CA125 Expression Mechanismon Cervicaland Vaginal Secresion In Patients With Cervical And Endometrial Lesions And Clinical Significance

Cervical and endometrial diseases are common in women, and their malignant lesions,cervical cancer and endometrial cancer, are threatening severely to women's health and lives. Therefore to explore a simple, high sensitive and specific detection method is important significance in their early diagnosis and prognosis.CA125,a cell surface molecule glycoprotein, is recognized as a gynecological tumor associated marker. Since CA125 has been discoved, domestic and foreign scholars mainly focus on the study of serum CA125, and has obtained obvious achievement. However, with the clinical practice in-depth and experience accumulation, it appeared that serum CA125 detection is not very sensitive and specific in diagnosis of cervical and endometrial pathological lesions. Therefore, It is necessary to find another clinical pathway and method to compensate for the weakness of serum CA125 in the diagnosis.Detection of the tumor makers in relevant body fluids (such as saliva, pleural effusion, ascites, etc.) and tissues have been applied, although the sensitivity and specificity are higher than that in serum,but at present it is found that rare perform with its clinical application. Abnormal elevation of CA125 is mainly caused by hyperplasia of relevant rich CA125 antigen tissues. As a result, we speculated that CA125 in the relevant body fluids and tissues should be able to more easily and directly detected, and should be more sensitive and specific than that in serum in the diagnosis of associated diseases.Cervical, vaginal secretions are mainly a liquid secreted from cervical and endometrial glands. According to its cell physiological and anatomic characters, certain soluble proteins secreted from cervical, endometrial lesions cell may be directly into the cervical and vaginal secretions. Therefore, the detection of CA125 levels in cervical and vaginal secretions may be more sensitive than that in serum. On the other hand, cervical and vaginal secretions are easy to collect, its method is simple, painless, safe and non-invasive, as well as can be repeatedly collected and detected, thus easy to be accepted by patients. In clinical practise, we found that CA125 in cervical and vaginal secretions also had been expressed.Subsequently,we performed a early pre-trial.The primary result shows that there are different CA125 expression and changing levels in cervical, endometrial benign and malignant pathological lesions.Regarding the research on CA125 expression in cervical, vaginal secretions and its clinical significance, has not been reported yet in domestic and abroad reference. This topic aims to explore CA125 expression on cervical, endometrial secresions in patients with cervical and vaginal pathological lesions, and to dynamically observe CA125 changing trend in endometrial and cervical benign and malignant pathological lesions.Initially to determine a normal and abnormal CA125 limited data in cervical and vaginal secretions, so as to provide a new and reliable detection pathway and a more sensitive and specific detection index in early diagnosis, prognosis and prevention for endometrial cancer and cervical cancer.Chapter 1 CA125 Expression Mechanism on Cervical and Vaginal Secretions in Women with Normal Procreating PeriodContents and MethodsTo investigate the tumor-associated antigen,CA 125 expression on cervical secretion, vaginal secretion and serum in women with normal procreating period, and to explore the initial detective value of tumor markers in cervical and vaginal secretions.147.cases were divided into 3 groups:Group1(20-29ages), group2(30-39ages),groups3 (over 40ages), and their CA125 level in cervical secretion, vaginal secretion and serum were detected by automatic electro-chemiluminescent immunoassay. Among 147 cases,28 cervical specimens,24 normal proliferative phase endometrial samples and 21 secretory phase endometrium specimens were selected randomly,and were analysed by CA125 immunohistochemistry.Results1. CA125 was expressed in 96.4% of the cervical glandular epithelial cells,and was expressed weakly possitive in normal endometrial glands; CA125 expression on local tissue was not related with endometrial cycle (P=1.000).2,There is no significant difference in CA 125 level of cervical secretion, vaginal secretion and serum among various age groups women with normal procreating period (P=0.713,P=0.553,P=0.880);3,Among 147 cases,CA125 average level in cervical secretions, vaginal secretions, compared the CA125 average level in serum, there was obvious significant difference (P=0.000);4, The normal upper limit:CA125 in vaginal secretion was170U/ml, in cervical secretion was 648U/ml, in serum was 35U/ml.SummaryThere is CA125 expression on endometrium and cervical epithelium cells in women with nornal procreating period, and its local expression is not related with the endometrial physiological cycle. There is CA125 expression on cervical and vaginal secretions in women with normal procreating period, and its level is significantly higher than that in serum, thus,it may be more convenient in early detection of vagina and uterus diseases.Chapter2 CA-125 Expression Mechanism on Cervical and Vaginal Secretions in Patients with Normal Endometrial and Its Pathological LesionsContents and MethodsTo investigate the tumor-associated antigen CA 125 expression on endometrial tissues in women with normal endometrial and its related pathological lesions,and to explore CA125 expression mechanism on cervical secretion, vaginal secretion and serum the initial detective value of the tumor marker in cervical and vaginal secretions.147 women with normal procreating period as controlled group; 148 cases with abnormal menstrual period or irregular vaginal bleeding were selected randomly from our hospital as trial group, and were divided into 6 groups:1.proliferative phase endometrium group,2.secretory phase endometrium group,3.non-functional endometrial polyps group,4.simple hyperplasia group,5.complex hyperplasia group,and 6. endometrial carcinoma group (below was ordinal group 1 to group 6); Their CA125 levels in cervical secretion, vaginal secretion and serum were detected by automatic electro-chemiluminescent