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CA125 and adenomyosis

I am in my forties and a working woman who exercises 3 to 4 times a week .When I went for my annual medical check-up last year my results were good except for the CA125 which was 45. This was slightly higher than the normal value of up to 35. Early this year, it was 62 and I took the blood test again 2 months ago and it was 79. The number appeared to climb higher and higher. Does that indicate that I am having some problem with my uterus?

My gynaecologist told me that my uterus had swollen to double the size of a normal one. He diagnosed me as having adenomyosis with some small fibroids. I had undergone a surgery 6 years ago to remove some fribriods. He suggested that I should remove my uterus which I really hesitate to do so. I have no menstrual discomfort except some bloated feeling occasionally.

I am really worried about the rising levels of CA125. If I were to leave it alone, will it lead to cancer or something that will affect my health? What should I do?

As I have totally no knowlegde about "Adenomysis", will be very grateful if you could give me some advice?

A. CA125 is an abbreviation for cancer antigen 125. It is a protein substance in the blood which is raised in some people with cancer. Thus, it is also known as a tumour marker. Its level is generally elevated in ovarian cancer, but may also be raised in other cancers such as those involving lining of womb (endometrium), fallopian tubes, lungs, breast , stomach and intestines.

It should be noted that CA125 is a non-specific test as it may also be raised in non-cancerous conditions, such as endometriotic cyst (blood cyst), adenomyosis, pelvic infection and pregnancy.

It is also not a very sensitive test since not every patient with cancer will have high levels of CA-125. In ovarian cancers, only about 80% have raised CA125.

In your case, the increasing trend of CA125 level is rather disturbing and may be due to adenomyosis as suggested by your gynaecologist.

To understand adenomyosis, one has to know the anatomy of the womb (uterus), which is composed essentially of 2 layers of tissues:

1. The inner layer (endometrium) which sheds off regularly every month in menstruation and

2. The muscle layer (myometrium) which gives rise to contraction pain during labour.

Adenomyosis is a troublesome disease where endometrium grows abnormally within the myometrium. The cause is unknown although there are many theories trying to explain it.

Some women, as in your case have no symptoms while others may experience:

· Excessive heavy or prolonged menstrual bleeding

· Severe cramping or sharp pain during menstruation

· Menstrual cramps that get worse with age

· Pain during intercourse

· Bleeding between periods

The uterus is usually uniformly enlarged and may increase to double or triple its normal size as in your case . The disease typically regresses after menopause.

Ultrasound may not differentiate adenomyosis from fibroid (a common muscle growth in the myometrium). To make matter worse, the two conditions often co-exist. MRI may be helpful in differentiating the two.

Since adenomyosis has not impacted your lifestyle very much ( except having a bloated tummy), you may wish to adopt a “watch and see” option as the disease regresses with the approach of menopause. Other treatment modalities in patients with symptoms include pain killers, oral contraceptive pills, hormone-impregnated intrauterine contraceptive device (Mirena IUCD) and hormone suppression injection (GnRH agonist). However, the outcome is usually temporary and may not result in reducing the size of the womb. In such cases, removal of the womb (hysterectomy) may be the last resort, as suggested by your gynaecologist.

If the CA 125 continues to rise, it may be advisable to rule out other cancerous as well as non-cancerous causes listed above.

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