Peritoneal trauma releases CA125?

Abstract

CA 125 is a high molecular weight glycoprotein that is detected in tissues derived from foetal embryonic coelomic epithelium (Kabawat et al., 1983). Serum CA125 levels are elevated in 80% of patients with epithelial ovarian cancer (Bast et al., 1983) although up to 70% of patients with small volume disease will have false negative values (Schilthuis et al., 1987; Niloff et al., 1985; Atack et al., 1986). Serum levels may in part depend on a tumour-peritoneal cavity-blood concentration gradient (Bast et al., 1981; Bergmann et al., 1987; Fleuren et al., 1987) and as ovarian cancer is a disease predominantly confined to the peritoneal cavity, peritoneal washings may be a more sensitive marker of small volume disease (Allegra et al., 1986). This has suggested the possibility that peritoneal lavage fluid (PLF) CA125 may be a useful staging tool at laparoscopy, and possibly at laparotomy in the detection of sub-clinical disease. As a preliminary investigation in the evaluation of peritoneal lavage fluid (PLF) CA125 as a marker of minimal residual disease in ovarian cancer, we wished to measure CA125 levels in the peritoneal lavage fluid obtained from healthy controls. Since there are isolated reports of serum CA125 levels rising as a consequence of abdominal surgery (Krebs et al., 1986, Cruickshank et al., 1987), it was essential to assess the effect of surgery on PLF CA125 levels. We performed the study in two groups of patients. In group I, pre-operative serum and peri-operative peritoneal lavage fluid were obtained from healthy pre-menopausal women undergoing either hysterectomy for dysfunctional uterine bleeding (n= 15) or laparoscopy (n = 40). The indications for laparoscopy were sterilization (n=28), unexplained pelvic pain (n =5), or infertility (n = 7). No evidence of disease, in particular endometriosis, was found at operation although there was histological evidence of adenomyosis in three of the hysterectomy specimens. Peritoneal lavage was performed at laparoscopy after the introduction of the laparoscope, whilst in patients undergoing hysterectomy, it was performed immediately after opening the peritoneal cavity, great care being taken to avoid contamination with blood. Peritoneal lavage was performed with 11 0.9% saline that was left in situ for 5min before a 20 ml sample was taken and added to a plastic universal container with 1 ml 3% sodium citrate. The operating table was repeatedly tilted to ensure as uniform a distribution as possible. Group II comprised 6 further patients undergoing hysterectomy for dysfunctional bleeding (median age 36, range 3142). In this group, the anterior abdominal wall was opened normally down to the peritoneum. Peritoneal lavage was then performed, instilling 11 0.9% saline via a small peritoneal incision just sufficient for a 12 g urinary catheter to pass through. A sample of PLF was obtained after a dwell time of 5 min. The peritoneum was then opened normally and a

DOI: 10.1038/bjc.1988.250

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@article{Redman1988PeritonealTR, title={Peritoneal trauma releases CA125?}, author={Charles W E Redman and S. R. Jones and David Michael Luesley and Sheldon Nicholl and Kathy Kelly and E . J . Buxton and Kin Chan and George R. P. Blackledge}, journal={British Journal of Cancer}, year={1988}, volume={58}, pages={502 - 504} }