Ask Endochick: High CA-125 & Endometriosis

I’m way behind on these, so please be patient as I catch up on “Ask Endochick” posts. As always, if you have something to contribute, leave a comment! You never know who you may help. 

Brooke writes: 

Does the CA-125 test check for endo? My friend said I can do that and not the surgery. I searched and see it also tests for cancer and endo?!?  Will my doctor know which I have?

 

You are not the only one confused. While popular, the belief that the CA-125 blood test is a one-stop shop diagnostic tool (or a way to tell if you have a particular disease) for endometriosis is false. Although, women think a blood draw will give them a definitive “yes” or “no.” 

Above all, CA-125 measures an inflammatory protein called glycoprotein. Cancer causes inflammation, so does endometriosis. Because the blood test measures all available tumor marker in your blood, it can’t tell endometriosis from cancer cells. Unless the marker counter is really high, in which case you’ll most likely be sent to a gynecological oncologist, you’ll be faced with treating symptoms or confirming with surgery. 

A high CA-125 value can indicate you have endometriosis, assuming you’re having symptoms that suggest the disease, like pelvic pain, dysmenorrhea (painful periods) and/or menorrhaghia (heavy bleeding).  And know a low result doesn’t put you in the clear, especially if you’re symptomatic. In the end, you and your doctor may decide a laparoscopy is the appropriate , plan of care.

Going through with the blood test is a personal decision. However, your insurance company may require it as part of the “exhaust all non-surgical intervention” phases before they will approve a diagnostic laparoscopy. 

 

 

 

 You 

 

Endometriosis = Cancer?

The big question a woman may ask her gynecologist after being diagnosed with endometriosis is, “will this turn into cancer?” And if your doctor is like mine, he/she will give a reassuring “no” and smile.

Yet researchers have been saying since 2003 that women who have ovarian endometriosis, as seen in the picture below, and do not get it treated via laparoscopy or with hormone therapy to starve off the tissue, have an increased risk of having their endometriosis turn into cancer.

As you can see, there are chocolate cysts on the ovary and other signs of endometriosis.

 The researchers at Tottori University School of Medicine in Nishimachi, Japan presented a case of a 23 year-old woman who underwent surgery for an endometrioma in their October 15, 2003,  submission to Gynecological Oncology. At time of surgery she also present with a high serum CA 125 level. Now, it isn’t uncommon for endometriosis patients to have high CA 125 levels, especially with endometriomas. Perhaps, this is cause of the correlation? Then 14 months later, the same patient presents with ovarian cancer. The article states: “Histological examination revealed endometrioid adenocarcinoma with transitions between endometriosis and adenocarcinoma.” The researchers conclude that patients presenting with endometrial cysts  and high CA 125 serum levels should be watched – even if they are young.

** Reason #(who keeps count anymore) why I’m switching gyno’s: I had a “suspicious” cyst that persisted for over a year. Even though it never grew, it was thick walled. It concerned my doctor enough that she was willing to take the ovary, yet she never once did a CA 125 test. I plan on printing the article I will be linking to in a moment out and taking it to my next gyno – especially since I’ve been in “I have a cyst on that darn left ovary AGAIN!!!” grief” since Thursday.**

You can find the article here: Ovarian endometrioid adenocarcinoma arising from endometriosis in a young woman

And from the abstract of the article “GSTM1 null polymorphism and susceptibility to endometriosis and ovarian cancer” as published in the January 2001 Oxford Press journal, Carcinogenesis, researchers S.W. Baxter, E.J. Thomas and I.G. Campbell write:

It is likely that heritable genetic factors contribute to thedevelopment of endometriosis, which is a putative precursorof the endometrioid and clear cell histological subtypes ofovarian cancer. The phase II glutathione S-transferases (GSTs)are a family of enzymes responsible for metabolism of a broadrange of xenobiotics and carcinogens. Allelic variants of GSTsthat have impaired detoxification function may increase therate of genetic damage and thereby increase the susceptibilityto cancer. The null genetic polymorphism in the gene encodingthe GST class µ (GSTM1) enzyme has been reported to besignificantly elevated in endometriosis patients and may representan endometriosis susceptibility allele. (Taken from the abstract) (GST stands for glutathione).

If you have a cyst that persists, is bothersome, grows, or just worries you – especially if you have known ovarian endometriosis – ask your doctor for an extensive work-up of ultrasound, with possible MRI, and a CA-125 cancer marker blood test. These test may save your life! If there is any doubt, a good doctor wouldn’t take risks, they would put you in for a lap to get a visual. ALWAYS follow your intuition even if your doctor says “don’t worry, it’s nothing.” It’s worth it to keep your sanity – your peace of mind… and possibly your life.

***MARCH BLOGGING MADNESS FOR ENDOMETRIOSIS AWARENESS***