From the Guidelines
CA125 levels can falsely rise due to several non-cancerous conditions, including endometriosis, uterine fibroids, pelvic inflammatory disease, ovarian cysts, pregnancy, and menstruation, as well as non-gynecological conditions like liver disease, pancreatitis, and inflammatory conditions 1. These false elevations occur because CA125 is produced not only by certain cancer cells but also by normal tissues like the peritoneum, pleura, and various epithelial tissues when they become inflamed or irritated. Some of the key conditions that can cause a false rise in CA125 levels include:
- Benign gynecological conditions such as endometriosis, uterine fibroids, and ovarian cysts 2
- Pregnancy and menstruation, which can cause temporary increases in CA125 levels 1
- Non-gynecological conditions like liver disease (particularly cirrhosis), pancreatitis, peritonitis, pleural effusion, pericarditis, and various inflammatory conditions 1
- Certain lung diseases, heart failure, and autoimmune disorders like lupus or rheumatoid arthritis can also contribute to elevated CA125 levels 2 It is essential to consider these potential causes of false elevation when interpreting CA125 levels, as they can lead to unnecessary anxiety and interventions if used in isolation 2. The use of multimodal screening, including serum CA125 measurement and ultrasound imaging, may be more effective in detecting ovarian cancer, but it is not yet considered the gold standard for early detection 2.
From the Research
Causes of False CA125 Rise
- Benign gynecological conditions, such as pregnancy, pelvic inflammatory disease, tuberculosis, and cirrhosis of the liver, can cause a false rise in CA125 levels 3
- Benign ovarian cysts, tubo-ovarian abscess, endometriosis, hyperstimulation syndrome, ectopic pregnancy, and fibroids can also lead to elevated CA125 levels 3
- Other malignancies, benign ovarian disease, and benign gynecological conditions, particularly leiomyomas, can cause false positive results 4
- Uterine fibroids can increase peripheral CA125 levels, and removal of the uterus or administration of GnRH analogue therapy can decrease these levels 5
- Endometriosis, especially cystic ovarian endometriosis and deeply infiltrating endometriosis, can cause marked increases in CA125 levels 6
- Acute pelvic inflammatory disease can also lead to elevated CA125 levels, which may decrease during treatment 7
Specific Conditions Associated with False CA125 Rise
- Pregnancy: CA125 levels can be elevated during pregnancy 3
- Pelvic inflammatory disease: CA125 levels can be elevated in patients with PID, especially those with adnexal masses or severe adnexal inflammation 7
- Endometriosis: CA125 levels can be elevated in women with cystic ovarian endometriosis or deeply infiltrating endometriosis 6
- Uterine fibroids: CA125 levels can be elevated in women with uterine fibroids, especially those with large fibroids 5