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CA 125 and ovary - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Excellent Posted in: Women's Health
Answered by

General & Family Physician
Practicing since : 2004
Answered : 37 Questions
Doctor :   Hi
User :   hello
Doctor :  
How can i help you?
User :   i would like to ask about the tumor marker CA 125
Doctor :  
ok
User :   i am undergone post subtotal hysterectomy 4 years ago
User :   and left salpingo-oophorectomy 2 years ago
Doctor :   ok

User :   i just turned 27 years old yesterday
User :   getting a CA 125 what would be the reference range value for my case
Doctor :  
ca 125 is present in the normal individuals and the levels will be below 35U/ml
Doctor :  
it is a glycoprotein present in the normal uterus tissue in less amount
User :   correct me if im wrong
User :   even if you had your uterus and 1 ovary taken out from you the refence range will be the same
Doctor :   yes the range of 0 to 35u/ml will remain the same

User :   in a whole abdominal ultrasound and tranvaginal, having seen a prominent right ovary what does it mean and is it related to ovarian cancer or might be sign of getting one?
Doctor :   in the ultrasound if the ovary is enlarged than it is seen as prominent ovary
Doctor :  
the enlargement may be simple cyst
Doctor :  
or may be a solid mass of inflammation or even a malignancy
User :   having seen a prominent ovary will these elevate your CA 125?
Doctor :   CA 125 levels will be elevated in many conditions like in pregnancy the first three months also it will be elevated
Doctor :  
coming to enlarged ovary and elevated Ca 125
User :   how about having moderate hydronephrosis of the kidney will these elevate it also?
Doctor :  
it can be in two conditions one is inflammation of the ovary
Doctor :  
and the other time it ovarian tumor
Doctor :  
no hydronephrosis will not elevate the Ca125 levels
User :   ok the doctor from the MRI who was doing a MRI for my spine told me after wards that if i was diagnose with kidney disease and that she saw a solid mass in my remaining ovary
Doctor :  
ok
User :   so to make sure a went to get a whole abdominal ultrasoung and the result was i have moderate hydronephrosis and prominent right ovary
Doctor :   ok

User :   we have a family history of breast cancer
Doctor :  
ok
User :   my legs are both numb and very sensitive with cold water
Doctor :  
ok
User :   MRI shows that i have slipped disc L3-4, L4-5, L5-S1 and S1 root nerve compression
Doctor :   ok

User :   would this may be ovarian cancer? the MRI doctor adviced me to go and see an oncologist
Doctor :   i would like to know why was hysterectomy's and removal of one ovary was done ?
User :   the hysterectomy was a misdiagnosis that led to malpractice
User :   and after 2 years the left ovary twisted and rupture
Doctor :   ok
User :   i have here the histopathology report of the ovary
Doctor :  
yes please
User :   for a while
Doctor :  
sure
User :   do i need to type all or just the diagnosis?
Doctor :  
just tell me the impression / diagnosis
User :   left ovary: serous cyst with hemorrhage and focal areas of infarction Left fallopian tube: congestion
Doctor :  
this is a simple cyst of the ovary which is congested due to torsion warranting removal
Doctor :   regarding your question of whether you are suffering from right ovarian malignancy's or not?
User :   yes please tell me truthfully
Doctor :  
the mass in the ovary was found in the MRI scan incidentally MRI scan was done for the assessment of the spine
User :   yes
Doctor :   the mass may be simple enlargement or malignant also
Doctor :  
the fact you have breast cancer in your family
Doctor :  
does put you in the high risk category for the ovary and breast cancer
User :   and speaking of the breast
User :   i think 2 months ago my breast out of nowhere became very itchy and after the itch it felt super heavy and very painful then i my husband and i tried to to the the breast exam there was one lump that is hard up to the bottom
Doctor :  
ok
User :   and up to this very moment its still there but only painfully when being pressed
Doctor :   where was the lump can you say like if the breast is divided into 4 quadrants upper outer and inner quadrant and lower outer and inner quadrant, where is the lump present

User :   right upper quadrant
Doctor :   is it increasing in size or is it same or is it decreasing

User :   desame
User :   ill ask my husband just to make sure
User :   he said that its desame
Doctor :   ok
Doctor :  
as you said there is family history of breast cancer, may i know at what age they were diagnosed of having breast cancer
User :   doctor are you still there?
Doctor :   yes

