Thanks.
Do you know what the pre-test clinical impression was?
Although many members of this group are very keen to point out the lack of specificity of CA125 for detection of malignant disease I find it hard to believe that the clinicians didn't have some sort of pelvic malignancy as the most likely diagnosis.
Were they establishing a pre-treatment concentration for use in post-treatment management rather than using the result to affect diagnosis?
As I read it the extract from the guidelines that you have included is intended to be used by GPs "with symptoms suggestive of ovarian cancer", not in the setting of the patient you describe.
Best wishes
Jonathan
On 19 Jul 2011, at 09:39, David Burgess wrote:
> Thanks to all who responded to my question,
> A 50 y.o. woman, an inpatient on the gynae ward, bleeding p.v. and with ascites and hydronephrosis has a CA125 1500 kU/L (N<35). There are no previous measurements. Should her results be accompanied by a cautionary note e.g. " may be raised in a number of benign conditions including endometriosis, inflammatory pelvic disease and acites"? Also should her results be phoned to the ward?
>
> The replies elucidated the issue which we discussed in this lab before I posted to mailbase.
> While conscious of the necessity to explain the specificity and sensitivity problems associated with CA125 measurements and the use of a comment which includes this information, I feel that in a situation like the one I described, and in that clinical setting, we undersell the power of this diagnostic tool by emphasising the problems with the result when it’s unlikely to be misunderstood.
> To quote the new guidelines;
> “A raised serum CA125 in younger women is less likely to be related to a diagnosis of
> ovarian cancer and when elevated in this group, can raise considerable worry for patient
> and GP alike. A serum CA125 of, for example, >1000 IU/ml in an older postmenopausal
> woman is a highly significant finding that points to some sort of malignancy, the most likely
> being ovarian or primary peritoneal cancer, although other cancers such as lung or
> pancreatic cancer cannot be excluded on this one test alone. In addition serum CA125
> levels of several hundred may occur as a consequence of non-malignant conditions such as
> heart failure”.
>
> Do you routinely phone abnormal tumour marker results?
>
> Regards,
>
> David
>
> -
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