I have seen this happen: 42 year old lady with general malaise and weight loss and abdominal bloating gets a CA-125 requested by GP and on finding it elevated he requests pelvic ultrasound, writing 'probably ovarian Ca' on the request form. Radiologist sees ascites but 'can't exclude small ovarian lesion' and she is transferred from DGH to teaching hospital for laparotomy and probable bilateral oophorectomy. Referral for TPN just before surgery resulted in the finding that she put away about 10 bottles of wine a week and had liver cirrhosis..
Clodagh
CM Loughrey MD MRCP FRCPath
Consultant Chemical Pathologist
Belfast City Hospital
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Frater John (RVW) Pathology
Sent: 29 June 2009 14:33
To: [log in to unmask]
Subject: Re: CA-125
Not only may finding an increased result for CA125 cause anxiety for the patient, it may (and has been known to) lead to incorrect clinical care of the patient, when the increased CA125 is due to a cause other than ovarian cancer. Clearly, missing the diagnosis of ovarian cancer is dreadful, but the incorrect management of the patient's condition can also have serious adverse consequences. Having said that, providing a suitable comment on the report, highlighting the possibility that increased CA125 may be due to other causes, may help avoid inappropriate action.
With regard to the cost involved, I believe we should take some responsibility for the sensible use of NHS funds even though it is not "our money". How we respond to requests should primarily be about quality of care, but costs are relevant to our service provision, though perhaps not easy to decide their significance when dealing with individual requests?
John
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Douglas Thompson
Sent: 29 June 2009 12:34
To: [log in to unmask]
Subject: Re: CA-125
Sorry Tim, cannot agree with this approach. We should be looking at the evidence and acting appropriately.
The evidence is that it is not helpful to do Ca 125 in this scenario. Ca 125 is not a diagnostic test and to do it may only result in increased patient anxiety when an elevated Ca 125 is reported.
Best wishes
Douglas
Dr D Thompson
Principal Biochemist
Clinical Biochemistry and Immunology
The General Infirmary
Leeds LS1 3EX
Tel 0113 3926503
Please visit our web-site at www.leedsteachinghospitals.com
>>> Reynolds Tim <[log in to unmask]> 29/6/09 10:25
>>> >>>
Personally, I would never refuse such a request because I have not seen the patient. It may be safe to reject them but when a patient has the test rejected and then in 3 years time is diagnosed with ovarian cancer, you will have a hard job fighting the local press. So, since PCTs are billed for the tests they have done, and its not your money, it is always safer to just do the test...
TIM
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Prof. Tim Reynolds,
Queen's Hospital,
Belvedere Rd,
Burton-on-Trent,
Staffordshire,
DE13 0RB
work tel: 01283 511511 ext. 4035
work fax: 01283 593064
work email: [log in to unmask]
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-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Bradbury Wayne
(RNL) North Cumbria University Hospitals
Sent: 29 June 2009 10:14
To: [log in to unmask]
Subject: CA-125
Hello all,
Is anybody else seeing a surge in requests from primary care for CA-125 on women
with "Abdominal bloating ?ovarian malignancy?"
I think this is related to an article in the BMJ on 4th June where a patient suggests her late
diagnosis of ovarian cancer could have been prevented if only her GP had asked for a CA-125.
http://www.bmj.com/cgi/content/full/338/jun04_2/b2072
I am declining these requests. Am I wrong?
Wayne Bradbury.
Mr WH Bradbury
Consultant Biochemist
Biochemistry Department
Cumberland Infirmary
CARLISLE
Cumbria
CA2 7HY
Tel: 01228 814521
Fax: 01228 814831
E-mail: [log in to unmask]
<mailto:[log in to unmask]>
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