Scribd
Upload
283 views3 pages

Ca 125

CA125 is a biomarker used to help manage ovarian cancer. It is elevated in over 85% of non-mucinous epithelial ovarian carcinomas and 100% of fallopian tube tumors. CA125 levels increase with more advanced stage disease. It can help monitor disease course and detect residual tumor after treatment, though levels may remain elevated in stable or progressive disease. CA125 is not a screening or diagnostic tool on its own due to limitations including normal levels in some ovarian cancers and possible elevation in non-cancerous conditions.

Uploaded by

डा. सत्यदेव त्यागी आर्य
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
283 views3 pages

Ca 125

CA125 is a biomarker used to help manage ovarian cancer. It is elevated in over 85% of non-mucinous epithelial ovarian carcinomas and 100% of fallopian tube tumors. CA125 levels increase with more advanced stage disease. It can help monitor disease course and detect residual tumor after treatment, though levels may remain elevated in stable or progressive disease. CA125 is not a screening or diagnostic tool on its own due to limitations including normal levels in some ovarian cancers and possible elevation in non-cancerous conditions.

Uploaded by

डा. सत्यदेव त्यागी आर्य
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 3

CANCER ANTIGEN (CA) 125

INTRODUCTION

Ovarian cancer is the most lethal malignancy of gynecological origin. Cancer in the ovary may derive
from epithelium (95% cases) or stromal supporting cells or germ cells. The most common ovarian
epithelial malignancies are Serous tumors (50%); Mucinous tumors (25%); Endometrioid carcinoma
(15%); Clear cell carcinoma (5%); Brenner tumor (1%). CA 125 is a marker of epithelial ovarian
malignancy.

NORMAL RANGE
<35.0 U/mL

CLINICAL USE

 An aid in the management of Ovarian cancer patients. Preoperative CA 125 level of < 65 U /mL
is associated with a significantly greater 5 year survival rate.
 Monitor the course of disease in patients with Invasive epithelial ovarian cancer
 Detection of residual tumor in patients with Primary epithelial ovarian cancer who have
undergone first line therapy. Persistent elevation of CA 125 levels after 3 cycles of therapy
indicates a poor prognosis.

STAGE OF OVARIAN CANCER PERCENTAGE POSITIVITY OF CA 125


Stage I 50
Stage II 90
Stage III & IV >90

INTERPRETATION

Increased Levels

Malignant disease  Non mucinous epithelial ovarian carcinoma (85%)


 Fallopian tube tumors (100%)
 Cervical adenocarcinoma (83%)
 Endometrial adenocarcinoma (50%)
 Squamous cell carcinoma cervix / vulva (15%)
 Trophoblastic tumors (45%)
 Non-Hodgkin lymphoma (40%)
 Cancer of Pancreas / Liver / Lung
Endometrial conditions  Pregnancy (27%)
 Endometriosis
 Menstruation
Pleural effusion  Cancer
 Congestive heart failure
Peritoneal effusion  Pelvic inflammatory disease
 Bacterial peritonitis
Non malignant conditions  Cirrhosis (66%)
 Disorders of GIT / Liver / Pancreas
 Renal failure
Healthy individuals 1%

Decreased Levels

 Postmenopausal women
 African American & Asian women have lower normal values

HIGH RISK FACTORS FOR OVARIAN CANCER

 Epidemiologic factors – increasing age specially above 60 years. Females have approximately
1:72 lifetime risk of developing ovarian cancer.
 Genetic factors – 10% women with ovarian cancer have a somatic mutation in BRCA1 or BRCA2
& Lynch syndrome Type II caused by mutations in repair genes (MSH2, MLH1, MLH6, PMS1 &
PMS2)
 Nulliparity
 Use of talc agents to the perineum
 Obesity
 Hormone Replacement Therapy (HRT)

PROTECTIVE FACTORS FOR OVARIAN CANCER

 Oral contraceptives
 Multiparity
 Breast feeding
 Fallopian tube ligation

EARLY DETECTION OF OVARIAN CANCER

 CA125 is recommended along with Transvaginal ultrasound (TVS) for early detection of ovarian
cancer in women with hereditary syndromes.

 It also acts as an adjunct in distinguishing benign from malignant suspicious pelvic masses in
postmenopausal women.

LABORATORY DIAGNOSIS
 Diagnosis of ovarian cancer is made on histological examination of tissue or cytology of
peritoneal or pleural fluid if present. Rarely abnormal glandular cells may be seen on Pap smear
which on further workup are found to originate from the ovary.
 Imaging for identifying an adnexal mass
 Blood biomarkers –
 CA125 – CA 125 is elevated in approximately 50% patients with early stage disease and
>80% patients with advanced disease. Thus serial CA 125 levels over time may be
beneficial as a screening tool.
 Human epididymis protein 4 (HE4) – helpful in diagnosing recurrent or progressive
disease or in the evaluation of a suspicious adnexal mass. This is an FDA approved test
for monitoring the disease.
 ROMA (Risk of ovarian malignancy algorithm) – it is used as a supplement to the
standard pre-surgical evaluation of a patient with a pelvic mass to assess likelihood of
malignancy prior to surgery specially in those cases where presurgical evaluation does
not indicate malignancy.
 Carcinoembryonic antigen (CEA) – non specific marker as it is elevated in non malignant
conditions also
 OVA1 – is a panel of 5 serum biomarkers of which 2 markers are up-regulated (CA125 &
Beta 2 microglobulin) & 3 markers are down-regulated (Transferrin, Transthyretin &
Apolipoprotein A1). An algorithm determines the patients risk for ovarian cancer

LIMITATIONS

 CA125 level is not increased in Mucinous adenocarcinomas.


 Normal concentration of CA125 does not exclude presence of the tumor.
 Even at high concentrations, CA125 alone is not useful for distinguishing benign from malignant
pelvic masses.
 Although CA125 may be increased 12 months before clinical evidence of disease, it is not
recommended for screening women for Serous carcinoma ovary because it is not increased in
20% cases at the time of diagnosis and in <10% cases with Stage I / II carcinoma.
 In postoperative monitoring cases for persistent / recurrent disease, 95% patients show CA125
>35 U/mL but a negative result does not exclude residual disease.
 In 0.6% of normal women >50 years of age, CA125 levels may be increased
 Rising level of CA125 during chemotherapy is associated with tumor progression and return to
normal is associated with a good response. However it may remain elevated in stable or
progressive Serous carcinomas.
 Different assays do not produce equivalent values and should not be used interchangeably.

You might also like