Evaluation of CA 125 levels in differentiating malignant from benign tumors in patients with pelvic masses

Serum CA 125 levels were assayed from 44 normal healthy women, 153 patients with benign pelvic masses, and 58 patients with malignant pelvic masses. CA 125 levels were less than 35 U/mL in 42 of the 44 normal women and were greater than 35 but less than 65 U/mL in the other two women. Among 153 patients with benign pelvic masses, CA 125 levels greater than 35, 65, or 194 U/mL were detected in 61 (39.9%), 31 (20.3%), and eight (5.2%) patients, respectively. Of 58 patients with malignant pelvic masses, CA 125 results were greater than 35, 65, or 194 U/mL in 48 (82.8%), 45 (77.6%), and 38 (65.5%), respectively. Among the latter group, the positivity rates of 30 patients with epithelial ovarian cancers were 100, 93, and 80%, respectively. This study suggests that defining positive serum CA 125 levels as those greater than 35 U/mL is of limited clinical value because there is a 39.9% false-positive rate in patients with benign disease. However, serum CA 125 values greater than 65 U/mL may be considered positive in clinically normal women. Serum CA 125 greater than 194 U/mL, representing the units at the 95th percentile for 153 patients with benign pelvic masses, is defined as a new positivity criterion, and could be used to differentiate malignant tumors from benign pelvic masses.     

Preoperative evaluation of serum CA 125 levels in patients with primary epithelial ovarian cancer

Serum CA 125 levels were measured preoperatively in 100 women undergoing diagnostic laparotomy for palpable adnexal masses. All 11 patients with frankly malignant nonmucinous ovarian carcinoma had serum CA 125 levels greater than 35 U/mL and nine of the 11 had serum CA 125 levels greater than 65 U/mL. If patients with mucinous and borderline lesions were included, serum CA 125 was greater than 35 U/mL in 11 of 18 and greater than 65 U/mL in nine of 18 patients. Among 14 individuals with pelvic masses and CA 125 greater than 65 U/mL, 13 had some form of gynecologic malignancy. These results suggest that CA 125 assay can be used as a diagnostic adjunct for discriminating benign from malignant pelvic masses.     

The association of ultrasonography and CA-125 test in the preoperative evaluation of ovarian carcinoma

The aim of this study was to verify the role of the association of pelvic ultrasonography and CA-125 assay in the preoperative evaluation of ovarian carcinoma. The Authors examined 119 patients undergoing laparotomy for adnexal masses. Thirty-six had an ovarian carcinoma, the other 83 patients were affected by benign ovarian pathologies. Before surgery every patient underwent a pelvic ultrasonography. The data resulting from ultrasonography were processed on the basis of a personal scoring morphologic echostructural evaluation system. Furthermore in every patient the preoperative serum levels of CA-125 were measured. In the group of patients with ovarian carcinoma the ultrasonography score was greater than or equal to 10 in 26, while serum CA-125 was greater than or equal to 65 U/ml in 30 and greater than or equal to 35 U/ml in 31. In the group of patients with benign ovarian pathology the ultrasonography score was found to be greater than or equal to 10 in 2, while serum CA-125 was greater than or equal to 65 U/ml in 4 and greater than or equal to 35 U/ml in 20. Fixing 10 as reference value of ultrasonography score for ovarian carcinoma diagnosis, pelvic ultrasonography and a sensitivity of 72.2%, a specificity of 97.9%, a diagnostic accuracy of 89.9%. With a reference value of 65 U/ml CA-125 had a sensitivity of 83.3%, a specificity of 95.2%, a diagnostic accuracy of 91.9%. With a reference value of 35 U/ml CA-125 had a sensitivity of 86.1%, a specificity of 75.9%, a diagnostic accuracy of 79.0%.(ABSTRACT TRUNCATED AT 250 WORDS)     

Significance of CA 125 serum level in discrimination between benign and malignant masses in the pelvis

