Introduction In the UK, a CA125 blood test is advised for anyone presenting to general practice with symptoms suggestive of ovarian cancer. If raised, they are referred for further investigation. Not all patients with a raised CA125 will have cancer. We have noticed a range of practice in our Trust and this likely relates to the lack of guidance on raised CA125 management in the absence of cancer, particularly in the pre-menopausal population.
Methods Retrospective review of all patients referred on the suspected cancer pathway to Chelsea and Westminster Hospital NHS Foundation Trust, UK between July 1st2022 and 31st December 2022, to identify management and outcomes.
Results 134/1895 patients were referred with a raised CA125. Only 5/19 ovarian cancer diagnoses in this time period were referred with a raised CA125. 4 patients had a diagnosis of non-ovarian cancers. Figure 1 shows the remaining causes. All patients who had a CA125 of over 3000 had cancer. No patient with a CA125 less than 60 had cancer. 81 patients were premenopausal. All patients underwent a pelvic ultrasound scan and amongst this group, management varied with only 40 removed from the suspected cancer pathway at first attendance. The remaining 40 underwent further investigation: Repeat CA125 (n=22), MRI (n=18).
Conclusion/Implications Lack of guidance for the management of raised CA125 reflects there being no level which is diagnostic of ovarian cancer. Raised CA125 may be physiological or due to benign conditions. Further research is needed to determine whether management pathways should differ depending on menopausal status or age.
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