Doctor :   can you read me?
Doctor :  
are you there?
User :   yes
Doctor :  
as you said there is family history of breast cancer, may i know at what age they were diagnosed of having breast cancer
User :   i think my aunt was diagnose in her 40's and died 7 years later im not sure
Doctor :   ok
Doctor :   so you are second degree risk in the family, and the breast cancer is occurring above 35 years of age
Doctor :  
fine
Doctor :   this lump need not to be worried as with 2 months there is no progression and it is very unlikely it is cancer
Doctor :  
secondly regarding the ovary enlargment
User :   yes
User :   yes
Doctor :  
the CA125 levels are elevated in the ovarian tumors or in the inflammation of the ovary.
User :   oh ok
Doctor :  
as your age is 27 and there is the history of ovarian cystadenoma which is been removed
User :   in my fathers side but i m not sure who
User :   in my fathers side almost most of the women get hysterectomized in theirn 20's
Doctor :   what is the reason?
User :   some are cancer and some are endometriosis
Doctor :  
even endometrosis also will cause the elevation of CA 125.

Doctor :  
asians do have increased incidence in uterus cancer and americans have the increased incidence of breast cancer
User :   does it mean to say that even i am already hysterectomized and oophorectomized i could still get endometriosis?
Doctor :   endometrosis is ectopic placement of the uterine issue, yes it is very much possible
Doctor :  
but it has the characteristic change like it will enlarge during mensus and decrease in size after mensus is over
User :   oh
Doctor :  
and one of the commonest site of endrometrosis is ovary
Doctor :  
so what i mean to say is mere enlargment of the ovary and increased levels of the CA125 do not say you have ovarian cancer
Doctor :  
there are many other non cancerous conditions like endometrosis and infection of the ovary and benign cystic enlargment of the ovary where the CA125 levels are increased and also the ultrasound say the ovary is enlarged
Doctor :  
and as such your age is just 27 which is very unlikely for the ovarian tumor to occur
User :   but what might the reason of the ovary being enlarge?
Doctor :  
one possibility is it may be the cystic disease which occurred in the left ovary being occurring in the right ovary also.
User :   last 2007 i had an ultrasound that says that i have urinary retention and a problem with my kidney but the doctor i went to told me that having hydronephrosis is impossible for my age
Doctor :   hydronephrosis can happen at any age
User :   is it a possibility that my right ovary will twist and rupture?
Doctor :   it depends on the size of the ovary
Doctor :  
if the ovary is quite big the possibility is there
User :   im looking at all the ultasound that dated from march 2006 up to a week ago the cysts that they saw is in every ultrasound i had the size difference is only 0.something only
Doctor :   ok

Doctor :   what did the MRI scan say about the measurement of the ovary
User :   3.4x3x2.4cm
Doctor :  
usually the ovary will be of 3x2.5x1.5 cm
Doctor :   there is mild increase in the size
Doctor :  
where is the hydronephrosis is it in the right side or in the left side
User :   right side
Doctor :  
left side the kidney is normal?
User :   my ultrasound last september 08, 2009 the ovary measures 3.5 x 2.3 x 2.4
User :   yes the left kidney is normal
User :   and on december 04, 2009 the ovary measured 3.4x 3 x 2.4
Doctor :   what is the cause for the hydronephrosis?

User :   the right kidney measures about 10.7 x 5 cm. the cortico-medullary junctions are intact. the right kidney shows shadowing echo's of about 1.4cm
Doctor :   ok
User :   seen within the middle central echo complex. There is moderate dilatation of the superior and inferior pols calyceal structures
Doctor :   these findings are consistent with the hydronephrosis

Doctor :  
hydronephrosis occurs due to the obstruction of the urine flow
User :   in my oct. 10,2006 ultrasound it says prominent cystic structure within the right ovary
Doctor :   cystic structure
User :   and the recdent ultrasound only says prominent right ovary
Doctor :  
i like to say it is very unlikely that the present ovary enlargement is because of the cancer
Doctor :   the reasons are
Doctor :  
if it is a cancer the size keeps on increasing and it will newer vary
Doctor :  
in your case there is variation is size which is increasing and decreasing
Doctor :  
and cystic lesions have been documented once in the ultrasound, which explains the variation in the size
User :   doctor one ultrasound dated march 3,2009 states the cervix is visualized, showing a large lobular anechoic structure of about 15.9 mm. size within its posterior upper segment. a smaller nodule of about 4.8mm size is noted superiorly
Doctor :   ok
User :   the right ovary is visualized, measuring about 3.2 x 2.3 x 2.2 cm. small low echogenicity foci are noted within its outline
Doctor :  
ok
Doctor :   what was the levels of CA125