immunoassay. Total 242 cases were randomly selected and performed by sub-curettage or hysteroscopy to collect endometrial specimens and to analysed by immunohistochemistry.Among them, 140 cases from trial group,97 cases with endometrial adenocarcinoma and 5 cases with complex endometrial hyperplasia selected from our hospital last 5 years,Results1.There was CA125 weak expression in normal endometrium and simple endometrium hyperplasia; CA125 expression in non-functional polyps and complex hyperplasia was significantly increased;There were differences in three kinds of benign endometrial lesions (χ2=41.055, P=0.000);2. CA125 expression in endometrial carcinoma tissues was significantly stronger than that in benign lesions, but expression level in pathological gradeⅠ,Ⅱwas significantly stronger than that in in gradeⅢ(χ2=15.635, P=0.000);3. With the pathological evolvement from benign endometrial lesions to malignant lesion,CA125 level in cervical and vaginal secretions also is increasing accordingly.4.There was no difference of CA125 level in serum compared with its normal upper limited level in endometrial carcinoma group;But there was significant difference of CA 125 level in cervical and vagina secretions compared with its normal upper limited level (vagina secretions t=4.408, P=0.000; cervical secretions t=4.262, P=0.000);6. CA125 detection by cervical secretion and vaginal secretion are more sensitive than that by serum (Q=18.421, P=0.000); while their specificy was significant difference (Q=8.000 P=0.018). CA125 levels in cervical secretion is more evaluable in early diagnosis of endometrial carcinoma.SummaryThere is CA125 expression on cervical and vaginal secretions in patients with normal endometrial and its related pathological lesions, both of CA125 levels in cervical and vaginal secretions are significantly higher than that in serum..With the pathological evolvement from benign endometrial lesions to malignant lesion,CA125 level in cervical and vaginal secretions also is increased accordingly. CA125 detection by cervical secretion is more sensitive and specificy. Moreover, it may be more evaluable in early diagnosis of endometrial carcinoma.Chapter3 CA 125 Expression Mechanism on Cervical and Vaginal Secretions in Patients with Normal Cervical and Its Related DiseasesContents and MethodsTo investigate the tumor-associated antigen, CA 125 expression mechanism on cervical and vaginal secretion in patients with different kinds of cervical pathological lesions.147 women with normal procreating period as control group. 105 cases diagnosed with cervical lesions and performed biopsy or surgical resection as trial group,and were divided into 1-5 group:CINⅠ-Ⅱ, CINⅢ(DCIS), invasive cervical cancer, well-differentiated cervical adenocarcinoma, poorly differentiated cervical adenocarcinoma. While the control group, randomly selected 28 cases with normal cervical samples as the clinical pathological group.Immunohistochemistry analysis were performed by the way of CA125 monoclonal antibody. CA125 expression sites on the biopsy or surgical specimen were observed.CA125 levels in cervical secretion, vaginal secretion and serum were detected by automatic electro-chemiluminescent immunoassay.Results1. There is no diference of expression rate on the free margin of glandular epithelial cells and hyperplasia epithelial cells between trial group and control group, there is diference on the gland cavity,dysplastic cell and tumor cell (the value ofχ2 and P as follows respectively:χ2=5.265 P=0.032.χ2=20 P=0.000).2.CA125 expression in abnormal dysplastic squamous cells/tumor cells, with the depth of invasion or the degree of differentiation increased were weaken.3.It was lowly expressed in normal cervical tissue,, and was highly expressed in cervical pathological tissues.4. In trial group,CA125 average level in cervical and vaginal secretions was 746.75±182.48 and 180.92±69.069 U/ml respectively, compared with the control group, there was significant difference (P=0.000).5.Surgical treatment and follow-up were taken in CINⅠ-Ⅱgroup. After surgical treatment,CA125 average level in vaginal secretions was 117.53±14.79 U/ml,, compared with the preoperative level,there was significant difference.6. The early diagnostic sensitivity of CA125 in cervical, vaginal secretions were higher than that in serum (Q=30.000, P=0.000), while their specificy was significant difference (Q=8.000 P=0.018). CA125 detection by cervical secretion is more sensitive and specific. Moreover, it may be more evaluable in early diagnosis of early cervical malignant pathological lesions.SummaryCA125 in cervical lesions and cervical normal tissues were expressed. With cervical epithelial dysplasia from mild to moderate and severe dysplasia development, CA125 level in cervical, vaginal secretions gradually increased.From CINⅢprogress to invasive cervical carcinoma,.CA125 expression in cervical, vaginal secretions also with the degree of tumor infiltration or increased differentiation weakened. CA125 detection by cervical secretion is more sensitive and specific. Determination of CA125 in cervical, vaginal secretions is contribute to early diagnosis of cervical lesions, efficacy and recurrence tracking.Conclusion1,There is CA125 expression on cervical and vaginal secretions in women with normal procreating period, endometrial related pathological lesions,and cervical related pathological lesions; both of CA125 levels in cervical and vaginal secretion are significantly higher than that in serum;2,With the pathological evolvement from benign endometrium to malignant lesion,and from CINⅠto CINⅢ,the CA125 expression also was more prominent accordingly; from CINⅢ(Carcinoma in situ) to invasive cervical cancer, the CA125 expression on cervical and vaginal secretions with the depth of invasion or increase the degree of differentiation were weaken. 3,In the early detecting of cervical early malignant lesions and endometrial malignant lesions, CA125 level in cervical secretion compared with that in seruml and vaginal secretion is more sensitive and the specificity does not decline. Thus, CA125 expression on cervical secretion and vaginal secretion maybe more useful in early diagnosis, efficacy evaluation and tracking to recurrence of endometrial and cervical related pathological lesions.