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Re: CA 125 and Serous ovarian tumor of low malignant potentialFrom: Hugo D. Ribot Jr. (hribot@obdoc.is.net)Tue Jun 25 09:33:04 1996
Peter V. Weston, M.D. wrote: > > I would appreciate help from the list members in managing a patient. > > 31 year old nulligravida who is currently not sexually active. > U/S showed a 15.2 X 9.7 X 8.9 cm cystic mass with internal pappilations. No > free fluid. > > > Cell washings were negative, the wedge resection showed normal ovarian > tissue. The final pathology report showed "A serous tumor of low malignant > potential. Neoplasm entirely confined within the ovary with no demonstrable > surface involvement." > > Intraaoperative CA 125 was 50.2 U/ml. > > THREE WEEKS LATER THE CA 125 WAS 52.2 U/ml. > > QUESTIONS > 1. What is the half life of CA 125? > > 2. How rapidly would you espect the rate of CA 125 to drop? > > 3. How often should one repeat the test? Or should we ignore this result? > > 4. What other tumor markers would y'all look for? > > 5. How actively should one follow a slightly elevated CA 125 in such a patient? > > Thank you! > > Peter > > Peter V. Weston, M.D. Peter: In this case I would treat the patient and her histology, not the lab test. I believe the specificity of CA-125 is much less reliable in premenopausal patients. Based on the path, I don't see a need for other serum markers, such as AFP or CEA. Now all this applies with the caveat that you have absolute confidence in your pathologist and their certainty regarding LMP tumors of the ovary, which can be hard to call. It sounds like you did a very reasonable approach. I believe there is still some debate/paranoia re: the appropriateness of adjuvant chemotherapy. I believe most would just follow clinically for recurrence. If at all an option, I would encourage her to get her childbearing out of the way. My $0.02 (not adjusted for inflation) Hugo
-- Hugo D. Ribot Jr. MD FACOG Private practice Northwest Georgia
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