Ca 125 Has gotten higher

[corky13]

Hello Doctor Goodman,

I have asked you questions in the past and you have been nice enough to give me your opinion, so I am hoping you can help with these questions as well.

In late 2007 I had some issues with ovarian cysts and pelvic pain. My doctor ordered my first ca 125 with came back elevated at 52. I was followed with repeat ca 125 tests that remained around the same. In April of 2008 I had a laparoscopy to get a look inside. My doctor stated that everything looked great, with the exception of a small patch of endometriosis in the right side of the cul de sac. She did remove this, but did not do a biopsy. All was good for a couple of months and then I stared have pretty intense right sided lower back pain. An ultrasound showed bilateral simple ovarian cysts. My doctor said this could not possible be the cause of the pain. The cyst sizes were 4  and 5cm. I was sent to a back doctor and had an mri. This stated a possible protruding disc. So I have been receiving treatments for this. This June I started experiencing bleeding after intercourse as well as prolonged menstrual bleeding. I have recently moved, so I found a new gyn. She did a uterine biopsy, pap test, tested for sdt's, ultrasoudn and a colposcopy. All returned as normal, except bilateral simple cysts. So I recently had a ca 125. It was actually done just as a follow up from the previous abnormal levels. Well now my ca 125 has come back at 142 and I am extremely worried.

My questions are...1. Do you think that this is cancer?
                            2. Could this mean that the endo has gotten worse and is also causing the excessive bleeding.

Thank you in advance for your time and help.
Corky

[Annekathryn Goodman, M.D.]

Hi Corky,
Thank you for the complete information.  CA 125 can be a very good measure of the activity of your endometriosis. You have never had a cancer diagnosis.So I suspect that your endometriosis has progressed.I would suggest that you talk to your doctor about a repeat laparoscopy. With your symptoms, you should consider removing those cysts and then once the diagnosis of endometriosis is confirmed, you should consider other therapy such as lupron
best wishes

[corky13]

Thank for all your feedback. Your expert opinion is greatly appreciated. I would like to ask you a couple more questions in regards to your last feedback.
I have asked the doctor to perform a lap and is stated it would do little good in the evaluation of the ca 125 and that he wants to wait 2 months and repeat the ultrasound, as the most recent showed that there is only the remaining right ovarian cyst. This cyst has not changed in size. I did try to get a second opinion, but without a diagnosis of cancer I was unable to obtain an appointment at Sloan Kettering.
I am still very nervous about the rise in ca 125. It went from 58 as of last year to 142 and I thought that rise was quite substantial.
Here are my questions...
1. In light of the recent painful swollen lymph node under my arm, could the ca 125 be elevated in a undiagnosed breast cancer?
2. Would a swollen node that was caused by breast cancer come and go? (it is  no longer swollen and the pain is gone)
3. Should an elevated ca 125 be investigated for other causes? (ie. breast cancer, colon, etc.)

I will try not to bother you again!! I truly appreciate your help.
Thank you,
Corky

[Annekathryn Goodman, M.D.]

Hi There
a mammogram would be the appropriate way to screen for breast cancer.
I think a repeat ultrasound is fine but I still feel that laparoscopy is the right next step

It is not over kill to take out the cysts. In fact, the standard curative treatment for advanced endometriosis in a woman who has completed child bearing is a full removal of the uterus , fallopian tubes, and ovaries.
best  wishes

[corky13]

I have been researching online to find out other causes of a rising ca 125 and read that breast cancer can also cause a rise in a ca 125. My patenal grandmother had breast cancer in her 80's. Could this be a concern as I am having issues with soreness and a swollen lymph node under my left arm. This began at the beginning of this month. It went away and returned within the last few days. Although it does seem to be getting better as of today. I have had no infections that I am aware of that would cause a swollen lymph node under the arm. I am assuming that a tooth infection would not do this. Any feedback would be appreciated.
Thank you,
Corky

[corky13]

One more question....I have noticed that I have had soreness under my arm of and on and wanted to know if this could be related to any of this.

[corky13]

Hi Dr. Goodman,
I wanted to thank you for answering my last questions and ask you some additional ones.. I was referred to a gyn/onc at Cooper in NJ due to the rise in the ca 125. It was 142. I had not had a ca 125 since October of last year. At that time it was in the 50's . So I guess this concerned my current gyn. I know it certainly concerns me. So, the the gyn/onc does a pelvic exam and looks over my prior history. He says he doesn't think this is anything to worry about and that many things can cause the ca 125 to rise.  I had also had a tooth infection and was on a never ending period when the last ca 125 was done. He decided to do another ultrasound (which I am having done this week) and another ca 125 in the middle of November. I am currently still having issues with constant or near constant bleeding which I have had a full work up for and I continue to have right sided lower back pain (although this does seem to be improving), and issues with yeast infections that go away, but always come back. I guess my questions are
1. In your opinion, is this the right course of action?
2. Would considering the removal of the ovaries be over kill.
I am just so sick of worrying. I know that endometriosis can raise the ca 125, but would it go this high? All the ultrasounds that I have had done always state that I have cysts usually between 2-5cm. They are always stated as simple. Does endometriosis cause simple appearing cysts?
Thank you for your help,
Corky