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The Adnexal Mass
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Connie D. Cao, Norman G. Rosenblum
Most tumor markers may be elevated in normal pregnancy and are generally not helpful in distinguishing between a benign or malignant ovarian mass in pregnancy. For example, up to 16% of pregnant patients may have an elevated CA-125 [21]. Levels of CA-125 peak in the first trimester (range, 7–251 units/mL) and decrease consistently thereafter. Low-level elevations in pregnancy are typically not associated with malignancy [22]. However, CA-125 levels from 1000 to 10,000 units/mL after 15 weeks of gestation are more likely to be cancer [9].
The Precision Medicine Approach in Oncology
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
Regarding selectivity, CA-125 has limited specificity for ovarian cancer because elevated CA-125 levels can be found in individuals without ovarian cancer. It may also be elevated in other cancers, including endometrial, fallopian tube, lung, breast, and gastrointestinal cancer. It may also be elevated in many relatively benign conditions such as endometriosis, several diseases of the ovary, menstruation, pregnancy, inflammatory conditions in the abdominal area (both cancerous and benign), cirrhosis, and diabetes mellitus. Thus, CA-125 testing is not specific for ovarian cancer and often results in false positives. The specificity of CA-125 is particularly low in premenopausal women because many benign conditions that cause fluctuations in CA-125 levels (e.g., menstruation, pregnancy, and pelvic inflammatory disease) are seen in this population.
Endometriosis
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Ceana Nezhat, Pavan Ananth, Dahlia Admon
A systematic review of the literature performed by Magalhães et al. identified 38 patients with endometriosis who presented with clinically significant ascites with no other known cause [34]. All were reproductive-age women. The ascites was acute in onset in eight patients, gradual in 24, and unreported in six. The most common description of the fluid was “hemorrhagic,” but some reports characterized it as yellow, clear yellow, brownish green, or loculated. Volume ranged from 4.2 to 7 L, when quantified, and 11 patients had associated pleural effusions. In the majority of cases that reported on CA-125, levels were elevated, ranging from 49 to >5000 U/mL. The most common primary clinical presentation was abdominal distension. Other signs and symptoms included abdominal pain or tenderness, palpable abdominal mass, shortness of breath, signs of hypovolemia, weight loss, nausea or vomiting, asthenia, malaise, and cachexia (loss of appetite) [34].
Endometriosis: What is the Influence of Immune Cells?
Published in Immunological Investigations, 2021
Paula Carolina Arvelos Crispim, Millena Prata Jammal, Eddie Fernando Candido Murta, Rosekeila Simões Nomelini
Diagnosing endometriosis is difficult because the signs and symptoms vary considerably, with reliable diagnostic biomarkers lacking in the clinical setting. Elevated levels of CA-125 biomarker are not specific, as they could also indicate the presence of various gynecological diseases, including endometriosis, ovarian cancer, or inflammation. In many patients, endometriosis is clinically suspected based on history and examination. It is empirically treated with hormone therapy (e.g., combined contraceptives or progestogen-only therapies), without surgery. Thus, the discovery of a reliable diagnostic biomarker would represent a major advance for the clinical diagnosis of endometriosis (Dawson et al. 2018). The study of some cytokines as predictors or discriminators of the disease is promising (Othman et al. 2008), since there is an inflammatory immune reaction in the peritoneal cavity due to endometriosis.
Diagnostic work-up in paediatric and adolescent patients with adnexal masses: an evidence-based approach
Published in Journal of Obstetrics and Gynaecology, 2021
Milan Terzic, Agnese Maria Chiara Rapisarda, Luigi Della Corte, Rahul Manchanda, Gulzhanat Aimagambetova, Melanie Norton, Simone Garzon, Gaetano Riemma, Cara Robinson King, Benito Chiofalo, Antonio Cianci
CA125, a membrane glycoprotein antigen commonly expressed in Müllerian and coelomic epithelial tissue derivatives, is the primary tumour marker of ovarian cancer, and the most commonly used gynecological tumour marker for evaluation of ovarian masses, also known as MUC16 (Su et al. 2013). A serum concentration of CA 125 > 35 U/ml may be indicative of potential malignancies. CA 125 levels are elevated in 50% of patients with an adnexal mass, and 90% of patients with advanced ovarian cancer (Su et al. 2013). CA 125 has a sensitivity of 61–90%, a specificity of 71–93%, a positive predictive value (PPV) of 35–91%, and a negative predictive value (NPV) of 67–90% when used to distinguish between a benign and malignant mass (Van Calster et al. 2007). CA 125 levels are typically associated with epithelial ovarian malignancy but have also been found to be elevated in some malignant yolk sac tumours and immature teratomas (Lahdenne et al. 1995). CA 125 has a lower sensitivity and specificity for the detection of epithelial malignancies in premenarchal compared to adults (Stankovic, Djuricic, et al. 2006). Moreover, in adolescents, CA 125 levels may fluctuate with frequent elevation during the menstrual cycle and secondary to benign pathologies, such as endometriosis (Laganà, Vitale, et al. 2017; Vitale, Capriglione, et al. 2018).
Clinical significance of combining salivary mRNAs and carcinoembryonic antigen for ovarian cancer detection
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2021
Jinfang Yang, Cuiping Xiang, Jianmeng Liu
Ovarian cancer is the deadliest gynecological disease, and contributes to approximately 184,799 female deaths in the world in 2018 [1,2]. The primary reason for such high mortality is that ovarian cancer is asymptomatic in the early stage. As a result, 60% of the ovarian cancer cases are diagnosed when the malignancies have spread to distant organs, and the 5-year survival rate is only 29% in the late stage1. Traditional tests for ovarian cancer detection include transvaginal ultrasound and computed tomography scans [3], which, however, are not efficient in lowering death rates caused by ovarian cancer. In addition, CA-125 is a common serum biomarker for advanced ovarian cancer (specificity >80%) [4], but its sensitivity is not high enough for early detection of ovarian cancer [5].