Raised CA-125 levels - query bank

Question: Raised CA125 (348 and 278 from two different labs) in a 32 year old woman. Two small (2-3 cm) fibroids being the only finding . LFTs, and abdominal scans are normal and she has no other complaints. What investigations / diagnostic laparoscopy should be performed?

Please note: the search for this response was carried out over 1 year ago. Eligible users may request an update of the evidence by submitting a new Clinical Query here.

Answer: No guidelines were found on investigations that should be performed when CA-125 levels are raised in the absence of other symptoms.

A similar question was answered by Tripanswers (1) in 2007 which says:

 “Elevated concentrations of CA125 are associated with malignant tumours of the pancreas, breast, lung, colon and ovary. Menstruation and benign conditions such as endometriosis, pelvic inflammatory disease and liver disease can also be associated with elevated concentrations of CA125. CA125 may also be elevated in women with ascites, pleural or pericardial effusions and in women who have had a recent laparotomy”....

“CA-125 can be high in many normal or benign conditions (for example, pregnancy, menstruation, endometriosis, pelvic inflammatory disease)”

A letter published in Lancet Oncology in 2007(2) lists conditions that can be associated with an increased serum CA-125 concentration (>35 U/mL) and ascites with or without pelvic masses


  1. TripAnswers Aside from malignancy, what conditions can causes a raised (and increasing CA125) and how should I investigate her? 2007
  2. Sevinc A. Adli M. Kalender ME. Camci C. Benign causes of increased serum CA-125 concentration. Lancet Oncology. 8(12):1054-5, 2007 Dec. Free full text on registration


Search date: May 2010

Classification of evidence levels

Ia Evidence obtained from meta-analysis of randomised controlled trials.

Ib Evidence obtained from at least one randomised controlled trial.

IIa Evidence obtained from at least one well-designed controlled study without randomisation.

IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.

III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.

IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.

This clinical query answer was produced following the clinical query protocol as described here.

The RCOG will not be liable for any special or consequential damages arising from the use or reliance on information contained within the Query Bank.

Date published: 25/05/2010

main menu