Identification of tumor markers is the basis of examination for the presence of various types of cancer. These are special substances that secrete unhealthy cells that have developed from previously normal ones. Some tumor markers can be detected at the stage of blood donation. If the norm of the tumor marker CA-125 is exceeded, then the presence of neoplasms is likely.
Norm SA-125
CA-125, scientifically called Cancer Antigen-125, is a substance that can be detected in a blood test of patients with ovarian cancer. The normal blood level for tumor marker CA-125 is less than 35 units/ml. Most cases of an increased indicator indicate that there is a neoplasm. But there is no need to panic or be upset, because a bad result does not always specifically mean the presence of cancer. Sometimes the level of tumor marker increases because disorders occur in the body that have nothing to do with cancer.
Reasons for exceeding the norm
Normally, CA-125 is present in small quantities in the uterine mucosa. Thanks to natural barriers, the CA-125 marker cannot penetrate the bloodstream. Its concentration may be slightly increased in women during menstruation, which is considered normal. In the initial trimester of pregnancy, a tumor marker test may also show an excess of 35 units/ml, which is not dangerous. The main possible reason for the increase in CA-125 may be endometriosis. In addition, exceeding the norms of this marker may be evidence of the presence of other diseases:
- ovarian cysts,
- inflammation of the appendages,
- peritonitis,
- pleurisy,
- chronic hepatitis and pancreatitis,
- breast neoplasms.
A slight increase in the indicator can be detected during the course of ARVI. The reasons for a significant increase in the level of CA-125 include serositis of tumor etiology (the above-mentioned peritonitis, pleurisy).
Experts say that increased concentrations of this type of tumor marker occur in 1% of healthy people and in approximately 6% of people with benign diseases.
Timely detection of elevated tumor markers
Only on the basis of a detected excess of the norm for CA-125, no doctor will undertake to make a diagnosis. A blood test is not enough for a medical opinion, because this is only the first step towards diagnosis. Only a thorough and detailed examination can reveal the presence of a truly serious disease at an early stage.
Tumor markers help specialists determine whether the patient is at risk and prevent relapse after treatment. Also, thanks to markers, doctors can distinguish a malignant tumor from a benign one.
The more advanced the stage of the disease, the higher the concentration of cancer marker 125, because the sensitivity of the analysis of this marker directly depends on the stage of cancer. For example, a patient with ovarian cancer may have a negative response to treatment. The process of identifying a tumor at an early stage before symptoms appear is called screening. During the screening process, very small tumors are diagnosed, and there are cases when screening reveals a precancerous condition, namely a pathology that threatens to develop into cancer. The screening program consists of laboratory diagnostics and consultation with oncologists. The sooner the patient is examined, the earlier the ovarian disease will be detected and, accordingly, the greater the chance of recovery.
Malignant epithelial neoplasms of the ovaries- asymptomatic, rapidly growing tumors with late onset of clinical manifestations, therefore, careful monitoring is necessary to detect early relapses. Large metastases may be hidden in many parts of the abdominal cavity, which cannot be detected by physical examination and using radiological diagnostic methods.
When monitoring patients after ovarian cancer treatment(OC) it is not always advisable to use such complex methods as CT. Some believe that to control the prevalence of the disease, it is necessary to periodically determine the level of CA-125 and widely use surgical methods - laparoscopy and laparotomy. Perhaps in the future latent forms of the disease can be diagnosed using PET.
The optimal strategy for monitoring patients without clinical manifestations of the disease after primary treatment of late stages of ovarian cancer(RY) is not defined. There is an active and passive approach. There are no data on the benefit of second-line therapy; These treatment methods are expensive, sometimes accompanied by severe complications and cause significant discomfort to patients. During repeated control laparotomy, a fairly accurate prognosis can be made about the further course of the disease, which will allow patients to plan their lives.
There is currently no evidence that intensive surveillance of symptomatic patients has a positive effect on overall symptom-free survival or quality of life. Therefore, the observation scheme should be developed individually, in accordance with the needs of each patient. There have been many studies of second-line XT showing that early diagnosis and treatment of relapses improves outcome, but this remains to be proven.
