A 57-year-old woman presents to a physician with chronic pelvic pain of many years duration. On fuher questioning, the woman also repos urinary frequency, constipation, pain with intercourse and bloating. On physical examination, a large mass is felt in the pelvic area. Follow-up ultrasound examination demonstrates that the mass involves the right adnexa and is composed of multiloculated cystic spaces. Prior to sending the patient to surgery, the primary care physician wants to order a serum tumor marker to screen for ovarian cancer. Which of the following would be the best choice?
A 57-year-old woman presents to a physician with chronic pelvic pain of many years duration. On fuher questioning, the woman also repos urinary frequency, constipation, pain with intercourse and bloating. On physical examination, a large mass is felt in the pelvic area. Follow-up ultrasound examination demonstrates that the mass involves the right adnexa and is composed of multiloculated cystic spaces. Prior to sending the patient to surgery, the primary care physician wants to order a serum tumor marker to screen for ovarian cancer. Which of the following would be the best choice?
💡 Explanation
**Question:** A 57-year-old woman presents to a physician with chronic pelvic pain of many years' duration. On further questioning, the woman also reports urinary frequency, constipation, pain with intercourse, and bloating. On physical examination, a large mass is felt in the pelvic area. Follow-up ultrasound examination demonstrates that the mass involves the right adnexa and is composed of multiloculated cystic spaces. Prior to sending the patient to surgery, the primary care physician wants to order a serum tumor marker to screen for ovarian cancer. Which of the following would be the best choice?
A. CA-125
B. CEA (Carcinoembryonic Antigen)
C. CA-19-9
D. AFP (alpha-fetoprotein)
**Correct Answer:**
**Core Concept:** Tumor markers are substances in the blood that can increase or decrease in response to pathological processes in the body, including cancer. Ovarian cancer is a common reason for elevated serum tumor markers.
**Why the Correct Answer is Right:**
A. CA-125 is the most commonly used serum tumor marker for ovarian cancer screening. It is a glycoprotein produced by the surface cells of most ovarian cancers and can be elevated in other conditions as well, like endometriosis, pelvic inflammation, and certain benign ovarian cysts. However, in this context, CA-125 is the most appropriate choice due to its high sensitivity and specificity for ovarian malignancies.
**Why Each Wrong Option is Incorrect:**
B. CEA (Carcinoembryonic Antigen) is a tumor marker for gastrointestinal cancers, particularly colorectal cancer. It is not specific to ovarian cancer and should not be used for ovarian cancer screening.
C. CA-19-9 is a tumor marker for pancreatic cancer and is rarely used for ovarian cancer screening. Its utility for ovarian cancer is limited.
D. AFP (alpha-fetoprotein) is a tumor marker for germ cell tumors and hepatocellular carcinoma, not ovarian cancer. It is not suitable for ovarian cancer screening.
**Clinical Pearls:**
1. In a clinical scenario involving suspected ovarian cancer, CA-125 is the most suitable serum tumor marker to consider due to its high sensitivity and specificity for ovarian malignancies. A persistently elevated CA-125 level should prompt further investigation for ovarian cancer, while normal levels can help rule out the diagnosis.
✓ Correct Answer: B. CA-125
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