Aim Our aim was to confirm that preoperative CA 125 serum level can be useful for discrimination between benign and malignant masses in the pelvis.Methods Preoperative CA 125 serum level was analyzed retrospectively in 121 patients who had surgery because of a malignant ovarian tumor and in 91 patients with benign masses in the pelvis. The cutoff serum level CA 125 between benign and malignant masses in the pelvis was 35 and 65 IU/ml.Results Of those patients with a malignant ovarian tumor, 65.3% had menopause whereas only 31.5% of those with a benign tumor did so. The average age of the patients with a malignant tumor was 54.2 years and of those with a benign tumor 46.8 years. The preoperative CA 125 serum level was higher than 35 IU/ml in 80.2% and higher than 65 IU/ml in 72.7% of all analyzed patients with a malignant tumor, whereas it was 23.9% and 9.8% respectively in patients with a benign mass. In early stage ovarian cancer disease (borderline stage, I/II) the preoperative CA 125 serum level was higher than 35 IU/ml in 67.8% and in 52.5% higher than 65 IU/ml. In advanced stages (III/IV), it was higher than 35 and 65 IU/ml in 96.1%. After therapy the CA 125 serum level dropped below 35 IU/ml in 70.8% and after three chemotherapy courses in 78.1%. A CA 125 level less than 35 IU/ml was achieved by therapy in 84.2% patients with an early stage disease (I/II) and in 62.1% in advanced stages (III/IV). The calculated sensitivity was 80.2% and negative 74.5% (CA 125 higher than 35 IU/ml) and 72.7%, 90.2%, 90.7%, 71.6% respectively (CA 125 higher than 65 IU/ml).Conclusion Preoperative determination of CA 125 is a very useful method to discriminate between benign and malignant masses in the pelvis.     

Preoperative evaluation of serum CA 125 levels in premenopausal and postmenopausal patients with pelvic masses: discrimination of benign from malignant disease

CA 125 levels were measured in 158 patients with palpable pelvic masses who were about to undergo diagnostic laparotomy. When the 68 patients found to have cancer were compared with the 90 patients with benign disease, those with malignancies were significantly older, were more frequently postmenopausal, and had significantly higher values of serum CA 125. Patients with benign pelvic masses had CA 125 levels greater than 65 U/ml in 8% of cases, whereas those with malignancies had CA 125 levels greater than 65 U/ml in 75% of cases. If only those patients who had frankly malignant, primary, nonmucinous epithelial ovarian carcinomas were considered, CA 125 levels greater than 65 U/ml predicted malignancy with a sensitivity of 91% for all patients. Greater sensitivity and specificity were observed in the postmenopausal subgroup than in the premenopausal subgroup. In the postmenopausal group with a 63% prevalence of ovarian cancer the predictive positive value was 98% and the predictive value negative was 72%. In a premenopausal population with a 15% prevalence of ovarian cancer the predictive value for a positive test was 49%, while the predictive value for a negative test was 93%.     

Urinary gonadotropin fragments (UGF) in cancers of the female reproductive system. I. Sensitivity and specificity, comparison with other markers

UGF is a mixture of human chorionic gonadotropin free beta-subunit and its fragments, and is detected in pregnancy and trophoblast disease urines. An examination of 67 nonpregnant cancer-free women showed average urine levels of 0.13 ng/ml. Six of the 67 (8.9%) had levels exceeding a selected cutoff value, 0.2 ng/ml. Of 112 woman with active gynecologic cancer, 72 (64%) had urine UGF levels exceeding this cutoff value. When urines were limited to those with creatinine greater than 0.5 mg/ml, or to first morning samples (mean creatinine 1.0 ng/ml), the sensitivity of UGF for all gynecologic cancers was raised to 76%. The sensitivity of UGF for cervical (73%), for endometrial (65%), and for ovarian (83%) cancers exceeded that of plasma CA 125 and lipid-associated sialic acid in plasma (LASA) in the same population. UGF is an exciting new tumor marker which warrants further evaluation.     

Urinary gonadotropin fragments (UGF) in cancers of the female reproductive system. II. Initial serial studies

Levels of UGF, which constitute the free beta-subunit of human chorionic gonadotropin, asialo free beta-subunit, and a core fragment of asialo free beta-subunit, detected by a single immunoradiometric assay, were monitored in the urines of 28 woman undergoing therapy for gynecologic cancer (3 cervical, 8 endometrial, and 17 ovarian). During a 7-month study, 24 of the 28 woman had elevated UGF levels (greater than 0.2 ng/ml). Correlation was observed of UGF levels and changing clinical status during therapy in 23 of these 24. Normal range CA 125 (less than 35 U/ml) was found throughout the study period in 4 of 14 woman undergoing therapy for serous ovarian malignancy. Three of the 4 had elevated UGF levels which accurately followed the course of their disease. These preliminary studies suggest that in monitoring therapy of gynecologic cancers UGF, alone or with CA 125, warrants evaluation.     

