A 59 year old patient who had ovarian cancer almost 5 years ago has a Ca 15-3 level of 58U/mL. Her last reading 5 months ago was 21U/mL. Her CBC and Kidney Function Test results are within normal limits. Is her Ca 15-3 result considered significant, and should further investigation be done?
First you need confirmation of this increase and youmust look at breasts, practice mammography and USonography. if nothing wrong pet scan
Voir la reponse du Dr Serin.
Le cancer ovarien est tres difficile a traiter et prudence vaut mieux que dire que tout est gagne. Bonne chance.
Any investigation should be done only if it alters the treatment and the prognosis. By ordering the CA you have committed yourself to the patient and yourself that the results will influence your further action. Therefore,in this patient, you have to do further evaluation.
If the present knowledge is that it is not something that is not important, you will have to explain to the patient that it was important when you ordered it and now the literature says that it is not important. This will be a difficult thing to do. Moreover you will be in trouble if she develops symptoms and signs of recurrence.
In future cases, you may take a ploicy decision whether to do this investigation as a routine follow-up one.
This principle is true for all investigations except may be a few basic ones such as TC, DC etc.
Narayanan
The first question I have is why did you order the test? If a patient has a history of Ovarian cancer, a base line CA 125 should have been drawn. CA 125 is considered a more sensitive and reliable marker as part of an overall evaluation of a patient with this history, not CA 15-3. REMEMBER: THIS MARKER IS NOT A SCREENING TEST. Tumor markers are designed to determine the biochemical effectiveness of therap.
That said, any tumor marker that has exhibited increased velocity and intensity over the evaluation period should be more thoroughly evaluated. All you can say, with a rise in the tumor marker is just that--the tumor marker has gone up. The marker cannot tell you about recurrent disease, location of disease, volume of disease or potential for response to therapy.
Tumor marker assessment is just one part of the patient clinical picture. This test, along with a clinical evaluation, imaging studies and possible biopsy of suspected recurrent disease will guide clinical decision making and patient therapy options.
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