Jacobs, Ian Jeffery; (1991) Ca 125 in the physiology and pathology of the female reproductive tract: With particular reference to the diagnosis of ovarian cancer. Doctoral thesis (M.D), UCL (University College London).

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Abstract

This thesis addresses the hypothesis that "the CA 125 tumour associated antigen is of value in the diagnosis of ovarian cancer". The literature concerning CA 125 and diagnostic aspects of ovarian cancer are reviewed in chapter 1 and the research methodology and the characteristics of CA 125 assay systems are described in chapters 2 and 3. Chapters 4-6 describe studies of the compartmental distribution of CA 125 in the female reproductive tract in physiological and pathological states. The results suggest that CA 12 5 is a product of normal endometrium, pregnancy endometrium and benign ovarian tumours as well as malignant ovarian tumours, and that there is a physiological rise in serum CA 125 levels during menstruation and early pregnancy. It is concluded that the main factor influencing serum levels of CA 12 5 is the integrity of the blood: tissue barrier. Chapter 7 describes a prospective study to evaluate serum CA 125 measurement in the preoperative diagnosis of ovarian cancer. The results indicate that the accuracy of CA 125 measurement is superior to clinical criteria and similar to ultrasound. The highest diagnostic accuracy was achieved by combining CA 125, ultrasound and menopausal status in a risk of malignancy index. Chapter 8 describes phase 1 of a prospective study of screening for ovarian cancer amongst postmenopausal women. The results indicate that to achieve satisfactory specificity will require a multimodal approach combining CA 125 measurement with either pelvic examination or ultrasonography. Chapter 9 is a report of a phase 2 study of screening for ovarian cancer using the sequential combination of CA 125 and ultrasound. The preliminary results in 20,000 postmenopausal volunteers suggest that the lead time achieved over clinical presentation using this screening protocol is greater than 1 year. It is concluded that despite limitations of specificity and sensitivity, CA 125 is of value in the preoperative diagnosis of ovarian cancer and may have a role in a multimodal screening protocol for early stage disease.

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