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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17516
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I am 86 and have recently had blood tests because of low energy

Customer Question

I am 86 and have recently had blood tests because of low energy levels and feeling poorly some of the time. The tests have all had normal results. I have just had a CA125 test. I had mentioned feeling a bit hot sometimes to my doctor. On my test request form to take to the phlebotomy unit he wrote "flushes". I really do not think I suffer from what are described as "hot flushes" such as those sometimes suffered at the menopause.
I see online that a single CA125 test is not sufficient to diagnose ovarian cancer because apparently only 3% of those with high levels have ovarian cancer and of those with this disease 20% do not have high levels.
When my test result comes through, should I request some further test please?
Susan
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. D. Love replied 1 year ago.
from JustAnswer.
It will help if you could provide some further information.
What other tests have been ordered?
Customer: replied 1 year ago.

I have not had any other tests ordered. The previous blood tests which all had a normal resuslt included those , coeliac disease kidney function and liver function. My blood pressure is very good.

Expert:  Dr. D. Love replied 1 year ago.
Thank you additional information.

There are several comments that are pertinent in this situation.

When your doctor wrote flushes, he rob ably did not intend to indicate post-menopausal hot flashes, as that would be very unusual to start having such symptoms in a woman that is your age. He probably only meant the sensation of heat that you describe.

Regarding the use of CA125, you are correct that there are a number of issues with using CA125 as a test to screen ovarian cancer. However, a woman with more advanced ovarian cancer is much more likely to have an elevated CA125, and if ovarian cancer is causing the symptoms that you are experiencing, it is more likely to be more advanced. So, from the perspective of whether ovarian cancer could be causing these symptoms, a negative CA125 would be more reassuring.

From the perspective of screening ovarian cancer, it is still uncertain how CA125 can best be used. There is no evidence that performing two tests in close proximity is any better than using a single value, as there is no evidence that the CA125 will vary from normal to elevated from one day to the next or one week to the next. The women with cancer and normal CA125 tend to continue to have normal levels and the women with cancer and an elevated CA125 tend to continue to have elevated levels. There are some studies currently being done that are looking at performing frequent levels of CA125, such as every 3-4 months, to see if this is better at detecting ovarian cancer, but this will also be uncertain until the current studies are completed.

So, in your situation, there would be no value in repeating the CA125 now, but it may be of value to repeat the test in 3-4 months.

From the perspective of screening cancer, the other issue to consider would be an ultrasound of the pelvis. There also is no clear evidence that this is effective at screening cancer, particularly early ovarian cancer. There are some current studies that are looking at using a combined approach, with both CA125 and pelvic ultrasound, but until these results are available, your doctor could consider such an approach.

From the standpoint of evaluation of your symptoms, the tests that have been done thus far and normal are reassuring, but there are some other tests that should be considered. Blood tests of thyroid function should also be checked, if not already done. Electrolytes are usually done as part of a general chemistry profile, but if not included with the liver and kidney tests, it should be done, including sodium, potassium, and magnesium levels. Certain vitamin and nutrient levels also could be checked, including iron, folic acid, and vitamin B12 levels. Other cancer screening also can be considered, such as breast and colon cancer screening, if not done recently.

If I can provide any further information, please let me know.

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