Ca125 100以上

卵巢肿瘤指标Ca125升高可能是癌，这2类女性一定要注意！

所有卵巢癌患者都会Ca125升高

但并不是升高了就一定得了卵巢癌

Ca125项目是啥？

这是一项提示卵巢肿瘤的指标，现在在临床上广泛被用来诊断卵巢癌，评估卵巢癌的治疗效果，化疗敏感性以及治疗后肿瘤是否有复发。

复旦大学附属妇产科医院姜伟副主任医师说：“Ca125这个指标，敏感性非常高，但特异性较低。”

啥意思呢？通俗来讲就是：基本上所有的卵巢癌患者都会有Ca125的升高，但并不是升高了就一定得了卵巢癌。

一般健康女性血液中的Ca125正常值小于35 U/mL。体检发现Ca125升高的女性大多数都是轻度升高。

引起Ca125升高的原因，有卵巢癌，腹膜癌，输卵管癌，子宫内膜癌，乳腺癌等常见的恶性肿瘤。

Ca125升高还可能是这些情况

①子宫内膜异位症：

是女性常见的妇科疾病，这类女性往往有痛经，性生活疼痛，不孕，有时候卵巢上会有子宫内膜异位囊肿，也就是常说的巧克力囊肿，另外还有子宫腺肌症等，通过门诊妇科检查结合B超等辅助检查，比较容易诊断。

②月经期：

由于经期的盆腔充血，经血逆流进入盆腔刺激腹膜，也会导致Ca125的升高，所以要避免在月经期或者月经刚结束不久抽血检查Ca125。

③各种炎症：

如盆腔炎，附件炎，结核性腹膜炎等，引起Ca125升高的原因也是因为腹膜受到刺激。

④妊娠期：

尤其是妊娠的前3个月内升高比较普遍。

⑤其他良性疾病

所以，发现Ca125升高的女性，首先要明确一下是否有上述情况，其次还要关注一下Ca125具体的数值。

一般来说，良性疾病的Ca125升高幅度比较小，很少有超过200的。

当然数值高的也不一定就是恶性，我至少遇到过3例输卵管积水或者化脓性输卵管炎的女性Ca125升高超过1000。还有少数良性卵巢肿瘤也会明显升高，如卵巢畸胎瘤等。

这2类女性发现Ca125升高

要特别小心！

①存在BRCA基因突变的女性

家族里有其他亲属患卵巢癌，乳腺癌等疾病，特别是做了相关的基因检测，发现存在BRCA基因突变。

要知道，具有这个基因突变的女性患乳腺癌和卵巢癌的风险分别为87%和50%，好莱坞著名影星安吉丽娜朱莉就是因为这个突变而切除了乳腺。

所以，存在BRCA基因突变的女性一旦发现Ca125升高，首先要排除卵巢肿瘤，输卵管肿瘤或者原发腹膜癌，乳腺肿瘤等疾病，可以通过进一步的相关检查明确。

另外，对于这类女性，如果已经完成生育，年龄大于40岁，还可以考虑做预防性的输卵管卵巢切除。

②绝经后的女性

绝经后的妇女发现Ca125升高也要特别当心。

因为绝经后基本上就不存在我前面所列举的一些引起Ca125升高的良性情况，所以一定要做全面的检查，排除恶性疾病的可能。

我两个月前就遇到一位患者，63岁，体检发现Ca125升高到100左右，做了各种检查，全身的B超，磁共振，CT检查，没有任何异常发现。

后来给这位患者从阴道做了个穿刺，仅仅得到2mL腹腔液体，结果就找到了癌细胞，进一步检查发现是原发性腹膜癌。

来源：“复旦大学附属妇产科医院”微信公众号

作者：复旦大学附属妇产科医院副主任医师 姜伟

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