We conduct physical examination and determination level CA-125 at regular intervals, reducing the frequency of observation as the disease-free interval increases. We use visualization methods according to individual indications. This practice does not have a good scientific and methodological basis, since, as stated earlier, the optimal strategy is unknown.
When 2 years have passed and no relapses have been identified, the number of visits is reduced to once every six months. In patients who did not undergo second-look laparotomy, in the first 2 years the frequency of visits is 1 time every 3-4 months. Many women insist on more frequent monitoring to ensure that the disease does not progress.
SA-125- antigen isolated by Bast using monoclonal antibodies OC-125, which were obtained from mice immunized with epithelial malignant ovarian cells. Antigenic determinants CA-125 are mucin-like glycoproteins with a molecular weight of more than 200,000 Da. Small amounts of the antigen are expressed in adult tissues derived from the coelomic epithelium, including the mesothelial cells lining the pleura, pericardium, and peritoneum.
This antigen is also detected in the epithelial component of the fallopian tubes, endometrium and endocervix. SA-125 not found in the ovaries of fetuses or adult women. However, CA-125 is expressed by more than 80% of nonmucinous epithelial ovarian malignancies.
Bast developed a radioimmunoassay for CA-125 level determination in serum and other biological fluids. The usual coefficient of variability of the analysis (different days) is approximately 15%. Therefore, only a doubling or halving of the antigen concentration is considered a significant change. At the upper limit of the norm of 35 units/ml, increased levels of CA-125 are noted in 1% of healthy donors, in 6% of patients with benign diseases, in 28% with non-gynecological malignant neoplasms and in 82% with verified OC. Niloff et al. reported an increase in CA-125 levels in late-stage adenocarcinoma of the fallopian tube, endometrium and endocervix.
More than 90% of cases ovarian cancer(OC) increases or decreases in CA-125 levels correlate with disease progression or regression. According to Niloff, with CA-125< 35 ед./мл в 14 из 36 случаев патологию не выявляли при ревизии во время операции «second-look» и ни в одном случае размер опухоли не превышал 1 см. Стойкое повышение уровня СА-125 связано с персистенцией заболевания. У 85 % пациенток с потерей опухолевых антигенов рецидив болезни выявили по повышению уровня этого маркера.
In a study presented by Knapp and Friedman, increase in CA-125 concentration were observed for 1 - 14 months. before relapse occurs (on average 5 months). It must be remembered that an increase in the level of CA-125 is also noted with damage to hepatocytes or chronic peritonitis, but this fact should not compromise the advantages of the method when monitoring the course of ovarian cancer (OC).
In fact, all patients with increased content of CA-125 determine residual tumors during a “second-look” operation or detect relapses of ovarian cancer (OC) over the next 4-6 months. A normal tumor marker level before relaparotomy is of limited value, since in more than 50% of patients with such a result and no clinical evidence of the presence of a tumor, the disease still progresses; residual tumor less than 2 cm rarely causes an increase in CA-125 concentrations.
Increased content of this indicator before surgery, “second-look” allows the gynecological oncologist to make an assumption about relapse or persistence of the disease, but does not provide a basis for accurately predicting the size of the residual tumor or the outcome, since in more than 1/3 of cases with a tumor larger than 2 cm, a normal level of SA is also observed -125. A rapid drop in tumor marker concentration to normal after the start of XT is often accompanied by negative results during the “second-look” operation.
Levin reported that in almost all patients with negative findings during second-look laparotomy, the CA-125 level remained within the normal range for 3 months. after primary cytoreductive surgery. Buller et al. showed that a pronounced drop in CA-125 levels after cytoreductive surgery and the start of XT is an indicator of a favorable outcome. These researchers showed that patients with a sharp drop in CA-125 levels to normal levels at the beginning of the third cycle of XT after surgery have significantly better survival compared to those whose marker remains elevated before the fourth cycle.