Differential diagnosis of ovarian cancer, benign ovarian tumor and endometriosis by a combination assay of serum sialyl SSEA-1 antigen and CA125 levels

We used a combination assay of serum sialyl SSEA-1 antigen (SLX) and CA125 levels, and evaluated the clinical usefulness of this technique for a differential diagnosis of ovarian cancer, benign ovarian tumor and endometriosis. In 82 patients with ovarian tumors, the sera of 20 (64.5%) of 31 with ovarian cancer and 15 (48.4%) of the 31 with endometriosis (endometrial cyst) were positive for both SLX and CA125, but serum SLX level was 5 U/ml or less in these 14 SLX- and CA125-positive patients with endometriosis. The sera of 16 (80.0%) patients with benign ovarian tumor were negative for both tumor markers. The sera of 3 (9.7%) of 31 with ovarian cancer and the sera of 2 (6.5%) of 31 with endometriosis were negative for both markers. The diagnostic accuracy (true positive rate X true negative rate) of the combination assay for ovarian cancer was 49.0% when the cutoff value of the serum SLX was 38 U/ml but improved to 78.5% when the value was set at 50 U/ml. When the cutoff value of serum SLX was set at 50 U/ml and that of serum CA125 at 35 U/ml, 27 of 37 patients who were positive only for CA125 had endometriosis. From the above observations, a combination assay of serum SLX and CA125 is a promising method for the differential diagnosis of malignant and benign ovarian tumors. Our results also suggest that to improve the diagnostic accuracy, the cutoff value of the serum SLX level should be 50 U/ml for ovarian tumors alone.     

A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer

Summary. Age, ultrasound score, menopausal status, a clinical impression score and serum CA 125 level were assessed to see how they could best distinguish between patients with benign (n = 101) and malignant (n – 42) pelvic masses. Each criteria used alone provided statistically significant discrimination. The most useful individual criteria were a serum CA 125 level of 30 U/ml (sensitivity 81 %, specificity 75%) and an ultrasound score of 2 (sensitivity 71%, specificity 83%). Three criteria could be combined in a risk of malignancy index (RMI) which is simply calculated using the product of the serum CA 125 level (U/ml), the ultrasound scan result (expressed as a score of 0, 1 or 3) and the menopausal status (1 if premenopausal and 3 if postmenopausal). This index was statistically virtually as effective a discriminant between cancer and benign lesions as more formal methods. Using an RMI cut-off level of 200, the sensitivity was 85% and the specificity was 97%. Patients with an RMT score of greater than 200 had, on average, 42 times the background risk of cancer and those with a lower value 0.15 times the background risk.     

A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer

Age, ultrasound score, menopausal status, a clinical impression score and serum CA 125 level were assessed to see how they could best distinguish between patients with benign (n = 101) and malignant (n = 42) pelvic masses. Each criteria used alone provided statistically significant discrimination. The most useful individual criteria were a serum CA 125 level of 30 U/ml (sensitivity 81%, specificity 75%) and an ultrasound score of 2 (sensitivity 71%, specificity 83%). Three criteria could be combined in a risk of malignancy index (RMI) which is simply calculated using the product of the serum CA 125 level (U/ml), the ultrasound scan result (expressed as a score of 0, 1 or 3) and the menopausal status (1 if premenopausal and 3 if postmenopausal). This index was statistically virtually as effective a discriminant between cancer and benign lesions as more formal methods. Using an RMI cut-off level of 200, the sensitivity was 85% and the specificity was 97%. Patients with an RMI score of greater than 200 had, on average, 42 times the background risk of cancer and those with a lower value 0.15 times the background risk.     