User :   5.50
Doctor :  
it is less than 35
Doctor :   so you need not worry

User :   another ultrasound states oct.2008 the right ovary is in normal size with unilocular cystic structure with irregular thickened border, measuring 1.5 x 1.4 (-) minimal free fluid in the cul-de-sac
Doctor :   ok
Doctor :   it is very unlikely you are suffering from cancer of the ovary
User :   ok thats good to her
Doctor :  
as your age does not fit and also the variation in size do not co incide with the growth pattern
User :   ok so what would be the cause of my abdominal pain
Doctor :   it is again the hydronephrosis and the slipped disc which might me causing the abdominal pain
User :   oh ok and is hydronephrosis dangerous
Doctor :   no it is not
User :   the slipped disc?
Doctor :  
they are not dangerous
Doctor :  
but are very troublesome
User :   very painful
Doctor :  
yes very painful
User :   in hydronephrosis war are my treatment options?
Doctor :   it again depends, so only i asked what is the cause for the hydronephrosis
Doctor :  
hydronephrosis means there is obstruction to the flow of the urine
User :   2007 it was already seen that urinary retention
Doctor :  
if the obstruction is found and relieved than there will be no hydronephrosis
Doctor :  
from when you have this hydronephrosis?
User :   consider pyelonephritis of thye right kidney. and presence of significant urinary bladder retention of urine was seen 08/17/07
Doctor :   so what did your doctor say at that time?

User :   the hydronephrosis was seen sept 08,2009 and was 2nd seen in MRI nov.11,2009 and the most recent was on dec,2009
Doctor :  
what i believe is due to the surgery in the removal of the uterus there will be fibrosis of the pelvic tissue and that might be the reason for the hydronephrosis
User :   im confuse would you explain it more
Doctor :  
what happens is during the surgery in the removal of the uterus, the surrounding structures will be manipulated
Doctor :  
and the wound of the removal of the uterus will heal forming a scar
User :   after the surgery when i was in icu i had 2 catheters one is derectly in my urinari bladder
Doctor :   yes
User :   where would the healed scar would be?
Doctor :  
so the scarring of the wounds might cause obstruction to the flow of urine and cause hydronephrosis
Doctor :  
it is inside
User :   i forgot to tell you that its been six months already thet my dysmennorhea like pain came back and its much painful
User :   is it near the kidney?
Doctor :   no it will be some where near the ureter
User :   ureter is the tube from the kidney to the bladder?
Doctor :  
yes
Doctor :  
which will carry urine from kidney to bladder
User :   does this mean that to be able to remove what s blocking the urine flow i have to to on surgery?
Doctor :   that depends on the severity of the obstruction, i believe it is not severe hence they might not look for the surgery.
Doctor :   over a period of time the scar might give way and the hydronephrosis will be relieved by itself
Doctor :  
so it is wait and watch approach
User :   but it is very painful urine already have blood
Doctor :   it explain the abdominal pain
Doctor :   what does the doctor say?
Doctor :  
are you there?
User :   that it is impossible for my age to have this?
Doctor :   about the diagnosis ?

User :   that its nothing to worry about
Doctor :   yes
User :   because of what happened when i had hysterectomy most of the doctors in my country either would not accept me or just tell me its nothing
Doctor :   ok
User :   at the same time i have severe anemia that really is causing me to be very dizzy
Doctor :   ok
User :   in my hysterectomy surgery i had 11 bags of blood tranfusion, had cardiac arrest was clinically dead for 3 mins i think and all of this pain came
User :   they said that i had total hysterectomy but i found out 2 years later when they just keep on telling me thats its gas pain the the cervix is still there
Doctor :   ok

User :   what would you doctor advice me to do/
User :   are there still test that i need?
Doctor :   as you are suffering from multiple problems

