The first reaction of a gynecologist when seeing an abnormally elevated CA125 on a laboratory test is nothing more than: ovarian cancer? For the more experienced, endometriosis and ovarian chocolate cysts (a special type of endometriosis) may also be considered. In the eyes of an oncologist, it may basically be considered: Cancer! What other conditions may have abnormal elevation of CA125? I have checked the information and found that there are quite a number of conditions that can cause CA125 to rise: ovarian cancer, endometriosis, lung cancer, adenomyosis, lung cancer ……, and it is also found in heart failure and pre-term abortion. Let’s “pick apart” the true face of CA125!
1, endometriosis Many clinical studies at home and abroad have shown that the level of CA125 in the peritoneal fluid and serum of patients with endometriosis is significantly higher than that of the healthy population, and is positively correlated with the severity of the disease. This may be related to the fact that endometrial cells reach the peritoneal cavity with the refluxed menstrual blood, stimulating biochemical interstitial changes in the peritoneal corpora mesothelial cells and producing more CAl25 antigen. However, the elevation of serum CA125 in patients with endometriosis is rarely higher than 200 U/ml. If it is higher than 200 U/ml, the possibility of ovarian cancer or ruptured ovarian-type endometriotic cyst should be considered.
2. Adenomyosis As a special type of endometriosis, adenomyosis is more difficult to diagnose than the general type of endometriosis because the endometrium penetrates deep into the muscle layer. Compared to the general type of endometriosis, its serum CA125 level is higher than that of the peritoneal fluid because its pure ectopic lesions are not exposed to the pelvic organs, and this can be distinguished from other types of endometriosis. Secreted by intermuscular ectopic endometrium, ectopic endometrium has a strong function of secreting CA125, which is usually 2 to 4 times higher than that secreted by normal endometrium.
3.Endometrial cancer Many epidemiological studies at home and abroad have shown that CA125 is abnormally elevated in the serum of patients with endometrial cancer, and the higher the stage and grade of the tumor, the larger the extent of the lesion and the deeper the myometrial infiltration, the higher the serum CA125 level. This may be due to the fact that the larger the tumor lesion, the higher the pathological grade, the deeper the muscle infiltration, the cervical involvement, the adnexal metastasis, the active division and growth of tumor cells, the wide range of tumor dissemination, and the metastasis of tumor cells to ovaries, fallopian tubes and other tissues, thus leading to the increase of CA125 secretion and more CA125 entering the body circulation. Dynamic monitoring of serum CA125 level of endometrial cancer patients can help to understand the disease and guide the treatment.
4.Cervical cancer Research shows that the serum CA125 levels of cervical cancer patients with different FIGO stages differ significantly, and the higher the stage, the higher the CA125 value, which is considered to be related to advanced cervical cancer patients with lesions invading the ovaries and stimulating abnormal CA125 secretion.
5. Pre-eclampsia In December 2015, an evidence-based study titled “CA125 is a better predictor of the outcome of pre-eclampsia than HCG and progesterone” was published in Human Reproduction Update, a top international journal of obstetrics and gynecology. The study, a meta-analysis of all articles published to date on CA125 as a predictor of preterm miscarriage, showed that serum CA125 levels in women with preterm miscarriage were highly predictive of continued pregnancy, whereas serum hCG and progesterone, the most commonly used predictors of fetal survival outcomes, appeared to be suboptimal. This is related to the abnormal elevation of serum CA125 due to maternal meconium cell destruction and separation of trophoblast cells from meconium cells during preterm abortion, which allows CA125 from fetal chorion, amniotic fluid and maternal meconium to enter the bloodstream.
6, ectopic pregnancy The lesions of ectopic pregnancy patients can stimulate the destruction of meconium cells and the stimulation of peritoneal epithelial cells, which leads to the increase of CA125 secretion level in corresponding tissues. The combined application of CA125, blood β-HCG and progesterone is often used clinically to increase the accuracy of the diagnosis of ectopic pregnancy.
CA125 in maternal serum during pregnancy mainly comes from meconium tissue. When placenta abrupts, the bottom meconium bleeds and meconium cells are destroyed, CA125 is released and enters maternal blood circulation, thus increasing maternal serum CA125 level, the larger the area of placenta abrupts, the more CA125 is released in it, so CA125 is a sign of damaged meconium placenta.
