-mucinous type were analyzed. RESULTS: (1) CA19-9 had the biggest area under curve (AUC) in mucinous tumors followed with CA125 while CA125 and CP2 had bigger AUC in non-mucinous tumor. (2) For the diagnosis of mucinous tumors, CA19-9 and CA125 combination showed a greatly increased sensitivity compared with CA19-9 or CA125 alone (93.8% versus 75.0% and 66.7%, P0.05). For the diagnosis of non-mucinous tumors, CA125 and CP2 combination showed an increased sensitivity compared with CA125 or CP2 alone (85.0% versus 80.7%, P>0.05, 85.0% versus 70.6%, P0.05). (3) Seventy percent of tumor marker-positive patients could undergo cytoreductive surgery. Compared with those who could not undergo cytoreductive surgery, they were more likely to have normal tumor marker two months after surgery (P0.05), with lower recurrence and death rate (P<0.05). All of the 20 tumor marker-negative patients could have cytoreductive surgery with only 10% recurrence. (4) CA19-9 increased mainly in recurrent mucinous tumor, while CA125 increased dominantly in recurrent non-mucinous tumor. (5) The survival rate of CA125 and CP2 positive patients was much lower than CA125 and CP2 negative patients (P<0.05), while the survival rate was similar between CA19-9 positive and CA19-9 negative patients. CONCLUSIONS: CA19-9 is a sensitive index for diagnosis of mucinous ovarian tumors. Combination of CA19-9 with CA125 can improve the sensitivity of diagnosis and postoperative monitoring of mucinous ovarian tumors. Combination of CA125 with CP2 is more valuable in the diagnosis of non-mucinous ovarian tumors.

[huda1211]

A related discussion, CA19-9 and ovarian cyst was started.

[huda1211]

A related discussion, CA 19-9 & ovarian cyst was started.

[SMPRENTISS]

Hi Doctor,

Thanks so much for responding and giving me the information.  Yes you are correct. My gyne confirmed that the condition I have is mucinous ovarian cysts.  He is awaiting my pathology and operative reports from 1997 to determine his next move. I'm really not sure why that is holding him from going through the surgery, but that is the direction he would like to take.  Also, I had another pelvic ultrasound/transvaginal ultrasound and the report came back that the cyst has decreased in size from 2.3cm to 2.0cm. His concern is the high elevation of the CA 19-9 report.  I just turned 42 years old on 10-16-08, and have already had a previous tubal litgation in 1988 after the birth of my only child, followed by the partial vaginal hysterectomy in 1997.  I have been experiencing a lot of lower abdominal pain, nausea and sharp pains that feel like it's in the rectal area.  The gyne doctor also believes I have some other underlying conditions with constipation. I am only experiencing the pain the majority of the time in my left side, and the reports only show the right ovary.  I keep stressing to the doctors that I rarely feel pain on my right side.  My question is: Should I continue the efforts to have the surgery that is tentatively set up for this November 2008? Or should I just wait to see if all of this will go away? I don't want to get false hope, and be faced in the future with more serious problems.

Thank you for your help in this matter.