Dilley, James;
Manchanda, Ranjit;
Johnson, Michelle;
Rosenthal, Adam N;
Gessler, Sue;
Menon, Usha;
(2016)
Importance of serial CM 25 measurements over an absolute cut-off value for the detection of asymptomatic ovarian cancer in high-risk patients.
International Journal Of Gynecology & Obstetrics
, 133
(2)
pp. 239-240.
10.1016/j.ijgo.2015.09.013.
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Abstract
A patient aged 45 years old presented to the authors’ familial gynecological cancer clinic. The patient's family history of cancer did not fulfil the high-risk criteria of the clinic or the national UK Familial Ovarian Cancer Screening Study. The patient had a history of diverticulitis. The patient had no living relatives affected by cancer and was not eligible for BRCA1/2 testing. Consequently, the patient was ineligible for risk-reducing salpingo-oophorectomy (RRSO) or for UK Familial Ovarian Cancer Screening Study screening every 4 months. Given the patient's family-history and wishes, annual CA125 and transvaginal ultrasound (TVUS) screening was scheduled. The patient's CA125 levels remained normal (≤ 30 U/mL) in 2008 (12 U/mL) and 2009 (24 U/mL), before increasing to 176 U/mL when recorded in July 2010 (Fig. 1). The patient's TVUS results remained normal throughout this period. In July 2010, the patient reported experiencing worsening constipation, bloating, urinary frequency, and left-sided pain during the preceding 7 months. Repeated CA125 screening recorded a CA125 level of 233 U/mL; TVUS demonstrated thickening of the left fallopian tube only and colonoscopy results were consistent with diverticular disease. A computed tomography scan, performed in August 2010, demonstrated widespread abdominopelvic peritoneal and omental disease. Omental biopsy confirmed a diagnosis of poorly differentiated serous carcinoma of ovarian/peritoneal origin. Following diagnosis, genetic testing demonstrated no BRCA1/2 gene mutations. A retrospective analysis of the patient's CA125 values using the risk of ovarian cancer algorithm [1] that has been used in screening trials, would have resulted in the patient being classified as at “high-intermediate” risk; this would have resulted in repeated CA125 screening and imaging within a 4–week period in July 2009, 12 months before diagnosis (Fig. 1).
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