Heard It Through the Grapevine

Clinical Ovarian Cancer

Image via Wikipedia

Occasionally a patient will come in for a visit and during discussion will ask that we run a specific blood or diagnostic test. Sometimes it’s just a matter of curiosity (“What’s my blood type?”), other times it’s because they have a friend or relative recently diagnosed with a disease and they want to be checked for this as well—although it’s difficult to understand how having a friend who has been newly diagnosed as diabetic puts this patient at risk. More often, the test they ask is one we normally check in healthy adults as part of their health screening.

It seems that more and more we start to get a request for a blood test that is not part of our usual screening. When enough patients’ begin asking for the test, we wonder where they’re getting their information, or what has triggered this special interest. Sometimes it’s an article in the local paper, or a late night news story. More often it seems the host of a popular TV show states—demands actually—that patients see their doctor right away and ask to have this test. In this regard, coming from the Land of Oz, the one blood test asked for often by female patients is the CA-125.

CA-125 is a protein secreted by abnormal ovarian cells. In a woman with advanced ovarian cancer, the CA-125 test can be extremely high. In patients who has been previously diagnosed and treated for ovarian cancer, the Ca-125 test is helpful in determining if there has been a recurrence of the disease. The symptoms of ovarian cancer are maddeningly nonspecific: the patient may complain of feeling full quickly, or have difficulty eating and digesting food; they may feel occasional pain in the abdomen, or have generalized bloating; urinary frequency or the urgent need to urinate may be another sign. Constipation, back pain, tiredness and pain with intercourse are other symptoms that may occur in patients with ovarian cancer. As you can imagine, woman without ovarian cancer can also have these symptoms and since ovarian cancer is still rather infrequent—the CDC estimates 22,000 cases in 2010—we tend to check for other causes first.

The CA-125 test is also not specific for ovarian cancer: other diagnoses that can cause an elevated CA-125 level are endometriosis, pelvic inflammatory disease, pregnancy, heart failure, diabetes, renal disease, lupus, and postoperative patients. Although the CA-125 test is helpful in following patients with ovarian cancer, it has never been approved as a screening test to diagnose possible ovarian cancer. As we’ve discussed, the test could be raised in a patient without the disease, potentially subjecting the patient to even further and potentially harmful diagnostic testing.

So what’s a knowledgable patient to do? Certainly always ask whether a particular test applies to your condition. Ask what we would should next if the test is abnormal, or normal, and how likely would it be that you could have that disease. Understand that medicine is constantly changing and that what’s in style today may be out tomorrow or vice versa. We can use what others say or advise as a way to discuss what concern’s you about your health. Just keep in mind that hearing it on the grapevine, or on TV, is usually only half the story. Working with your physician can give you the true picture.

About Steve P. Sanders

A general internist writing and sharing ideas and art.

2 Responses to “Heard It Through the Grapevine”

  1. This is a really good read for me, Must admit that you are one of the best bloggers I ever saw.Thanks for posting this informative article.

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