From the Guidelines
Laparoscopic surgery is not recommended for ovarian cysts with elevated Cancer Antigen 125 (CA125) levels, as it may not provide adequate access for proper staging and treatment of potential malignancy. The decision to perform surgery on an ovarian cyst with elevated CA125 levels should be made with caution, considering the potential for malignancy. According to Greer et al. 1, patients with elevated CA 125 or imaging studies suggestive of malignancy have indications for referral to a qualified surgeon, and laparoscopic management of potentially malignant masses is not recommended.
Key Considerations
- Elevated CA125 levels can indicate malignancy, but can also be elevated in benign conditions such as endometriosis, pelvic inflammatory disease, and during menstruation.
- A thorough preoperative workup, including transvaginal ultrasound and possibly CT or MRI, is necessary to characterize the cyst and assess the risk of malignancy.
- Surgical laparotomy should be performed through a midline or para-median abdominal incision to allow adequate access to the upper abdomen, as recommended by Greer et al. 1.
- The ovarian tumor should be removed intact and a frozen section obtained to guide the extent of the procedure.
Recommendations
- Patients with ovarian cysts and elevated CA125 levels should undergo full evaluation and appropriate surgery by a qualified surgeon.
- Gynecologic oncology consultation prior to surgery is advisable when CA-125 is significantly elevated or when imaging shows complex features concerning for malignancy.
- The patient should be counseled about the possibility of finding cancer and potentially needing more extensive surgery.
From the Research
Laparoscopic Surgery for Ovarian Cyst with Elevated CA125
- Laparoscopic surgery can be considered for ovarian cysts, but the decision to perform the surgery depends on various factors, including the size and type of the cyst, as well as the patient's overall health 2.
- Elevated CA125 levels do not necessarily indicate malignancy, as they can also be found in patients with benign ovarian tumors, particularly those with ascites 3, 4.
- In some cases, laparoscopic surgery may be performed to diagnose and treat ovarian cysts, even with elevated CA125 levels, as long as the patient is well-selected and the cyst is amenable to minimally invasive resection 5.
- The use of CA125 as a diagnostic tool should be interpreted with caution, as it can be elevated in both benign and malignant conditions, and other diagnostic tools, such as imaging and cytology, should also be considered 6.
- The management of ovarian cysts with elevated CA125 levels should be individualized, taking into account the patient's specific circumstances and the results of other diagnostic tests 2, 4.