Expression of Tumour Markers CA125, CASA and OSA in Minimal/Mild Endometriosis

EDITORIAL COMMENT: This study confirms most of the findings reported by Fraser et al A in their study of serum CA‐12S levels in women with endometriosis before and after medical therapy. Both studies showed that serum CA‐125 levels were suppressed during treatment but tended to rise after treatment even in women in whom the disease had not recurred. There is an extensive literature concerning the use of serum CA‐125 as a marker of recurrence or persistence of ovarian carcinoma after treatment; it would seem that the assay is of limited value and does not for example replace the need for second look laparotomy by identification of women with residual disease requiring further chemotherapy. It is difficult to judge how troublesome raised serum CA‐125 levels due to endometriosis are to oncologists ‐ how many of their patients with ovarian cancer still have functioning ovarian tissue? We accepted this paper for publication because the authors have 2 new serum tumour markers, which apparently are superior to CA‐125 in detecting small volume ovarian cancer, and yet, as this study shows, do not show elevated levels in patients with mild endometriosis. As stated in a previous editorial comment* we require a marker for ovarian cancer that is cheap enough to apply as a screening test to identify asymptomatic lesions ‐ to be useful it must be cheaper than vaginal ultrasonography; we look forward to the results of the authors' study using these markers to screen 10,000 asymptomatic women for malignant disease; presumably this paper indicates that such a study could include premenopausal patients since the 2 markers are not tricked by endometriosis in the 23 cases reported here. Fraser IS, McCarron G, Markham R. Serum CA‐125 levels in women with endometriosis. Aust NZ J Obstet Gynaecol 1989; 29: 416–420. Ward BG, McGuckin MA, Hurst TG, Khoo SK. Expression of multiple tumour markers in serum from patients with ovarian carcinoma and healthy women. Aust NZ J Obstet Gynaecol 1989; 29: 340–345. Summary: Ovarian cancer associated antigens CA125, CASA and OSA were measured in serum from 23 patients with mild endometriosis before, during and after medical therapy. Pretreatment CA125 levels were elevated above 35/ml in 4 (17%), and above 25/j/ml in 7 (30%) patients. Mean CA125 levels decreased during treatment, but in only 10 patients did levels reflect disease response. There was no correlation between CA125 levels and disease severity as measured by modified American Fertility Society Scoring. Neither CASA nor OSA were detected in these women.