What labs should be ordered for a patient with a history of ovarian cancer presenting with night sweats, dysuria, chronic pelvic pain, left axilla pain, and left breast pain?

Laboratory Workup for Patient with History of Ovarian Cancer and Current Symptoms

For a patient with a history of ovarian cancer presenting with night sweats, dysuria, chronic pelvic pain, left axilla pain, and left breast pain, serum CA-125 testing should be ordered as the primary tumor marker, along with a complete urinalysis, CBC with differential, and comprehensive metabolic panel. 1, 2

Initial Laboratory Workup

Essential Tests:

• Serum CA-125: Primary tumor marker for ovarian cancer recurrence

  • Elevated in approximately 85% of patients with advanced ovarian cancer 1, 2
  • Should be compared to previous values if available
  • Rising CA-125 typically precedes clinical relapse by 2-6 months 2

• Complete Urinalysis and Urine Culture

  • Essential for evaluating dysuria symptoms
  • Rules out urinary tract infection as cause of pelvic pain and dysuria

• Complete Blood Count (CBC) with differential

  • Evaluates for anemia, infection, or other hematologic abnormalities
  • Important baseline for potential treatment decisions

• Comprehensive Metabolic Panel (CMP)

  • Assesses organ function and metabolic status
  • Provides baseline renal and hepatic function

Additional Tumor Markers:

• CEA and CA 19-9
  • Particularly if the original cancer was mucinous or endometrioid type 1
  • Should be ordered if CA-125 was not elevated in the original diagnosis 1
  • CA-125/CEA ratio <25:1 may suggest gastrointestinal origin 1, 2

Breast and Axillary Symptoms Evaluation

Given the left breast and axillary pain:

• Mammography and breast ultrasound should be ordered (though not laboratory tests)
• Consider breast cancer markers if imaging is suspicious:
  • CA 15-3 or CA 27.29
  • This is important as breast is one of the most common primary origins of secondary ovarian cancer 3

Interpretation Considerations

• CA-125 can be elevated in benign conditions including endometriosis, ovarian cysts, and other non-ovarian conditions 2
• A normal CA-125 does not exclude the presence of recurrent disease 1
• If CA-125 is rising from normal range to >25 U/mL, this may predict recurrent disease with high accuracy 4
• Changes of ≥50% in CA-125 levels compared to reference values can predict tumor response or progression in 95% of patients 4

Follow-up Testing

If initial tests suggest recurrence:

• CT scan of thorax, abdomen, and pelvis should be ordered 1
• Transvaginal and transabdominal ultrasound 1
• If both CT and ultrasound are negative but tumor markers are elevated, consider immuno-scintigraphy 1

Important Caveats

• Rising CA-125 alone in asymptomatic patients has not been shown to increase survival when used to initiate early treatment 2
• However, this patient is symptomatic, making tumor marker evaluation crucial
• Night sweats may indicate systemic disease and should prompt thorough evaluation
• Breast and axillary pain requires careful evaluation to rule out breast cancer or metastatic disease

Remember that approximately 75% of patients with advanced-stage ovarian cancer relapse within 2 years of initial treatment 5, making vigilant monitoring essential in a patient with these symptoms.