Saliva and serum CA 125 assays for detecting malignant ovarian tumors

The aim of this study was to determine whether CA 125 was present in saliva and, if it was present, to compare saliva and serum levels in patients with pelvic masses in order to determine whether saliva assays would be useful in identifying patients with ovarian malignancies. Saliva and serum CA 125 levels were assayed in specimens obtained from 55 normal healthy women, 92 patients with benign pelvic masses, and 41 patients with malignant pelvic tumors. We defined a serum CA 125 value greater than 65 U/mL and a saliva CA 125 value greater than 3000 U/mL as the positivity criteria. No serum or saliva assay was positive in the 55 normal women. The sensitivities of the saliva and serum CA 125 assays in 16 patients with epithelial ovarian cancer were 81.3 and 93.8%, respectively. A linear correlation was observed between serum and saliva CA 125 levels. The false-positive rates of serum CA 125 in patients with endometriomas and pelvic tuberculosis were 72.7 and 80%, respectively, but the false-positive rates for saliva CA 125 assays were only 13.6 and 10%, respectively. Therefore, the saliva CA 125 assay had a better diagnostic value than the serum CA 125 assay. In addition, collection of saliva is simple, noninvasive, and inexpensive, and samples could be obtained easily and repeatedly. For these reasons, assays of saliva CA 125 levels may be a new way of screening for malignant ovarian tumors.     

Urinary gonadotropin fragment, a new tumor marker: I. Assay development and cancer specificity

Urinary gonadotropin fragment (synonyms: UGF and human chorionic gonadotropin beta-subunit core fragment) is a small peptide which is present in the urines of pregnant women, of those with trophoblast disease and of those with certain nontrophoblastic malignancies. We developed a new UGF assay with improved specificity and then investigated levels in urines of 493 women: 155 healthy and postmenopause, 79 healthy and premenopause, 89 with benign gynecologic disease, and 170 with active gynecological cancer. A UGF cutoff level of greater than 3 fmole/ml was chosen to monitor the progress of patients during and after cancer therapy. Using this cutoff value, UGF specificity and sensitivity for active cancer were 90 and 66%, respectively. Levels exceeded this cutoff in 74% of women with recurrent disease. For screening purposes and for differentiating benign and malignant disease a cut-off of 8 fmol/ml, was indicated. At this higher cutoff specificity and sensitivity for active cancer were 99 and 46%, respectively.     

Preoperative serum tumor-associated antigen levels in women with pelvic masses

Preoperative sera were assayed for tumor-associated antigens CA 125, TAG 72, and CA 15-3 in 100 women with pelvic masses. Serum CA 125 levels were elevated above 65 U/mL in 83% of 42 patients with ovarian malignancies, in 58% of 12 patients with nonovarian malignancies, and in 17% of 46 patients with benign pelvic masses. Elevations of TAG 72 and CA 15-3 levels occurred less frequently in all groups of patients. Serum CA 125 levels distinguished most effectively between patients with malignant pelvic masses and those with benign pelvic masses, having a sensitivity of 78% and a specificity of 83% at a threshold level of 65 U/mL. When comparing 33 patients with epithelial ovarian carcinomas to 46 patients with benign masses, the CA 125 level alone yielded a sensitivity of 88% with a specificity of 83%. Coordinate elevations of CA 125 (above 65 U/mL) and TAG 72 (above 10 U/mL) or CA 15-3 (above 30 U/mL) distinguished ovarian epithelial carcinomas from benign masses with a sensitivity of 73% and a specificity of 98%, which improved to 81 and 100%, respectively, among patients over 50 years of age. Given the marked increase in specificity observed with this panel of three serum tumor-associated antigens, use of multiple markers might facilitate screening for ovarian carcinoma and appropriate referral of patients with pelvic masses for cytoreductive operations.     

Primary research on saliva and serum CA125 assays for detecting malignant ovarian tumors

Saliva and serum CA125 levels were assayed in specimens obtained from 55 normal healthy women, 92 patients with benign pelvic masses and 41 patients with malignant pelvic tumors. A saliva CA125 value greater than 3,000 kU/ml and serum CA125 value greater than 65 kU/ml were defined as positive. Only one saliva assay was positive in 55 normal women. The sensitivity of saliva and serum CA125 assays in 16 patients with epithelial ovarian cancer was 81% and 94% respectively. A linear correlation was observed between serum and saliva CA125 levels in 32 patients with malignant ovarian cancer. The false positive rate of saliva and serum CA125 assays in patients with endometriomas and pelvic tuberculosis was 13.6%, 10% and 72.7%, 80% respectively. Therefore, the saliva CA125 assay had better diagnostic value than the serum CA125 assay. In addition, collection of saliva is simple, noninvasive, and inexpensive and could be obtained repeatedly. For these reasons, assays of saliva CA125 levels may provide a new way of screening for malignant ovarian tumors.     