Buller described the S-shaped regression curve of CA-125 levels and suggested the use of alternative XT in patients with a delayed curve or increased regression. Hogberg and Kagedal reported that 23 patients with a CA-125 half-life of less than 16 days during induction XT had an estimated survival after second-look laparotomy of 59 months. amounted to 68%. In 49 women with a CA-125 half-life of more than 16 days, this figure was 18%.
Everyone female patients who have successfully completed treatment for (OC) are observed at least once every 3 months; CA-125 levels are determined at each visit. With normal clinical examination data and an acceptable level of CA-125, the risk of relapse is low; with a pronounced increase, it is high. A positive cytological analysis of the fluid obtained during laparocentesis confirms the suspicion of relapse. With an increase in CA-125 levels followed by stabilization of values at a plateau level and the absence of clinical manifestations of the disease, careful monitoring is indicated (especially with a minimal increase, for example, to less than 100 units) until a relapse is confirmed or a change in the tumor marker concentration curve.
Concomitant diseases of the liver, heart, arthritis and others may be the reason for the persistent increase in CA-125. The initial level of this indicator in women with advanced disease who responded to treatment does not always correlate with survival. Latimer et al. conducted a multivariate analysis and showed that CA-125 level was not a prognostic factor for survival, independent of disease stage. In other words, if an objective response to treatment occurs, survival does not depend on whether CA-125 levels were high or low before treatment.
Increased CA-125 levels after treatment, during the observation period, usually indicates a relapse, even if it is not clinically manifested. Most of these patients are indicated for repeat chemotherapy (XT). Unfortunately, federal regulatory agencies currently do not consider elevated tumor marker levels to be an indicator of relapse, which makes it difficult to interpret the results of randomized clinical trials aimed at potential drug approval. However, according to Rustin et al., “CA-125 progression” is the equivalent of disease progression proven by standard clinical or imaging diagnostic methods.
Tumor markers are substances of protein origin that increase in human blood during cancer and other conditions. When even a small number of tumor cells appear in the body, markers of tumor growth begin to be synthesized and released into the blood, where they can be detected. Cancer tumor markers can also increase with inflammation or benign tumors.
The level of markers determines the presence or absence of a tumor and the effectiveness of cancer treatment. When examining a patient, one cannot rely only on this sign of a tumor; it is necessary to evaluate all criteria of the disease in order to avoid errors in diagnosis. One of these markers is the ovarian tumor marker. The tumor marker for ovarian tumors is called CA 125.
Why does CA-125 increase?
There are many markers, each of which is responsible for the tumor of its organ. An ovarian tumor is characterized by an increase in the blood marker CA-125. It is found not only in the cells of the ovaries, but also in the serous membranes (pleura, peritoneum, pericardium), in the cells of the digestive system, lungs, kidneys, testicles in men. Therefore, with an increase in CA-125, only in 80% of cases can one assume the presence of a tumor of the testicles in men and ovaries in women, and in 20% of cases the presence of a tumor of other organs is likely.
The marker increases with inflammatory diseases in these organs, benign formations, during pregnancy or with autoimmune diseases, so its increase does not necessarily indicate a tumor process. If the tumor marker CA-125 for an ovarian tumor is elevated, decoding can only be done by a doctor.
To clarify the diagnosis, it is necessary to conduct an ultrasound examination, computed tomography or MRI of the organ, and endoscopic examinations. In difficult cases, a puncture biopsy with tissue examination for the presence of tumor cells will help.
How to conduct research on CA-125
It is necessary to donate blood strictly on an empty stomach to avoid false results. You should not drink any drinks before donating blood, with the exception of water. The analysis can be carried out during the day if more than 8 hours have passed since eating. One hour before the test you should not smoke.
It is advisable to conduct the study in the first half of the cycle after menstruation. Many medical procedures and medications can affect the results, so before the study you should consult your doctor about the need to discontinue them. To monitor the cure for tumors, the study is carried out once every three months.