8.Breast cancer Many studies have shown that the serum CA125 level of breast cancer patients after radical surgery is significantly lower than that before surgery, and the CA125 level is statistically correlated with the pathological histological results, so CA125, CA199 and CEA are often used together as the serological evaluation index for the treatment effect of breast cancer patients.
9.Lung cancer Many studies at home and abroad have shown that abnormally elevated serum CA125 levels are associated with TNM stage of lung cancer and whether it is accompanied by pleural fluid. Dynamic monitoring of CA125 in serum and pleural fluid is helpful for the diagnosis of non-small cell lung cancer of different stages. Clinical monitoring of CA125 is often used as a reference indicator for clinical efficacy observation and prognosis judgment.
10.Tuberculous pleurisy In tuberculous pleurisy, the pleural mesothelial cells are stimulated and the CA125 gene is activated, resulting in the release of a large amount of CA125 into the pleural fluid and its reabsorption into the blood circulation through the pleura, resulting in an increase in blood CA125 in patients with tuberculous pleurisy. There are also many clinical studies in China that confirm the conclusion that CA125 is abnormally elevated in the serum of patients with tuberculous pleurisy.
11, chronic obstructive pulmonary disease (COPD) Recent studies have shown that CA125 is distributed in the cupped epithelial cells and submucosal mucus cells of the airway, which are the main components of the airway mucus barrier and can effectively adsorb various pathogens and irritants from the airway. In the development of COPD, chronic inflammatory responses accumulate extensively in the airways, and inflammatory cells are activated, stimulating an increase in inflammatory factors such as IL-6, IL-10, inducing the release of extracellular matrix, which may stimulate mesothelial cells, leading to the production and continuous release of CA125. Clinical studies have shown that as the severity level of COPD increases, the increase in CA125 concentration is statistically significant.
12. Silicosis Domestic scholars have done studies comparing CA125 levels in the serum of patients with silicosis and healthy individuals. It was found that serum CA125 levels were significantly higher in patients with silicosis than in healthy subjects, indicating that CA125 has a greater correlation with the development of silicosis and may be a serological indicator for the early diagnosis of silicosis. And in patients with silicosis in stages I, II and III, serum CA125 levels gradually increased with disease progression.
13, chronic pulmonary heart disease Some studies have shown that with the deterioration of cardiac function, the level of abnormally elevated blood CA125 in patients with chronic pulmonary heart disease also gradually doubles. The main cause of elevated serum CA125 in patients with pulmonary heart disease may be the secretion of CA125 by pleural mesothelial cells in chronic pulmonary heart disease. plasma IL-6 promotes the proliferation of CA125-secreting cells so that their levels increase in cardiac insufficiency. In chronic pulmonary heart disease, the plasma membrane surface exudates and accumulates fluid, resulting in elevated IL-6, which causes elevated serum CA125.
In myocardial infarction, the myocardial remodeling process after ischemic necrosis and apoptosis of myocardial cells can increase ventricular wall tension and is accompanied by the expression of certain cytokines such as IL-1, IL-6, and TNFα, which can stimulate mesothelial cells to secrete CA125. This is consistent with the fact that larger myocardial infarcts result in lower LVEF and E/A, producing higher ventricular wall tension and overexpression of the above cytokines, which stimulate higher levels of CA125 production by mesothelial cells. 15. Heart Failure As early as 1999, it was found that in patients with chronic heart failure In 1999, serum CA125 was found to be elevated in patients with chronic heart failure and correlated with the severity of symptoms. In the past 10 years, the research on CA125 and heart failure has been very hot. The elevated serum CA125 concentrations in heart failure patients may be due to stimulation of the pericardial pleura or other mesothelial cells, and there are statistically significant differences in the expression levels of CA125 in different types and degrees of heart disease, and it is believed that CA125 will soon become an official serologic marker.
That’s it for today’s study on some diseases that lead to elevated CA125, for the rest of the content, then tomorrow at the same time, we will unveil the rest of the mystery of elevated CA125 for you, don’t miss it!