Abstract
Janice is 52 years old. She works in the local supermarket and you do not see her very often. She has an appointment with you one morning. She has been under a lot of stress as her marriage is in difficulty and her 17-year-old daughter is also playing her up. She feels tired and has been having a lot of problems with her tummy with abdominal bloating and a new tendency to constipation. Her last period was just over a year ago, and she wonders if her symptoms are due to menopause or perhaps irritable bowel syndrome (IBS) as a result of the stress, although she has never had IBS before. Abdominal and pelvic examinations are normal.
What would be your differential diagnosis?
What further tests would you request?
You send Janice to have some blood tests done. Janice comes back to see you for her results 2 weeks later. All her tests are normal apart from her cancer antigen 125 (CA125), which is raised at 86 IU/l.
What is a raised CA125 associated with?
What would you do next?
Helpful links
Leeds Teaching Hospitals. Tumour markers: CA 125. Accessed via www.pathology.leedsth.nhs.uk/pathology/ClinicalInfo/CommonTestsInvestigations/TumourMarkers.aspx
NICE. Referral for suspected cancer: quick reference guide (2005; updated 2011). Accessed via www.nice.org.uk/nicemedia/live/10968/29813/29813.pdf
NICE. Ovarian cancer: the recognition and initial management of ovarian cancer (2011). Accessed via www.nice.org.uk/nicemedia/live/13464/54266/54266.pdf