Post-treatment alterations of serum cancer antigen 125, cancer antigen 19.9 and carcinoembryonic antigen levels in patients with gynecological malignancies in a tertiary care hospital in eastern India

Soumyabrata Munshi, Aditi Kishore Shinde, Subhash Chandra Biswas, Avijit Hazra, Sasanka Chakrabarti


Background: Gynecological carcinomas form a significant proportion of all malignancies in women across the globe. These are associated with an increase in the serum concentrations of certain tumor markers such as cancer antigen (CA)125, CA19.9 and carcinoembryonic antigen (CEA) that correlate with the tumor burden.

Methods: Pre- and post-treatment serum levels of CA125, CA19.9 and CEA were determined in 36 patients of ovarian carcinoma, 31 patients of cervical carcinoma and 20 patients of endometrial carcinoma using enzyme-linked immunosorbent assay. The pre- and the post-treatment levels of these markers have been compared and correlated.

Results: With primary treatment, CA125 level was significantly reduced in ovarian, endometrial (ps < 0.001) and cervical (p = 0.001) carcinomas and that of CA19.9 was significantly decreased in cervical and endometrial carcinomas (ps < 0.001). Surprisingly, post-treatment CEA level was significantly increased in cervical carcinoma (p = 0.001) with significant increase after radiotherapy (p = 0.003), but not after surgery (p = 0.091). Treatment had no effects on CA19.9 level in ovarian carcinoma and on CEA levels in ovarian and endometrial carcinomas. Pre- and post-treatment levels of CA125, CA19.9 and CEA showed strong positive correlation in cervical carcinoma, while those of CA19.9 showed very strong positive correlation in endometrial carcinoma.

Conclusions: Post-treatment serum CA125 level best reflects the treatment effect in all three types of gynecological carcinomas. CA19.9 is reliable to evaluate treatment effect in patients of cervical and endometrial carcinomas. Studies involving larger population size should be conducted to identify the changes in CEA while assessing treatment effect in cervical carcinoma patients.


Cancer antigen 125, Cancer antigen 19.9, Carcinoembryonic antigen, Gynecological carcinoma, Enzyme linked immunosorbent assay

Full Text:



Mishra K. Gynaecological malignancies from palliative care perspective. Indian J Palliat Care. 2011;17 Suppl:S45-51.

Chhabra S, Sonak M, Prem V, Sharma S. Gynaecological malignancies in a rural institute in India. J Obstet Gynaecol. 2002;22(4):426-9.

Sarkar M, Konar H, Raut DK. Gynecological malignancies: epidemiological characteristics of the patients in a tertiary care hospital in India. Asian Pac J Cancer Prev. 2012;13(6):2997-3004.

Sankaranarayanan R, Ferlay J. Worldwide burden of gynaecological cancer: the size of the problem. Best Pract Res Clin Obstet Gynaecol. 2006;20(2):207-25.

Ueda Y, Enomoto T, Kimura T, Miyatake T, Yoshino K, Fujita M, et al. Serum biomarkers for early detection of gynecologic cancers. Cancers (Basel). 2010;2(2):1312-27.

Passerini R, Cassatella MC, Boveri S, Salvatici M, Radice D, Zorzino L, et al. The pitfalls of CA19-9: routine testing and comparison of two automated immunoassays in a reference oncology center. Am J Clin Pathol. 2012;138(2):281-7.

Neunteufel W, Bieglmayer C, Breitenecker G. CA19-9, CA125 and CEA in endometrial carcinoma tissue and its relation to hormone receptor content and histological grading. Arch Gynecol Obstet. 1988;244(1):47-52.

Paramasivam S, Tripcony L, Crandon A, Quinn M, Hammond I, Marsden D, et al. Prognostic importance of preoperative CA-125 in International Federation of Gynecology and Obstetrics stage I epithelial ovarian cancer: an Australian multicenter study. J Clin Oncol. 2005;23(25):5938-42.

Dorigo O, Berek JS. Personalizing CA125 levels for ovarian cancer screening. Cancer Prev Res (Phila). 2011;4(9):1356-9.

Sørensen SS, Mosgaard BJ. Combination of cancer antigen 125 and carcinoembryonic antigen can improve ovarian cancer diagnosis. Dan Med Bull. 2011;58(11):A4331.

Sturgeon CM, Duffy MJ, Stenman UH, Lilja H, Brünner N, Chan DW, et al. National Academy of Clinical Biochemistry laboratory medicine practice guidelines for use of tumor markers in testicular, prostate, colorectal, breast, and ovarian cancers. Clin Chem. 2008;54(12):e11-79.

van Nagell JR Jr, Donaldson ES, Wood EG, Goldenberg DM. The clinical significance of carcinoembryonic antigen in the plasma and tumors of patients with gynecologic malignancies. Cancer. 1978;42 (3 Suppl):1527-32.

Eagle K, Ledermann JA. Tumor Markers in Ovarian Malignancies. Oncologist. 1997;2(5):324-29.

Wong LC, Ngan HY, Cheung AN, Cheng DK, Ng TY, Choy DT. Chemoradiation and adjuvant chemotherapy in cervical cancer. J Clin Oncol. 1999;17(7):2055-60.

Lee LJ, Sadow CA, Russell A, Viswanathan AN. Correlation of point B and lymph node dose in 3D-planned high-dose-rate cervical cancer brachytherapy. Int J Radiat Oncol Biol Phys. 2009;75(3):803-9.

Mukaka MM. Statistics corner: a guide to appropriate use of correlation coefficient in medical research. Malawi Med J. 2012;24(3):69-71.

van Nagell JR Jr, Donaldson ES, Hanson MB, Gay EC, Pavlik EJ. Biochemical markers in the plasma and tumors of patients with gynecologic malignancies. Cancer. 1981;48 (2 Suppl):495-503.

Cruickshank DJ, Fullerton WT, Klopper A. The clinical significance of pre-operative serum CA 125 in ovarian cancer. Br J Obstet Gynaecol. 1987;94(7):692-5.

Gadducci A, Cosio S, Fanucchi A, Negri S, Cristofani R, Genazzani AR. The predictive and prognostic value of serum CA 125 half-life during paclitaxel/platinum-based chemotherapy in patients with advanced ovarian carcinoma. Gynecol Oncol. 2004;93(1):131-6.

Sturgeon C. Practice guidelines for tumor marker use in the clinic. Clin Chem. 2002;48(8):1151-9.