A comparison of color flow Doppler and serum CA 125 measurement in the preoperative evaluation of a complex pelvic mass

Ferrier AJ, Picker RH, Sinosich M. A comparison of color flow Doppler and serum CA 125 measurement in the preoperative evaluation of a complex pelvic mass. Int J Gynecol Cancer 1998; 8 :113–118.
Preoperative diagnosis of a malignant pelvic mass is frequently missed, resulting in suboptimal surgical management. This study evaluated the diagnostic properties of color flow Doppler and a single preoperative serum CA 125 measurement in discriminating malignant from benign pelvic tumors. Sixty-two patients were assessed, 32 with an histologically proven ovarian malignancy. Using an upper cutpoint of 0.40 for the resistance index (RI), the likelihood ratio (LR) for the diagnosis of a malignant tumor was 1.72 (95% CI 0.73–4.07). The associated probability of a malignant pelvic mass was 0.63 (95% CI 0.42–0.80). The LRs for CA 125 at the lower cutpoints of 35 U/ml and 65 U/ml were 3.62 (95% CI 1.86–7.04) and 4.50 (95% CI 1.97–10.27), respectively. The corresponding probability estimates were 0.78 (95% CI 0.065–0. 88) and 0.82 (95% CI 0.66–0.91), respectively. Combining the RI (cutpoint 0.40) and CA 125 (cutpoint 35 U/ml) resulted in a LR of 5 (95% CI 1.62–15.4) and a probability estimate of 0.83. This is only a marginal increase over CA 125 measurement alone. This study does not support the use of color flow Doppler in the diagnostic assessment of a suspicious pelvic mass.     

A comparison of the usefulness of serum measurements of CA 125, CA 50 and TATI in patients with malignant and benign gynecological pathology

CA 125, CA 50 and Tumor Associated Trypsin Inhibitor (TATI) levels were assayed in blood samples drawn at diagnosis from 149 patients with malignant or benign gynecological pathology. CA 125 serum levels greater than 35 U/ml and 65 U/ml were respectively found in 34/38 (89.5%) and in 33/38 (86.8%) patients with ovarian carcinoma, in 17/61 (27.9%) and in 6/61 (9.8%) with benign ovarian pathology, in 6/30 (20.0%) and in 1/30 (3.3%) with cervical carcinoma, in 6/20 (30.0%) and in 6/20 (30.0%) with endometrial carcinoma. TATI serum levels greater than 22 ng/ml were observed in 17/38 (44.7%) patients with ovarian carcinoma, in 3/61 (4.9%) with benign ovarian pathology, in 1/30 (3.3%) with cervical carcinoma and in 3/20 (15.0%) with endometrial carcinoma. CA 50 serum levels greater than 20 U/ml were found in 11/38 (28.9%) patients with ovarian carcinoma, in 19/61 (31.1%) with benign ovarian pathology, in 7/30 (23.3%) with cervical carcinoma and in 6/20 (30%) with endometrial carcinoma. This study confirmed that CA 125 is the most reliable marker for ovarian carcinoma; however TATI could have a role in the diagnostic evaluation of adnexal masses, because of its very good specificity, CA 125 and CA 50, but not TATI, could be of some benefit in the management of endometrial and cervical carcinoma.     

Accuracy of CA 125 in the diagnosis of ovarian tumors: a quantitative systematic review

A quantitative systematic review was performed to estimate the accuracy of CA 125 assay in the diagnosis of ovarian tumors. Studies that evaluated CA 125 levels for the diagnosis of ovarian tumors and compared them with paraffin-embedded sections as the diagnostic standard were included. Seventeen studies were analyzed, which included 2374 women. The pooled sensitivity for the diagnosis of borderline tumors or ovarian cancer was 0.80 (I.C. 95% 0.76-0.82) and the specificity was 0.75 (I.C. 95% 0.73-0.77). The diagnostic odds ratio for ovarian cancer and borderline lesions vs. benign lesions was 21.2 (95% C.I., 12-37). Summary receiver operating characteristic curves were constructed due to heterogeneity in the diagnostic odds ratio. For malignant and borderline ovarian tumors vs. benign lesions the area under the curve was 0.8877. A CA 125 level of >or= 35 U/ml is a useful preoperative test for predicting the benign or malignant nature of pelvic masses. The accuracy of CA 125 in the diagnosis of ovarian tumors is high and very important in helping the surgeon to decide what kind of surgery should be performed.     