What is the norm of CA-125
There are generally accepted laboratory standards for this indicator: for women, its level should be no more than 15 U/ml, from 15 U/ml to 35 U/ml is considered a questionable result, and an indicator of more than 35 U/ml is considered elevated. CA-125 in cancer usually increases several times. Sometimes in the early stages of tumors the marker is normal. The tumor marker for probable ovarian cancer may remain at a normal level.
False-positive results are observed in benign tumors and other inflammatory and immune diseases. If the level of CA-125 is increased or its result is questionable, a blood test is additionally performed for the HE-4 marker, which is more specific and sensitive for ovarian cancer.
This marker does not increase during inflammatory processes and cysts and is detected at all stages of cancer. To clarify the presence of an ovarian tumor, gynecologists often prescribe a blood test for the ROMA index, which includes determining the marker CA-125, HE-4 and calculating the likelihood of tumor development using a special method.
Against the background of ongoing antitumor therapy, the level of reduction of this marker is often assessed. If it remains elevated despite treatment, this means that the therapy is ineffective and the tactics must be changed. A decrease in the marker by two or more times indicates the effectiveness of treatment and a good prognosis.
Indications for examination on CA-125:
- Ovarian cyst. The Ca-125 marker with a cyst can be increased to two levels. This does not necessarily indicate its malignancy, but requires additional examination. The cyst itself is a precancerous disease; the risk of cancer especially increases during menopause. Therefore, when a cyst is detected and the tumor marker level increases, the doctor may prescribe surgery.
- Endometriosis. With this disease, endometrial cells grow and spread outside the uterus. This disease can also be a precursor to cancer. CA-125 in endometriosis can be increased several times. Treatment begins with the use of hormones, and in severe cases, surgery is prescribed.
- Uterine fibroids. This is a benign tumor in which the marker can be two or three times elevated. To clarify the nature of the process, ultrasound and MRI must be prescribed. But often, even when the benign nature of the process is confirmed, surgery is prescribed, since the risk of cancer degeneration is quite high.
- Pregnancy. Changes in hormone levels can cause an increase in the marker in the blood. In addition, the child’s fetus itself becomes the source of the formation of the marker and its release into the blood. To clarify the diagnosis, it is necessary to do a dynamic study, as well as donate blood for additional tumor markers.
- Menopause. During this period, an increase in the CA 125 tumor marker is most dangerous, since with age the risk of the formation of malignant tumors in the body increases. In patients during menopause, it is necessary to conduct a thorough examination to exclude oncology (MRI, ultrasound, CT, additional tumor markers).
If a gynecological examination does not reveal pathology, and the CA-125 marker is elevated, it is necessary to exclude tumors of other locations. First you need to conduct an examination of the gastrointestinal tract.
Perform an ultrasound examination of the abdominal organs and kidneys, perform fibrogastroduodenoscopy, colonoscopy or irrigoscopy of the stomach and intestines. To exclude tumors of the lungs and pleura, an X-ray or tomographic examination must be done. Pericardial tumors can be detected by Doppler echocardiography and chest tomography.
It must be remembered that the level of tumor markers cannot be the main criterion of the disease. Only a doctor can assess the patient’s condition and make a diagnosis after a complete examination. If you detect an increased level of tumor markers in the blood, you should not despair; this can be caused by other diseases.
Modern medicine can already determine the presence of cancer cells through a blood test. These studies are called tumor markers. Today there are several dozen types, each of which is able to recognize a specific type of cancer. However, positive tumor marker results do not always indicate oncology. There are a number of reasons that may affect the result of the analysis. One of the most important tests for women is the CA 125 marker, which indicates ovarian tumors. CA 125 tumor marker, its meaning and norm.
The essence of the analysis
Essentially, all tumor markers are tests for the presence of special protein compounds that appear in the blood as a waste product of a cancerous tumor. However, these substances can also appear in other diseases. For this reason, tumor markers are not a 100% method for detecting cancer.
However, these tests are a method of early diagnosis. And, despite the fact that they can show false positive results, oncologists believe that it is better to undergo an examination once again and suspect the presence of the disease in time than to detect it in the later stages.
