From the Guidelines
Yes, liver metastasis can present with elevated Cancer Antigen 125 (CA-125) levels while maintaining normal Liver Function Tests (LFTs). This occurs because CA-125 is primarily a marker for ovarian cancer but can be elevated in various malignancies that metastasize to the liver, including ovarian, pancreatic, breast, and colorectal cancers 1. Early liver metastases may not disrupt hepatic function enough to affect LFTs, as the liver has substantial functional reserve, requiring approximately 70% of liver tissue to be compromised before LFTs become abnormal. The metastatic tumor burden may be sufficient to release CA-125 into circulation while being too small to impair overall liver function.
Some key points to consider in this scenario include:
- The type and stage of the primary tumor can influence the likelihood of liver metastasis, directing the use of imaging tests 1
- Breast, lung, colorectal, gastric, and pancreaticobiliary malignancies are common carcinomas that can develop liver metastasis 1
- Comprehensive diagnostic approaches, including imaging studies such as contrast-enhanced CT, MRI, or PET scans, are crucial for evaluating potential liver metastases, even when LFTs appear normal
In patients with elevated CA-125 and normal LFTs, further imaging studies are recommended to evaluate for potential liver metastases, highlighting the importance of a comprehensive diagnostic approach in cancer surveillance. This is particularly relevant in early metastatic disease when tumors are small and localized to certain segments of the liver.
From the Research
Liver Metastasis and Elevated Ca 125
- Liver metastasis can present with elevated Cancer Antigen 125 (Ca 125) levels, as seen in studies 2, 3, 4.
- Elevated Ca 125 levels are not exclusive to ovarian cancer and can be found in patients with liver metastases from colorectal cancer 2, 3, 4.
- The predictive value of serum Ca 125 in diagnosing liver metastases from colorectal cancer has been evaluated, and it was found to be an independent prognostic predictor 2.
Normal Liver Function Tests (LFTs)
- Normal LFTs do not rule out the possibility of liver metastasis, as liver function can be preserved even in the presence of metastases 4.
- Elevated Ca 125 levels can be seen in patients with liver metastases, even with normal LFTs, as shown in a case report 3.
- The combination of Ca 125 with other tumor markers, such as CEA and CA19-9, can enhance the sensitivity of diagnosis of liver metastases 2, 4.
Correlation with Disease Severity
- Elevated Ca 125 levels have been correlated with disease severity in cirrhosis, including the degree of ascites and portal hypertension 5.
- However, the correlation between Ca 125 levels and liver metastasis is not fully understood and requires further study 2, 3, 4.
- The use of Ca 125 as a tumor marker in the management of colorectal carcinoma metastatic to the liver has been suggested, particularly in patients with normal CEA levels 3.