Cancer FAQ - Part II

Woman's Diagnostic Cyber - Frederick R. Jelovsek MD

• CA-125 blood test, what is it and what does it show?
• Do I need a CA-125 test after hysterectomy and ovary removal?
• Condyloma treatment to prevent cervical cancer

CA-125 blood test, what is it and what does it show?

I was told to take a CA-125 blood test and haven't gotten the results yet. What does this show exactly, and does it show malignancy in the ovaries?

CA-125 is a cancer antigen that is elevated in many diseases affecting the peritoneal lining of the abdominal and pelvic cavity. Certain types of ovarian cancer elevate this antigen. Many benign conditions in the premenopausal age range can also elevate it: endometriosis, fibroids, benign cysts and tumors of the ovary, liver and bowel disease and so on. It really shouldn't be used as a screen in the premenopausal age range because there are too many false positives. It is used if there is a tumor or cyst seen on ultrasound as a baseline prior to already-decided surgery. That way if it turns out to be malignant, you have a tumor marker to follow subsequent therapy if the tumor happens to be a type that elevates CA-125. Premenopausally it should not be used to make a decision about surgery. Those decisions need to be made on symptoms and imaging.

Postmenopausally, CA-125 is also used if there is a mass and you will undergo surgery. It can also be used as a screen because many of the benign conditions that elevate CA-125 go away after menopause. There are still a lot of false positives. Postmenopausally, about 1 in 10 elevated CA-125s will actually turn out to have a malignancy. That yield is high enough that if a woman has an elevated blood test, she should go ahead and have imaging studies done.

The reason the test can't be used to make a decision about a mass is that only about 60% of malignant ovarian tumors will have an elevated CA-125. It would be a mistake, if a mass was already present, to decide on surgery only if the test was positive.

Condyloma treatment to prevent cervical cancer

How long is too long to get treated for condyloma? A friend got cervical cancer for letting it go too long untreated. I have no money. What should I do?

Condyloma accuminata is caused by the human papilloma virus which is associated with cervical dysplasia and cervical cancer. It usually takes awhile to progress to a cancer but you don't know where you are in that progression.

If any of the biopsies come back high grade dysplasia or more (CIN 2 or CIN 3) you really have to have it checked out and give up whatever other pleasures in life to preserve life.

Do I need a CA-125 test after hysterectomy and ovary removal?

Prior to a complete hysterectomy in 1997, I had periodic CA 125 tests for cancer. The test numbers gradually escalated over the years. No cancer was found when I had the hysterectomy but I have not had a CA 125 test since. Should I? My father died at age 50 of colon cancer and my mother was diagnosed with breast cancer at 75, at 84, she is a breast cancer survivor. Does the CA 125 only address uterine or ovarian cancer or is it a more general indicator of the presence of cancer somewhere in the body?

Ca-125 is a blood cancer antigen that measures almost any disease in the abdominal cavity (peritoneum). It is primarily used to detect ovarian cancer since that spreads over the peritoneal cavity. Unfortunately it can pick up endometriosis, fibroids, liver disease, colon inflammatory disease among other conditions. It is not effective as a screen for uterine cancer.

While a rising CA-125 is worrisome, many times it turns out to be nothing identifiable or a benign condition. In fact if the CA-125 is elevated, a pelvic ultrasound is next performed. If it is normal, usually no further diagnostic tests are performed except for a follow-up ultrasound.

Now that you have had both the uterus and ovaries removed, there is no point in having a CA-125 test done any more. There is a rare form of peritoneal cancer after removal of the ovaries that could be picked up by a CA-125 test but it is so uncommon that it is not felt to be cost effective for screening with the blood test.

It would be best to concentrate on detecting early breast cancer (mammograms) and colon cancer (stool testing for occult blood or colonoscopy.