CA 125 analysis is a marker that shows ovarian tumor. Protein CA 125 is found in the body of any person. In women, it can be found in the endometrium and uterus, serous or mucinous fluid. However, from these tissues the protein does not enter the blood plasma due to the presence of certain natural protection. An exception may be cases when the tissue of the uterus or endometrium is damaged, for example, after an abortion, childbirth, or during menstruation.
Norms
The rate of the CA 125 compound depends on the gender of the patient; today doctors use the following values to decipher the analysis:
- Healthy women: 10-35 units/ml.
- Healthy men: 0-10 units/ml.
- Normal value for ovarian cyst: up to 60 units/ml.
For the diagnosis of cancerous tumors, highly elevated levels of this antigen are important for doctors. If the elevations are small, it may indicate another, non-cancer-related condition.
Who needs research
Most often, CA 125 is prescribed to patients who are at risk. These women include:
- Patients with a hereditary predisposition.
- Women working in hazardous work.
- Women living in environmentally hazardous areas.
Sometimes women at risk are prescribed additional diagnostics even if the CA 125 value is normal. Women at risk should be under special supervision. Such patients are most often prescribed the tumor marker HE 4. The test can be taken as prescribed by a doctor at the oncology center or independently in paid laboratories. Every woman, upon reaching menopause, must pass this marker for her own peace of mind.
False Positives
False-positive results of the CA 125 tumor marker do not mean that the person is completely healthy. This means that the increase in the marker occurred due to the influence of third-party factors or the presence of other non-oncological diseases.
Common causes of a false positive test result are diseases such as:
- Endometriosis.
- Ovarian cyst.
- Pleurisy.
- Inflammatory diseases of the reproductive system.
- Hepatitis and pancreatitis in chronic form.
What else can affect the result?
Protein CA 125 can increase not only from the presence of diseases, but also from some completely third-party factors. In order for the diagnostic results to be as accurate as possible, each patient must follow the rules for taking the test.
You need to know that the following factors can influence the tumor marker result:
- Eating before donating blood.
- Drinking alcohol and smoking.
- Medications.
- Fatty and fried foods.
- Stress and overwork.
- Ultrasound, x-ray.
- Pregnancy.
- Menstruation.
- Menopause.
Thus, every woman should eliminate as much as possible factors that could affect the results of the analysis. If you cannot eliminate medications, be sure to tell your doctor. Also let him know if you are pregnant or have already reached menopause.
Analysis transcript
A blood test for tumor markers should only be interpreted by an experienced doctor. However, there are some approximate figures that you can rely on when deciphering the indicators of the CA 125 tumor marker. You must remember that these figures are quite approximate and it is absolutely unacceptable to make one or another diagnosis for yourself, much less engage in self-medication!
A blood test for CA 125 showed a value of 35-60 units/ml. These numbers indicate the possible presence of a cyst in the ovary. CA 125 norms in women with cysts should not exceed these values. Indicators are increased as a result of destruction of the epithelium. CA 125 with a cyst must be constantly monitored. Women with this disease are at risk of cells degenerating into malignant ones. This is especially true for women who have reached menopause.
If a cyst is diagnosed, you need to undergo immediate treatment.
CA 125 showed an increase to 100 units/ml. This is a serious deviation from the norm. With such values, the woman is prescribed additional diagnostics. Your doctor may suspect cancer, endometriosis, or uterine fibroids. In the case where additional diagnostics do not reveal third-party diseases, the woman is prescribed another tumor marker HE 4. The combination of these tests can increase the diagnostic accuracy up to 80%, and the percentage of detecting a malignant tumor at an early stage reaches 93%.
What else can a tumor marker indicate?
A high level of tumor marker may indicate more than just ovarian cancer. These indicators also increase in other tumor diseases. Most often, CA 125 is elevated in the following types of cancer:
- Pancreas cancer.
- Liver cancer.
- Fallopian tube cancer.
- Endometrial cancer.
- Breast cancer.
- Lungs' cancer.
