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CA-125, cancer antigen-125, is a protein that is found at levels in most ovarian cancer
cells that are elevated compared to normal cells. CA-125 is produced on the surface of
cells and is released in the blood stream.

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The CA-125 test assesses the concentration of CA-125 in the blood. The test requires a
sample of the patient's blood to be drawn.

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The second generation test is less likely to fluctuate from day to day. The two tests are
not interchangeable. The second generation test results are slightly higher than the first
generation ones.

Both can be used serially as long as the test data in each series is from the same
generation test.

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Serial CA-125 testing is a series of CA-125 tests repeated over a period of time.
Performing several CA-125 test over a period of time allows evaluation of the rate that
CA-125 concentration increases.

The rate at which CA-125 levels increase is a more accurate method of detecting the
presence of ovarian cancer, than a single CA-125 test. An algorithm by SJ Skates
detected 83% of ovarian cancer cases and 99.7% of positive results were truly ovarian
cancer. This represents a dramatic improvement on the accuracy of a single CA-125 test.

When looking over serial test results check to make sure the test used in each case was
the same generation, same manufacturer, and same type of assay.



 

 


 

The CA-125 test only returns a true positive result for about 50% of Stage I ovarian
cancer patients. The CA-125 test is not an adequate early detection tool when used alone.

The CA-125 test has an 80% chance of returning true positive results from stage II, III,
and IV ovarian cancer patients. The other 20% of ovarian cancer patients do not show
any increase in CA-125 concentrations.

However several women's reproductive disorders can cause a false positive result.
Endometriosis, benign ovarian cysts, first trimester of pregnancy, and pelvic
inflammatory disease all produce higher levels of CA-125.
 70% of people with cirrhosis, 60% of people with pancreatic cancer, and 20%-25% of
people with other malignancies have elevated levels of CA-125.

A study of about 22,000 post menopausal women 45 years or older screened about
11,000 with the CA-125 test. 468 patients with elevated CA-125 levels were given an
ultrasonography test. Of those patients, 29 underwent surgical procedures. 6 had ovarian
cancers, 2 had adenocarcinoma of unknown origin, 14 had benign tumors, 4 had fibroids,
and 3 had no abnormalities.

CA-125 test has a lower specificity in premenopausal women than postmenopausal

women.

The CA-125 test is not recommended for use alone as an early detection method. The rate
of false positives is very high, and there has been no data concerning change in mortality.

The CA-125 test should not be used alone to detect ovarian cancer, but rather with
transvaginal sonography and rectovaginal pelvic examination for greater accuracy.

Combining detection methods lowers the number of false positive results.

The CA-125 test should be done serially for best accuracy.

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A CA-125 test result of greater than 35 U/ml is generally accepted as being elevated.

A true positive result is when the CA-125 test identifies a patient as having ovarian
cancer, and they do have ovarian cancer.

A false positive result is when the CA-125 test identifies a patient as having ovarian
cancer, and they do not have ovarian cancer.

A true negative result is when the CA-125 test identifies a patient as not having ovarian
cancer, and they do not have ovarian cancer.

A false negative result is when the CA-125 test identifies a patient as not having ovarian
cancer, and they do have ovarian cancer

Any result of the CA-125 test should be supplemented with transvaginal sonography,
rectovaginal pelvic examination, and serial CA-125 testing.

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Elevated CA-125 levels can be a false positive, benign tumor, ovarian cancer, or another
type of cancer.
 A false positive patient will most likely be identified by a physician as being cancer-free.
The possibility that normal ovaries are surgically removed due to a false positive result
does exist.

A study done in 1999 by IJ Jacobs screened about 10,000 postmenopausal women over
the age of 45 using the CA-125 test alone. Results of that study showed a false positive
rate of about 80%.

From total positive results; patients between the ages of 20-34 have a 17% chance, and
patients older than 34 have a 30% chance of having a benign tumor or pre-cancer
conditions.

Benign tumors, pre-cancer conditions, and stage I cancers will result in pelvic surgery
and removal of ovaries. This procedure will almost completely eliminate the risk of
ovarian cancer.

Stage II, III, and IV ovarian cancer patients undergo pelvic surgery and are placed on
Taxol and platinum based chemotherapy.

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Normal CA-125 levels can be a true negative, or a false negative result. Depending on
what risk factors exist for the patient, follow-up tests might need to be conducted.

All negative CA-125 results are verified using other diagnostic methods. The CA-125 test
is more accurate for later stage cancers, making it a poor early detection method.

   
   


 

Other tumor antigens do exist like OVXI, M-CSF, CA 15-3, and CA 19-9. Only OVXI
has shown to have diagnostic potential.

There is currently a tumor marker test that measures levels of plasma lysophosphatidic
acid (LPA) being developed.

A study using the LPA test showed increased levels from 9 of 10 stage I ovarian cancer
patients, and all 24 stage II, III, and IV patients.

There is also a correlation between BRCA1 and BRCA2 gene mutation and ovarian
cancer. Women with BRCA1 or BRCA2 mutations have a 23% chance of having ovarian
cancer by age 30, and a 63% chance by age 70.


 
  



 
 Further CA-125 tests for stage II, III, and IV ovarian cancer patients during
chemotherapy helps to determine the activity of the cancer, and the status of
chemotherapy on the cancer.

If serial CA-125 testing results double beyond normal parameters of the Skate algorithm,
then this suggests progression of the cancer.

Milroy disease

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Lymphedema is classified into primary and secondary forms. Secondary lymphedema occurs as
a result of obstruction of lymphatic flow by known mechanisms, ie, filariasis, silica, obstruction
by a proximal mass, postsurgical mechanisms (eg, mastectomy), and fibrosis secondary to
chronic infections.

Primary lymphedema is divided into 3 groups based on age of onset.1 Congenital lymphedema
that is present at birth and associated with an autosomal dominant familial history is called
Milroy disease.2 Lymphedema praecox (Meige disease) occurs after birth but before 35 years; the
age of onset is generally in adolescence.3 Lymphedema tarda occurs in individuals older than 35
years. Of patients with primary lymphedema, 10% have Milroy disease, 80% have lymphedema
praecox, and 10% have lymphedema tarda (manifesting in persons older than 35 y).