Can metastatic cancer or cancer from lymph nodes presenting on the ovary increase the Cancer Antigen 125 (CA125) level in postmenopausal women?

CA-125 Elevation in Postmenopausal Women with Metastatic Cancer to the Ovaries

Yes, metastatic cancer or cancer from lymph nodes that present on the ovary can raise the CA-125 level in postmenopausal women. This is an important clinical consideration when evaluating adnexal masses in patients with a history of other malignancies.

CA-125 Elevation Patterns in Metastatic Disease to Ovaries

• CA-125 is a tumor marker that can be elevated in various conditions, including both primary ovarian cancer and metastatic disease to the ovaries 1
• Research shows that higher CA-125 serum levels can be found in patients with metastatic adnexal masses compared to primary ovarian cancer 2
• In women with a history of breast cancer who develop adnexal masses, metastatic disease to the ovaries was observed in more than 50% of cases, and these cases demonstrated elevated CA-125 levels 2

Metastatic Disease Types Associated with CA-125 Elevation

• Metastatic colorectal adenocarcinoma to the ovary can cause elevated serum CA-125 levels in at least 32.6% of cases 3
• The elevation can be substantial, with reported CA-125 ranges of 39.0-556.3 U/mL (median 143.0, mean 199.1) in patients with metastatic colorectal cancer to the ovary 3
• Lymph node metastases presenting in the ovary can lead to elevated CA-125, particularly when associated with peritoneal inflammation or ascites 4

Interpreting CA-125 in Postmenopausal Women

• CA-125 has higher specificity in postmenopausal women (98.5%) compared to premenopausal women (94.5%) 4
• The upper limit of normal CA-125 for postmenopausal women without vaginal bleeding should be considered 20 U/mL, while for those with vaginal bleeding, it should be 35 U/mL 5
• Progressive elevation of CA-125 over time is more concerning for malignancy than a single elevated value 4, 1

Diagnostic Considerations

• When evaluating a postmenopausal woman with an adnexal mass and elevated CA-125:

  • Consider both primary ovarian cancer and metastatic disease in the differential diagnosis 3
  • Evaluate for other primary malignancies, even in the absence of a known history of cancer 3
  • Recognize that metastatic disease can mimic primary ovarian tumors both grossly and histologically 3

• Additional diagnostic steps when metastatic disease is suspected:

  • Consider measuring serum CEA and CA 19-9 in addition to CA-125 to help distinguish primary ovarian tumors from gastrointestinal metastases 1
  • Perform imaging studies including transvaginal ultrasound and CT scan of the abdomen and pelvis 4
  • Consider referral to a gynecologic oncologist for evaluation 1

Clinical Implications

• Postmenopausal women with elevated CA-125 have a significantly increased risk of death from all causes in the next 5 years 6
• Factors that can influence CA-125 levels in postmenopausal women include race, prior hysterectomy, smoking, caffeine consumption, and history of non-ovarian cancer 7
• CA-125 can be used to monitor response to therapy and detect recurrence in patients with known malignancy 1

Remember that while CA-125 elevation is common with metastatic disease to the ovaries in postmenopausal women, the pattern of elevation, clinical context, and additional diagnostic studies are crucial for accurate diagnosis and appropriate management.