The concomitant determination of different tumor markers in patients with epithelial ovarian cancer and benign ovarian masses: relevance for differential diagnosis.

The serum levels of CA 125 (cutoff limit, 65 U/ml), CA19.9 (cutoff, 40 U/ml), CA 15.3 (cutoff, 32 U/ml), CA72.4 (cutoff, 3.8 U/ml), and TATI (cutoff, 22 ng/ml) were preoperatively measured in 90 patients with epithelial ovarian cancer and in 254 patients with benign ovarian pathology. CA125 had a sensitivity of 75.6%, a specificity of 86.6%, and a diagnostic accuracy of 83.7% for epithelial ovarian cancer; CA19.9 had a sensitivity of 35.6%, a specificity of 81.1%, and a diagnostic accuracy of 69.2%; CA15.3 had a sensitivity of 57.1%, a specificity of 93.9%, and a diagnostic accuracy of 84.6%; CA72.4 had a sensitivity of 70.7%, a specificity of 91.8%, and a diagnostic accuracy of 86.2%; and TATI had a sensitivity of 47.3%, a specificity of 95.3%, and a diagnostic accuracy of 82.9%. CA 125 was the most sensitive marker for nonmucinous tumors, while CA19.9 and CA72.4 were the antigens more frequently expressed by mucinous malignancies. The sensitivities of serum CA 125 (81.1% vs 50.0%; P = 0.01) and TATI (55.2% vs 18.8%; P = 0.02) were higher in patients above 50 years of age than in younger patients while specificities were quite similar in both age groups. The association of serum CA125 and CA19.9 had a significantly higher sensitivity (93.2% vs 81.1%; P = 0.03) and a slightly lowered specificity (78.9% vs 86.0%; P = 0.46) than CA125 assay alone in the differential diagnosis of ovarian masses in patients above 50 years of age.     

The CA 125 assay as a predictor of clinical recurrence in epithelial ovarian cancer

Serum CA 125 levels were obtained from 55 women with epithelial ovarian cancer before a second-look surgical procedure and serially thereafter. All patients were clinically and radiographically free of tumor at the time of the second-look operation and were followed to clinical recurrence. Median follow-up was 12 months. CA 125 levels obtained at the second-look operation had a sensitivity and specificity for predicting clinical recurrence of 94% and 88%, respectively. Patients with an elevated CA 125 level (greater than or equal to 35 U/ml) had a 60% chance of clinical recurrence within 4 months, while patients with levels less than 35 U/ml had a 5% chance of clinical recurrence over the same time period. Serial CA 125 levels obtained after second-look operations were strong predictors of clinical outcome, and distinctly different monitoring profiles were observed among those patients remaining clinically free of tumor and those suffering clinical recurrence. The CA 125 assay became elevated (greater than or equal to 35 U/ml) before clinical recurrence in 94% of 35 cases with a median lead time of 3 months. The CA 125 assay identifies patients destined to suffer a clinical recurrence and provides a warning measurable in months. This may have important implications for therapy.     

CA125 Serum Levels and Secondary Laparotomy in Epithelial Ovarian Tumours

CA125 serum levels were assayed prior to 57 secondary laparotomies for ovarian epithelial tumours. Tumour was present in all 16 patients with an elevated level greater than 35 U/ml but the absence of tumour was incorrectly predicted in 15 of the 33 (45.5%) patients with CA125 levels less than 35 U/ml. For these patients the CA125 level was elevated in 14 of 20 (70%) with tumour greater than 1.5 cm, 1 of 7 (14.3%) with macroscopic tumour less than or equal to 1.5 cm and 1 of 4 (25%) with microscopic tumour. Tumour was resectable to less than or equal to 0.5 cm in 7 of 12 (58.3%) patients with CA125 less than 35 U/ml, 2 of 4 (50%) with CA125 in the range 35-100 U/ml and only 1 of 11 (9.1%) with CA125 greater than 100 U/ml (p less than .05). The CA125 level was elevated in 1 of 13 (7.7%) patients with less than 15 cm3 of tumour compared with 16 of 18 (88.9%) patients with 15 cm3 of tumour or more (p less than .0001). The correlation between the CA125 serum level and the tumour volume was almost statistically significant (r = +0.31, p = .053). The level of CA125 was normal in all 8 patients with mucinous tumours--4 of whom were found to have tumour at secondary surgery.(ABSTRACT TRUNCATED AT 250 WORDS)