From the Guidelines
Elevated Cancer Antigen 125 (CA 125) and normal Carcinoembryonic Antigen (CEA) levels in a male are not specific for any particular disease, but may indicate the presence of a non-gynaecological malignancy or a benign condition.
Key Points
- Elevated CA 125 levels are not specific to ovarian cancer and may be found in non-gynaecological malignancies (e.g. breast, lung, colon, and pancreatic cancer) and benign diseases (e.g. endometriosis, pelvic inflammatory disease, and ovarian cysts) 1.
- A normal CEA level does not rule out the presence of a malignancy, as CEA is not a specific marker for any particular type of cancer.
- The CA 125/CEA ratio may be useful in distinguishing between primary mucinous ovarian tumors and gastrointestinal metastasis, but this is not relevant in the context of a male patient 1.
- Further evaluation, including imaging studies and biopsy, is necessary to determine the cause of elevated CA 125 levels in a male patient.
Clinical Implications
- Elevated CA 125 levels in a male patient should prompt a thorough clinical evaluation to rule out non-gynaecological malignancies and benign conditions.
- A normal CEA level should not be used to rule out the presence of a malignancy, and further evaluation should be based on clinical suspicion and other diagnostic findings.
- The use of CA 125 and CEA levels in the diagnosis and management of cancer in male patients should be interpreted with caution, as these markers are not specific for any particular type of cancer 1.
From the Research
Significance of Elevated CA 125 and Normal CEA Levels in Males
- Elevated CA 125 levels can be associated with various conditions, including cirrhosis, as seen in a study where 85% of patients with cirrhosis had elevated CA 125 levels 2.
- The study also found that higher MELD scores were associated with higher CA 125 levels, and that CA 125 levels correlated with the degree of ascites and disease severity 2.
- In another study, CA 125 levels were found to be elevated in patients with non-small cell lung cancer, and were correlated with stage and histopathology 3.
- Normal CEA levels, on the other hand, may indicate a lower likelihood of certain types of cancer, such as adenocarcinoma, as seen in a study where CEA levels were significantly higher in patients with adenocarcinoma 3.
- It is essential to note that CA 125 and CEA are not specific to any particular type of cancer, and can be elevated in various benign and malignant conditions, as seen in a study where CA 125, CA 19-9, CA 15-3, and CEA levels were elevated in patients with end-stage liver disease who did not develop tumors after liver transplantation 4.
Possible Interpretations
- Elevated CA 125 levels in a male with normal CEA levels could indicate a non-cancerous condition, such as cirrhosis or another liver disease, as seen in a study where CA 125 levels were elevated in patients with cirrhosis 2.
- Alternatively, it could indicate a type of cancer that is not typically associated with elevated CEA levels, such as epithelial ovarian cancer, as seen in a study where CA 125 levels were elevated in patients with epithelial ovarian cancer 5.
- Further testing and evaluation would be necessary to determine the underlying cause of the elevated CA 125 levels and normal CEA levels.
Tumor Markers and Diagnostic Accuracy
- The sensitivity and specificity of CA 125 and CEA vary depending on the type of cancer and the population being studied, as seen in a study where the sensitivity and specificity of CA 125 and CEA were evaluated in patients with adnexal masses 6.
- Combining multiple tumor markers, such as CA 125 and CEA, may improve diagnostic accuracy, but the effectiveness of this approach depends on the specific context and population being studied, as seen in a study where the combination of CA 125 and CEA did not significantly improve diagnostic accuracy 6.