Oncology and Fibroids
A 35 yr old woman presents with primary infertility & palpable pelvic mass. Her CA-125 level is 90 U/ml. diagnosis is (AIIMS May 2011)
|D||Borderline ovarian tumor|
1. In ovarian tumor Ca 125 is elevated but it is in very high range (800-1000+ IU/ML).
2. In endometriosis it is mildly elevated, & besides the patient has infertility & a pelvic mass , all these go infavor of a endometrioma.
3. CA 125 is best a marker for ovarian cancer, but it may also be elevated in other cancers, including those originating in the endometrium, fallopian tubes, lungs, breast and gastrointestinal tract.CA-125 may also be elevated in a number of relatively benign conditions, such as endometriosis, several diseases of the ovary, and pregnancy. It also tends to be elevated in the presence of any inflammatory condition in the abdominal area, both cancerous and benign.
4. Thus, CA-125 is not perfectly specific for cancer nor is it perfectly sensitive since not every patient with cancer will have elevated levels of CA-125 in the blood.
5. While this test is not generally regarded as useful for large scale screening by the medical community, a high value may be an indication that the woman should receive further diagnostic screening or treatment. Normal values range from 0 to 35 (U/mL).
6. Elevated levels in post-menopausal women are usually an indication that further screening is necessary. In pre-menopausal women, the test is less reliable as values are often elevated due to a number of non-cancerous causes, and a value above 35 is not necessarily a cause for concern.
7. An endometrioma, (endometrioid cyst, endometrial cyst, or chocolate cyst) is caused by endometriosis, and formed when a tiny patch of endometrial tissue bleeds, sloughs off, becomes transplanted, and grows and enlarges inside the ovaries.
8. It is an estrogen-dependent disease and, thus, usually affects reproductive-aged women. Endometriosis has a prevalence rate of 20-50% in infertile womenand as high as 80% in women with chronic pelvic pain.
9. Transvaginal sonography is a useful method of identifying the classic chocolate cyst of the ovary. The typical appearance is that of a cyst containing low-level homogenous internal echoes consistent with old blood.