Doctor :  
it needs to be handled one by one
User :   unfortunately yes
Doctor :  
first and fore most i suggest you to correct the anemia
User :   oh i also became epileptic but my tonic clonic siezures is already controlled for 10 months now
User :   sorry about forgetting so many thing
Doctor :   good to hear that you are symptom free from epilepsy for the past 10 months
User :   my stool also is black and at the end it has fresh blood
Doctor :  
correction of the anemia will DRAMATICALLY improve other symptoms also
Doctor :   what medications are you taking presently?
User :   oh... thank you for telling me that no one from here give any concern
User :   lyrica, topamax, immigran,
Doctor :  
ok
User :   and not very stong pain relivers if my head ache is just starting
Doctor :   ok
Doctor :   i shall suggest you the following
Doctor :  
correction of the anemia should be attempted first
Doctor :   it will take time may be a month or two. than you can see the marked improvement in headache, fatigue, mild abdominal discomfort, and mood changes
Doctor :   what is your present HB levels
User :   where can i see my HB level?
Doctor :  
blood report, it will be written as hemoglobin
User :   the last is 8 L
Doctor :   RBC count?
User :   2.72L
Doctor :  
both are at the lower limit
User :   it was taken 3 weeks ago when i was hospitalized
Doctor :   ok

Doctor :  
consume one multivatimin tablet everyday in the night after dinner
User :   my fever for 4 days did not lower down from 40-38
User :   ok
User :   is ferrous sulfate helpful?
Doctor :   increase the green leafy vegetable content of the food.
Doctor :  
ferrous sulphate is gastric irritant and it will cause abdominal pain, black stools and blood in stools also
Doctor :  
so its better to get iron from natural sources like green leafy vegetables and liver
Doctor :  
than the medications
User :   oh was just thought of that because when pregnant they say that it supplements the iron/ blood
Doctor :   natural source is always best

User :   ok i agree with that.
Doctor :   so also need to do the physical exercise, morning 30 minutes of physical exercise
Doctor :  
this will regulate the digestion and improve the immune system of the body
User :   that i cannot do because of my numb 2 legs and left knee totally without strenght
User :   doctor just type first ill just go very quickly to the bathroom be back in less than 30 seconds
Doctor :   ok

Doctor :  
the exercise will improve the regulation of the various organs
Doctor :   you need to do some sort of physical activity
User :   im back
Doctor :   fine
User :   the most physical activity that i do is when i walk the dog but not that very far
Doctor :  
i was just telling it is essential for the digestive and other systems of the body to function properly daily exercise is necessary
Doctor :  
that is enough
Doctor :  
you can improve and work on it right
Doctor :  
may be make it brisk and daily increasing the distance by 100 to 200 meters further
User :   yes i will do in the best way that i could to do that
Doctor :   continue to take the tablet what you are consuming presently
User :   ok
Doctor :   concenterate on the anemia correction and improving the physical strength
Doctor :  
this will make a marked difference in the sufferings you have had till now
User :   thank you and i think it will be
Doctor :   yes definitely it will be

User :   after the anemia what should be my next step?
Doctor :   presently anemia correction and increase in the physical strength is sufficient
Doctor :  
lets tackle one by one
Doctor :   the next step depends on the marked improvement in the symptoms
User :   ok, sorry im just getting a little bit excited even by just thinking of me getting back to normal
Doctor :  
it would to aim at reduction in the medication consumption future hospital visits
Doctor :  
meaning to have a symptom free period for a long duration
Doctor :  
the improvement in the symptoms will guide us further.
User :   ok, may i also know the name of the kind patient doctor im talking to
Doctor :  
dr shekar
User :   ok my name by the way is XXXXXXXX from the philippines.
Doctor :  
nice to have you on the chat
User :   from my heart and from my family we are taking you for helping me understand the health problems im going thru
Doctor :   please fill the feed back form
Doctor :   i am here to help you
Doctor :  
i shall do my best.
Doctor :   you can always address your concerns at any hour of the day, we are available 24/7
User :   i will follow your advice and after 2 months ill contact you agaiN TO GIVE YOU GOOD NEWS AGAIN I THANK YOU
Doctor :   thanks for consulting healthcare magic,
Doctor :  
bye for now
User :   BYE
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