Indicators may also increase in other oncological pathologies. For an accurate diagnosis, any patient who has an elevated normal level of this tumor marker is prescribed a full-scale examination. Moreover, doctors will never make a terrible diagnosis based on tumor markers alone. Most likely, repeat tumor markers will be prescribed in combination with other examinations.
The diagnosis of cancer is made only with repeated high analysis with increasing indicators over time.
If the patient has no third-party diseases. And CA 125 levels are rising, the oncologist urgently must use all available diagnostic measures to make an accurate diagnosis. Cancer can be successfully treated in the early stages, and therefore the earlier the tumor is detected, the greater the chance of a complete cure for this disease.
Cancer is a terrible disease that is extremely difficult to cure if not diagnosed in time. The insidiousness of the disease lies in its asymptomatic course until the late stages. Modern medicine can detect an illness in the early stages, but to do this, every person must consult a doctor for any ailments, so that a specialist can suspect the illness and carry out a diagnosis. Don’t be afraid to take tumor markers; these tests can save the life of a person who doesn’t even know about his illness.
In contact with
CA-125 is a high molecular weight glycoprotein that is produced in the uterus, mainly in the endometrium, as well as in mucinzone and serous fluids. Ca-125 is also present in the epithelial tissue of the kidneys, pancreas, gall bladder, gastrointestinal tract, bronchi and ovary. It is usually undetectable in the blood unless natural barriers are broken down. A small amount of this compound can be found in a woman’s blood during menstruation and pregnancy.
CA-125 is of great interest in laboratory diagnostics as a tumor marker for ovarian cancer and metastases.
Normal CA-125 in the blood. Explanation of the result (table)
A CA-125 test is prescribed if it is necessary to confirm or exclude malignant ovarian tumors in a woman. This study makes it possible to differentiate cancer from benign tumors. It is also necessary to donate blood for the CA-125 tumor marker to control the quality of the treatment provided.
Blood is drawn from a vein, in the morning, on an empty stomach. In addition, since during menstruation a certain amount of CA-125 is found in the blood of women, blood should be donated no earlier than 3 days after its end. It is recommended not to smoke half an hour before donating blood.
The norm of CA-125 in the blood of ordinary people and pregnant women is:
If CA-125 is elevated, what does it mean?
An increase in the level of CA-125 in the blood, as a rule, clearly indicates the presence of a malignant tumor. Another question is that this does not always apply specifically to the ovaries. A significant excess of the CA-125 norm can be caused by the following diseases:
- malignant ovarian tumor,
- malignant tumor of the uterus,
- malignant endometrial tumor,
- fallopian tube cancer,
- pancreas cancer,
- mammary cancer,
- lungs' cancer,
- stomach cancer,
- liver cancer,
- rectal cancer,
- malignant formations in other organs.
Now for the good news. There are diseases in which the level of CA-125 can increase slightly (and sometimes increase quite strongly). These are diseases such as:
- inflammatory processes in the appendages,
- endometriosis,
- STD,
- cyst or polycystic ovary syndrome,
- cirrhosis of the liver:
- chronic form of hepatitis,
- pleurisy,
- peritonitis,
- chronic pancreatitis,
- some autoimmune diseases.
Obviously, there are a lot of diseases that can cause an increase in the level of this tumor marker in the blood. Therefore, to make an accurate diagnosis and begin treatment, it is necessary to conduct an additional examination of the patient.
As mentioned above, a slight increase in CA-125 levels is observed during monthly bleeding in women. Therefore, if you took the test immediately after the end of menstruation, then it is possible that its result will be slightly higher than normal.
Please note that during pregnancy, during the first trimester, CA-125 levels physiologically increase. This is not a pathology and should not cause concern to the expectant mother.
If CA-125 is lowered, what does that mean?
Normally, human blood should not contain more than 35 U/l CA-25. this means that if it is completely absent, then this is completely normal and indicates your complete health. If the level of CA-125 in the blood begins to decrease after treatment, this indicates its success and makes the prognosis very favorable.
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