What serum level should I check in a 69-year-old female (yo) with a history of epithelial ovarian cancer, now presenting for routine follow-up with a normal physical examination (PE)?

From the Guidelines

For a 69-year-old female with a history of epithelial ovarian cancer presenting for routine follow-up with a normal physical examination, you should check her serum CA-125 level. This recommendation is based on the most recent and highest quality study available, which suggests that CA-125 is the simplest tool to trigger imaging and is a better approach than regular routine imaging for diagnosis of recurrent ovarian cancer 1. The normal range for CA-125 is generally less than 35 U/mL, though individual baseline values may vary. Rising CA-125 levels, even within the normal range, can indicate disease recurrence before clinical symptoms or radiographic evidence appears.

Some key points to consider when monitoring CA-125 levels include:

• The test should be performed consistently, ideally using the same laboratory for comparison purposes
• CA-125 is particularly useful for monitoring epithelial ovarian cancer because approximately 80% of these cancers express this glycoprotein antigen, making it a sensitive marker for disease activity in most patients
• In addition to CA-125 monitoring, routine follow-up should include a thorough history, physical examination, and consideration of imaging studies based on the patient's risk of recurrence and time since completion of primary treatment
• Imaging studies, such as CT scans, should only be carried out if clinically indicated, based on symptoms, clinical examination, or a rising CA-125 level 1

It's also important to note that while CA-125 monitoring is a useful tool for detecting recurrence, it is not a guarantee of early detection, and patients should be educated on the signs and symptoms of recurrence and the importance of regular follow-up appointments 1. Additionally, the use of CA-125 monitoring should be discussed with patients, including the pros and cons, and individualized based on patient preferences and risk factors 1.

From the Research

Serum Level to Check

In a 69-year-old female with a history of epithelial ovarian cancer, now presenting for routine follow-up with a normal physical examination (PE), the following serum level should be checked:

• CA-125 level, as it is a commonly used tumor marker for epithelial ovarian cancer 2, 3, 4

Rationale

The CA-125 level is used to monitor for recurrence of ovarian cancer, as a rising level can indicate disease progression 2, 3. A study found that the nadir CA-125 level was an independent predictor of progression-free survival and overall survival in patients with epithelial ovarian cancer 3. However, it is essential to note that the use of CA-125 tests for routine surveillance in ovarian cancer has been debated, and some guidelines categorize CA-125 testing as optional 4.

Additional Considerations

Other factors to consider when monitoring a patient with a history of epithelial ovarian cancer include:

• Histological subtype of the cancer, as different subtypes have unique genomic characteristics and may require different treatment approaches 5, 6
• Genetic testing for gene mutations that affect treatment, such as BRCA1 and BRCA2 mutations 5, 6
• The patient's quality of life and symptom control, particularly in the case of recurrence 5, 6