The role of CA 125 and conventional examinations in diagnosing progressive carcinoma of the ovary.

The clinical significance of the serum marker CA 125 and conventional examinations in diagnosing progressive disease was evaluated in 98 patients. The examinations included CA 125, gynecologic and complete physical examination, abdominal computed tomography (CT), roentgenogram of the chest, second look operation and serum biochemistry profile. Progressive disease occurred in 49 patients and the time to progression was a median of 12 months (range of four to 52 months). At the time of progression, an elevated CA 125 was found in 73 percent of the patients, and in 63 percent of the patients, CA 125 increase preceded clinical progression for a median of four and one-half months (range of 0.5 to 29.5 months). A positive gynecologic examination at progression was found in 67 percent of the patients, physical examination and abdominal CT scan were positive in 30 percent, intervention operation in 14 percent and roentgenogram of the chest in 12 percent of the patients. With the combination of serum CA 125, gynecologic and general physical examination, progressive disease could be diagnosed in 92 percent of the patients. The false-positive rate in the 49 patients with no evidence of disease was 1.6 percent for CA 125, 2.0 percent for gynecologic examination, 4.0 percent for physical examination, 14.0 percent for CT scan and 2.0 percent for roentgenograms of the chest. Serum CA 125 is the most reliable examination to detect progressive disease early. With the combined use of serum CA 125 and the gynecologic and general physical examination, progression of the disease can be detected in about 90 percent of the patients.