Unexpectedly high level of cancer antigen 125 (CA 125) in endometriosis: A case report

Michał Kostrzanowski, Agata Mandes, Grzegorz Ziółkowski, Filip Dąbrowski
In: Journal of Endometriosis and Pelvic Pain Disorders · 2025 · vol. 17(4) , pp. 230–233 · doi:10.1177/22840265251363681 · W4413030752
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This case report details a patient with endometriosis who presented with unexpectedly high cancer antigen 125 (CA 125) levels, initially suggesting ovarian neoplasm.

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This case report describes a patient with endometriosis who presented with unexpectedly high levels of cancer antigen 125 (CA-125), a tumor marker often associated with malignancies. The authors highlight that while CA-125 is frequently elevated in endometriosis, such pronounced increases can mimic ovarian cancer, creating diagnostic challenges for clinicians. The paper emphasizes the importance of considering benign conditions like endometriosis when interpreting elevated CA-125 results to avoid unnecessary aggressive interventions. This paper is centrally about endometriosis — specifically focusing on the diagnostic utility and potential pitfalls of using CA-125 as a biomarker in this condition.

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Abstract

Endometriosis is defined as the presence of the endometrial tissue, glands, and stroma, outside the endometrium and myometrium and is characterized by chronic pain and subfertility. Recently, clinical interviews and imaging have increasingly supplemented, and in certain contexts replaced, laparoscopy as the main diagnostic method. However, when we suspect cancer, laparoscopic inspection of abdominal and pelvic cavity, with biopsies and histological confirmation remains the gold standard. The most important biomarker used in endometriosis diagnosis remains CA 125, which is a well established marker in ovarian cancer. The sensitivity of CA 125 limits its clinical usefulness in endometriosis diagnosis. In this paper we present the case of the patient with significantly elevated levels of CA 125 and high suspicion of ovarian neoplasm in imaging studies.
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endometriosis

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