Raised CA 125

This blog post covers important points about CA125 which are taken from a recently published TOG article in January 2021. CA125 has been used as a tumor marker for ovarian cancer but with some limitations. 

I hope this quick post is helpful. 

Feel free to leave your feedback in comments and suggestions to improve future posts are welcome.

Thanks

Introduction

• Leading cause of death from any gynae malignancy → Ovarian Cancer
• Over 70% present with late stage disease (Stage III or IV)
• Normal Level CA 125→ <35 IU/ml
• Level can increase in both physiological or pathological conditions
• CA125 expressed in tissues derived from embryonic coelomic epithelia which includes endometrium, mullerian epithelium, peritoneum, pleura & pericardium
• CA125 has role in cell-mediated immunity
• Antigen is not produced directly by tumour & not a tumour marker per se

CA125 & mechanical stress

• Highest levels of CA125 seen in ascites associated with ovarian cancer
• CA125 correlates positively with ascites volume
• Levels are much higher in ascitic fluid than blood levels which shows that antigen originates in ascitic fluid rather than tumour itself

Ovarian Cancer & CA125

Use in Diagnosis

• CA125 increased in epithelial ovarian cancers & less commonly in non-epithelial
• Used with TVS to calculate RMI which guides further management
• If RMI >250 iu/ml → Refer to Cancer Centre
• 50% with stage I & occult cancers have normal levels

Use in follow-up

• After surgical resection→ serum levels fall by half within 10 days

GTG 69 NVP & Hyperemesis Gravidarum

This is the summary of GTG -69 Hyperemesis Gravidarum released in 2016. This is one of a frequently tested guideline in the exam. Nausea and vomiting of pregnancy is one the most common indication for admission with typical stay of 3-4 days in the Hopsital. Hyperemesis Gravidarum is the severe form of NVP which can adversely affect the QoL and has a high recurrence in next pregnancy. 

I hope this post is helpful. Suggestions to improve future posts are welcome.

Thanks

To download the full GTG 69 Click Here

All GTGs links Click Here

Epidemiology

NVP symptoms of nausea ± vomiting during early pregnancy where no other causes 80%

HG severe form of NVP 0.3-3.6%

Recurrence 15%-80% 

• Reduced if change in paternity in second pregnancy 10.9%

Diagnosis of NVP & HG

NVP diagnosis  ONLY when onset in 1st trimester + other causes excluded 

• If after 10+6 wk→ consider other causes 
• Typically starts 4-7th wk Peaks 9th wk Resolves by 20 wk in 90%

HG diagnosis Protracted NVP with triad of >5% pre-pregnancy weight loss, dehydration & electrolyte imbalance

Severity NVP classify Objective & validated index of N & V PUQE Pregnancy Unique Quantification of Emesis

Initial clinical assessment & baseline investigations

• Features in history, examination & investigations to asses & diagnose NVP and HG for monitoring of the severity