Raised CA125 – what we actually know…

Abstract

Carbohydrate antigen 125 (CA125) is an antigen used in the diagnosis of epithelial nonmucinous ovarian cancers. CA125 may be elevated in many benign and malignant conditions, so elevated levels can cause confusion over patient management. The multidisciplinary team is important when planning care for patients with suspected ovarian cancer. Learning objectivesTo know the factors leading to CA125 production and its mechanism of action.To understand how CA125 is used as a diagnostic tool and to assess the treatment response of ovarian cancer. To appreciate patient care options in cases of falsely elevated CA125. Ethical issuesIs the CA125 blood test being used in patients appropriately and safely? In patients with elevated CA125 levels, does this lead to unnecessary investigations and invasive treatments? Keywords: CA125 / gynaecological causes of raised CA125 / nongynaecological causes of raised CA125 / ovarian cancer / ovarian cancer follow-up

Thoracic Gorham-Stout disease masquerading as an ovarian malignancy: a differential diagnosis in non-malignant causes of raised Ca-125 and overview of this rare pathology

“…Ca-125 levels can increase in both physiological and pathological conditions such as the menstrual cycle, first trimester pregnancy, ovarian carcinoma, fibroids, endometriosis, pelvic inflammatory disease, benign ovarian cysts, hepatitis, ascites, pleural effusions and lymphangioleiomyomatosis (LAM) 11 12. It has been suggested that Ca-125 is synthesised in the mesothelial cells as a stress response to either fluid congestion (mechanical stress) or cell mediators (inflammatory stress) 13. Howe et al comment on the importance of understanding how these biological mechanisms correlate with a wide range of conditions, for clinicians who are assessing the significance of elevated Ca-125 levels 13.…”

“…It has been suggested that Ca-125 is synthesised in the mesothelial cells as a stress response to either fluid congestion (mechanical stress) or cell mediators (inflammatory stress) 13. Howe et al comment on the importance of understanding how these biological mechanisms correlate with a wide range of conditions, for clinicians who are assessing the significance of elevated Ca-125 levels 13. Our case highlights the importance of appreciating and communicating to the patient, the limitations, implications and potential harmful consequences of using this particular ‘gold standard’ tumour marker.…”