Does high CA-125 confirm that I have cancer?

Question

Hello doctor,

I have a history of inflammatory myofibroblastic tumor detected at the age of 11 years, which was around 12 years back and had undergone an operation for the same. Currently, my CA-125 in serum is 125.37 U/ml. The ultrasound scan revealed large multiloculated well-defined bilateral adnexal lesions with enhancing solid component. Lesions measured about 3.93 x 3.5 x 3.97 inches on the right side and 1.96 x 1.57 x 2.04 inches on the left. There was thick enhancing septae noted within the lesion. Bilateral cystic lesions abutting the iliac vessels and the ureters noted. However, there is no direct evidence of any invasion. The right ureter is displaced posteromedially by a right adnexal lesion and left ureter is displaced posteriorly by the left adnexal lesion. The CT scan revealed bilateral multiloculated well-defined adnexal complex cyst with thick enhancing septae likely of an ovarian neoplasm. There was bilateral hydroureteronephrosis, likely due to the pressure effect by the adnexal cysts with no obvious infiltration of the ureteric wall. What shall I do at this moment? Is it an ovarian tumor or a relapse of inflammatory myofibroblastic tumor? As CA-125 is very high, does it confirm that I have a cancer? Some doctors told me to operate the tumors and if after the operation malignancy is confirmed, and then they would take necessary steps. Should I take any additional precautions or test before the operation? I need your suggestion for a treatment plan and also about open cystectomy or Wertheim's operation. Also I wanted to know, whether my CA-125 will decrease after the removal of ovaries and uterus. I have attached the necessary documents for your reference. Currently, I am taking Megestone and Ferium XT daily.

Answer 1

Hi,

Welcome to icliniq.com.

Based on your reports, there seem to be ovarian tumors on both sides. The type of tumor, either benign or malignant, can be revealed only after removal. It may be unrelated to your previous tumor. The value of CA-125 though raised does not indicate malignancy. It is marginally elevated and it is highly unlikely that you will have epithelial cancer of the ovaries at this age, for which it is an ideal marker. A Wertheim's hysterectomy is done for cervix cancer and you would not require it. For your age, if possible fertility preserving surgery is ideal. The best line of management would be to get a CT scan or an MRI to clearly define the type of ovarian tumor as there are suspicions of dermoid and chocolate cysts. After that, a fertility preserving surgery in the form of ovarian cystectomy preserving the ovary can be planned at least on one side. It is very likely that your cysts turn out benign. Kindly get evaluated and operated with a surgical oncologist as the management should be proper especially if you require a staging procedure in case the cyst is malignant.

Answer 2

Hi,

Welcome back to icliniq.com.

I can see that your doctors are gynecologists (attachment removed to protect patient identity). My suggestion is to meet a surgical oncologist as the option of fertility preserving surgery can be discussed if feasible, especially if they are non-malignant or cancerous. So, kindly search for one at your place.