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elevated CA-125 level

Dear dr. Goodman,
I have been diagnosed with breast cancer , underwent surgery in Oct. 2007, lymph nodes negative, underwent 32 radiation sessions, chemotherapy not needed. I am now on Tamoxifen. I am a carrier of BRCA1 mutation, heavy family history of ovarian cancer, had my ovaries removed 10 years ago in the age of 50, before menopause. My CA-125 levels were 47 before breast surgery a year ago, 43 in March 2008, and 53 now in September. My doctor sent me to do PET+CT of the body and the result of the test was negative. The result of MRI breasts in August was  also negative.
What can be the cause of the rising level of CA-125 ( I will repeat the blood test 6 weeks from now) ?  does it indicate a malignant process?  where can this process be if the PET+CT  does not detect it ?  is there a possibility of other causes for a rising level of CA-125?
I will appreciate a detailed reply.
Thank you so much.
9 Responses
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Avatar universal
Dear Dr. Goodman,
Thank you so much !!!
Sincerely
overseas
Helpful - 0
242604 tn?1328121225
MEDICAL PROFESSIONAL
Hi There

All tests have a limit to detection. That is below a certain size, an xray willlook normal even when there is something abnormal.

here is a very nice site with some general information about PET scanning. I have pasted the section on limitations
best  wishes

http://www.radiologyinfo.org/en/info.cfm?pg=PET&bhcp=1
What are the limitations of Positron Emission Tomography – Computed Tomography (PET/CT)?
Nuclear medicine procedures can be time-consuming. It can take hours to days for the radiotracer to accumulate in the part of the body under study and imaging may take up to several hours to perform, though in some cases, newer equipment is available that can substantially shorten the procedure time. You will be informed as to how often and when you will need to return to the nuclear medicine department for further procedures.

The resolution of structures of the body with nuclear medicine may not be as clear as with other imaging techniques, such as CT or MRI. However, nuclear medicine scans are more sensitive than other techniques for a variety of indications, and the functional information gained from nuclear medicine exams is often unobtainable by any other imaging techniques.

PET scanning can give false results if chemical balances within the body are not normal. Specifically, test results of diabetic patients or patients who have eaten within a few hours prior to the examination can be adversely affected because of altered blood sugar or blood insulin levels.

Helpful - 0
Avatar universal
Dear dr. Goodman,
Thank you !
One more question, please :
isn't the PET-CT  sensitive enough to detect a peritoneal tumor ?
Regards,
overseas
Helpful - 0
Avatar universal
Dear dr. Goodman,
Thank you !
One more question, please :
isn't the PET-CT  sensitive enough to detect a peritoneal tumor ?
Regards,
overseas
Helpful - 0
242604 tn?1328121225
MEDICAL PROFESSIONAL
Dear Overseas,
thank you so much for your responses.

Having a repeat CA 125 is very reasonable. Sometimes the abnormal value is an error.
having said that, with your personal and family history, if the CA 125 is still elevated, I would reccomend an evaluation of the uterus with a biospy or dilation and curettage (D&C). There is a risk of peritoneal cancer (cancer that looks like cancer of the ovary but arises from the lining of the abdomen) for women with the BRCA mutation. For this reason, an unexplained elevation of CA 125 should be evalauted by looking inside the abdomen by laparoscopy.

best wishes
Helpful - 0
Avatar universal
Dear dr Goodman,
I appreciate it that you ask more questions..
I had my ovaries removed ONLY  because of the history of ovarian cancer in my family. No other reason whatsoever. The pathological report of the removed ovaries showed nothing out of order..
I did not have my uterus removed. The surgery was by the laparascopy method.
I did not and do not have any cardiac, gallbladder or lung problem, and no infection that I know of.  The liver function showed slight disorders since the time I started Tamoxifen ( in March ), I understand that this is one of the possible side-effects of the drug.
Thank you so much
Overseas
Helpful - 0
242604 tn?1328121225
MEDICAL PROFESSIONAL
Dear Overseas,

thank you for your question.I have a few questions for you:

Did you have your uterus removed when you had your ovaries removed 10 years ago?
Why did you have that surgery?
was it as a prevention against ovarian cancer or was something else going on like a cyst or endometriosis ?
Do you know what the pathology report on the ovaries showed?
do you have any cardiac or lung disease?
any current signs of infection?
any trouble with your liver or gallbladder?

I will check back for your answers to better answer your question.

Dear Rosy75 - what a hard, hard situation!
do you know what kind of cancer your granddaughter has? is it epithelial ovarian cancer? or a germ cell tumor ?(more common at her age)
how many treatments of chemotherapy has she received? how many before surgery and how many after?  What kind of side effects is she having?

Dear Thalassa,
thank you for your insightful questions.
it is hard to second guess another doctor's decision without all the information.
there are two main reasons for changing chemotherapy regimens:
-intolerable or dangerous side-effects and toxicities
-progression of the cancer

best wishes
Helpful - 0
Avatar universal
Hello
I do not understand why doctors continue with Doxil while the CA came down in the
standards after carbotaxol and after CHIP ?
What is that there is no danger that the body develops resistance? Why doctors do not leave quiet the maintaining body ?  what is that it are going to change an additional chemotherapy with Doxil?
Thank you !
Helpful - 0
562501 tn?1223921789
Upon reading Overseas's letter to you I am wondering if my granddaughter who was diagnosed ovarian cancer stage 4 on April, 2008, age 19, should have a test to know is she has BRCA mutation.  Doctors have doubts of being an origin ovarian cancer because of her age.  She had a debulking surgery of 26 hours.  She had chemotherapy before the surgery carbotaxol, and directly in her abdom after the surgery.  Her CA125 is 14 now, was at 130 at the beginning, nothing showed on her PET.  She is still suffering a lot of diharrea.  She is waiting to be stronger to continue chimo wwith doxil.  Thanks, Rosy75
Helpful - 0

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