Uterine Fibroids, Teratomas, and CA125 Levels in Women

Uterine fibroids, teratomas, CA-125?

Hello Dr.
Huang, I have a few questions I would like to ask.
During a health check-up, my CA-125 levels were found to be elevated, so I sought treatment at the gynecology department of National Taiwan University Hospital.
A vaginal ultrasound revealed a 5 cm uterine fibroid, adenomyosis, and a small chocolate cyst on the ovary.
The doctor mentioned that the elevated CA-125 could be related to the fibroid and advised not to worry.
Subsequently, I switched to abdominal ultrasound for follow-up and did not continue monitoring CA-125 levels.
Later, during a CT scan at Chi Mei Medical Center in southern Taiwan, a mature teratoma was found on the right ovary along with a 6 cm fibroid.
However, due to health issues, I returned to the south for recovery and have not yet found a regular gynecologist for consultation.

Additionally, I have been experiencing anal fissures for over two years, which have developed into chronic fissures.
A colorectal surgeon noted that my anal sphincter is tighter and stronger, which contributes to the fissures.
Therefore, I would like to ask Dr.
Huang:
1.
Is it possible for a 6 cm uterine fibroid to compress the rectum or anus, causing excessive tightness in the sphincter? (I am concerned that the fibroid may be the cause, but if I undergo surgery thinking it is solely a sphincter issue, could the situation worsen if the fibroid issue improves, leading to excessive looseness in the sphincter?)
2.
Is surgical removal of a teratoma generally recommended? Can the teratoma and fibroid be removed without removing the uterus? (Although the doctor suggested that if the fibroid is to be removed, the uterus should also be taken out, I am worried about potential complications from removing the uterus, even though I understand that fibroids can easily recur...)
3.
Although I have not continued monitoring CA-125 levels, I am concerned that the teratoma could be malignant, which might explain the elevated CA-125 (since the CA-125 test at National Taiwan University only detected the fibroid and did not identify the teratoma).

Thank you, Dr.
Huang, for your patience in reading this.
I appreciate it.

Niming, 30~39 year old female. Ask Date: 2021/03/27

Dr. Huang Yuande reply Obstetrics and Gynecology

1.
A 6 cm fibroid is unlikely to cause significant pressure symptoms; confirming its location should provide clarity.
2.
Although teratomas are mostly benign, it is still recommended to remove them, as laparoscopic surgery is not difficult.
3.
CA-125 levels will not be elevated in teratomas.
Thank you for your inquiry.

Reply Date: 2021/03/27

More Info

Understanding the relationship between uterine fibroids, teratomas, and CA125 levels is crucial for women experiencing gynecological issues. CA125 is a protein that is often elevated in women with certain conditions, particularly those related to the reproductive system. It is important to note that while CA125 can be a useful marker, it is not specific to any one condition and can be influenced by various factors, including the presence of fibroids, endometriosis, and even benign conditions.

1. Impact of Uterine Fibroids on Rectal and Anal Pressure: A 6 cm uterine fibroid can indeed exert pressure on surrounding structures, including the rectum and anal canal. This pressure can lead to symptoms such as constipation or discomfort during bowel movements, which may contribute to anal fissures or chronic anal fissure issues. If the fibroid is causing significant pressure, it may lead to increased tension in the anal sphincter, potentially resulting in a tighter sphincter muscle. If the fibroid is removed and the pressure is alleviated, it is possible that the anal sphincter may relax, but this would depend on the individual’s anatomy and the extent of the fibroid's impact. It is essential to have a thorough evaluation by a gynecologist and possibly a colorectal specialist to determine the best course of action.

2. Management of Teratomas: Teratomas, particularly mature teratomas, are generally benign tumors that can contain various types of tissues, including hair, muscle, and fat. Surgical removal is often recommended, especially if the teratoma is symptomatic or growing. The decision to remove both the teratoma and the fibroid should be made in consultation with a gynecologist. If the fibroid is causing significant symptoms, removal may be warranted. However, the concern about removing the uterus (hysterectomy) should be discussed thoroughly with your doctor, as it can have implications for future fertility and hormonal balance. In some cases, myomectomy (removal of fibroids while preserving the uterus) may be an option, depending on the size and location of the fibroids.

3. CA125 Levels and Malignancy Concerns: While elevated CA125 levels can be concerning, it is important to remember that many benign conditions can cause an increase in CA125. The presence of fibroids and endometriosis are common reasons for elevated CA125 levels. Mature teratomas are typically benign, but if there are concerns about the nature of the teratoma (e.g., if it appears atypical on imaging), further evaluation may be necessary. It is advisable to follow up with imaging studies and possibly repeat CA125 testing after any surgical intervention to monitor changes in levels.

In summary, it is essential to have a comprehensive approach to managing these conditions. Regular follow-ups with a gynecologist, possibly a colorectal specialist for the anal fissure issues, and imaging studies will provide a clearer picture of your health status. Surgical options should be discussed in detail, weighing the benefits and risks of each procedure. It is also crucial to address any concerns regarding malignancy with your healthcare provider, who can guide you through the necessary evaluations and reassure you based on your specific circumstances.

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