From the Guidelines
Blood work screening for ovarian cysts should include CA-125 levels, but it is essential to interpret these results with caution due to the potential for false positives and the fact that only about 50% of stage I ovarian cancer patients have true-positive results 1. When evaluating ovarian cysts, several blood tests can provide valuable information.
- A complete blood count (CBC) can help identify infection or anemia associated with certain types of cysts.
- Hormone tests, such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and testosterone, can help detect hormonal imbalances that may cause or result from ovarian cysts.
- CA-125, a tumor marker, may be ordered if there is concern about potential malignancy, although it is not specific for cancer and can be elevated in conditions like endometriosis, benign ovarian cysts, pregnancy, and pelvic inflammatory disease 1.
- Pregnancy tests (hCG) are crucial to rule out ectopic pregnancy, which can present similarly to ovarian cysts. These blood tests should be used in conjunction with imaging studies like ultrasound, which remains the primary diagnostic tool for visualizing ovarian cysts.
- The results of blood work should always be interpreted by a healthcare provider in the context of symptoms and imaging findings, considering that CA-125 levels have a high correlation with the clinical course of the patient during chemotherapy and can predict tumor recurrence in patients who are clinically tumor-free 1.
From the Research
Ovarian Cyst Blood Work Screen
- The use of CA-125 as a screening method for ovarian cancer is not recommended by any professional society for average-risk asymptomatic women 2.
- CA-125 has been used as a tumor marker for ovarian cancer, but its effectiveness in screening for the disease is limited 3.
- Serum CA-125 levels can be used to differentiate between benign and malignant ovarian cysts, with higher levels indicating a higher likelihood of malignancy 4, 5.
- A serum CA-125 level below 35 IU/ml is associated with a high likelihood of benign disease in postmenopausal women with ovarian cysts 5.
- The American College of Obstetricians and Gynecologists (ACOG) recommends conservative management of simple ovarian cysts in postmenopausal women, with follow-up including a CA-125 blood test and transvaginal ultrasonography (TVU) 6.
Diagnostic Criteria
- A CA-125 level below 35 IU/ml is associated with benign histopathology in postmenopausal women with ovarian cysts 5.
- A combination of serum CA-125 levels and cyst fluid parameters (such as E2, FSH, and CASA) can improve the sensitivity and specificity of predicting malignancy in ovarian cysts 4.
- TVU screening examination is considered positive when findings include ovarian volume greater than 10 cubic cm, cyst volume greater than ten cubic cm, any solid area or papillary projection, or any mixed (solid/cystic) component within a cystic ovarian tumor 6.