Primary Care (NICE CG 122):
If serum CA125 is 35 IU/ml or greater, an ultrasound scan of
the abdomen and pelvis should be arranged. For any woman who
has normal serum CA125 (less than 35 IU/ml), or CA125 of 35
IU/ml or greater but a normal ultrasound then assess her
carefully for other clinical causes of her symptoms and
investigate if appropriate. If no other clinical cause is
apparent, advise her to return to her GP if her symptoms
become more frequent and/or persistent.
raised CA125 (usually < 100 kU/L) may be due to normal
physiology (e.g. pregnancy or menstruation) or a benign
process (e.g. endometriosis, benign ovarian cysts,
Ovarian cancer cannot however be excluded and guidelines
recommend ultrasound of abdomen and pelvis, particularly
in those with relevant symptoms.
concentrations of CA125 are more likely to be associated
with malignancy; 98% of post-menopausal and 49% of
pre-menopausal women with CA125 >70 kU/L have malignant
levels are >35 kU/L in 50% patients with stage I
ovarian carcinoma and in over 90% of patients with stage
II, III, or IV disease.
Note however that since
CA-125 may be normal in 50% of patients with stage 1
ovarian carcinoma, if suspicion is high despite a CA-125
<35kU/L, an ultrasound of the abdomen and pelvis is
is raised in liver disease, 70% of patients with cirrhosis
and 13% of patients with liver fibrosis have a raised
CA-125. Moderately raised CA125 (usually < 100 kU/L).