Re: Post-menopausal cyst
From: art fougner, md (evsono@pipeline.com)
Mon Jul 17 08:23:21 2000
Joanne -
scope for slight elevation and no palpable nor sonographically
demonstrable ovarian enlargement is not indicated. however, repeat
ca125 in say 3 mos seems reasonable to look for trend. this was a
disturbing case on many levels for once the ca125 elevation was
dramatically confirmed, it was difficult to convince the consultant gyn
oncs that surgical diagnosis was in order. i agree that ca125 has many
shortcomings as a screen. hopefully, more efficient markers are on the
horizon, perhaps as the result of genomics. for some patients, however,
the combination of ca125 and sonar is all we have. here's a reference
which might prove thought-provoking if little else - Lancet 1999; 353:
1207 - 1210.
Art
At Sat, 15 Jul 2000, Joanne Bulley, MD wrote:
>
>Art -
>
>As your story *and* mine demonstrate - a CA-125 NEITHER rules in nor out
>Ovarian Cancer - therefore it is - as yet - not a very good screening
>tool. Having said that - I do do them on occasion...
>
>Your patient was perhaps lucky she asked for the CA-125. Her disease
>also shows that one of our theories on "ovarian Ca" may be correct -
>that it is perhaps a carcinomatosis of the peritoneal cavity and NOT
>primary in the ovary that then disseminates to the peritoneal cavity.
>
>I think NONE of us would suggest doing CA-125's monthly from age 52 to
>death...
>
>Although they are not worthless, I just think that they are non-specific
>enough that they are frequently non-helpful.
>
>If your lady had been lapscoped for the CA-125 of 50 - perhaps NOTHING
>would have been found. Would you have taken out or biopsied normal
>looking ovaries and peritoneum?
>
>Should she have had an MRI after that first level of 50?
>
>I agree - once you have an elevated CA-125 you must act on it - but how
>many lapscopes, oophorectomies and complications of those procedures
>will hapen for the woman with a level 0f 50 to be identified before it
>gets to 100 or 1000?
>
>To quote George Morely - "a difference to be a difference must make a
>difference" - does doing CA-125's make a difference? Is your patient (or
>any of ours...) any more likely to get a cure of her stage 3 'ovarian'
>Ca and survive to her ripe old age than succumb to disease by having had
>the test?
>
>At Sat, 15 Jul 2000, art fougner, md wrote:
>>
>>Joanne -
>>
>>last year we had the flip side case.
>
>>further w/u failed to explain the new
>>onset free pelvic fluid with CA125 elevation and the patient was
>>explored, at which time disseminated intraperitoneal carcinomatosis was
>>found - diffuse implants of papillary serous tumor without a discrete
>>primary mass. in fact, aside from surface studding, the ovaries were
>>quite nl in appearance. so perhaps the CA 125 should not be discarded
>>so quickly.
>>we still have so far to go in the diagnosis and treatment of ovarian
>>cancer. perhaps with the advances in genomics, better markers can be
>>found to help better stratify risks.
>>
>>art fougner, md
>>
>>A series of 1000 cases begins with but a single anecdote.
>>
>--
>Joanne Bulley, MD
>Keene, NH, USA
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
