Could shingles vaccine have caused a spike in CA-125?
DEAR DR. ROACH: I have a history of cancer with an elevated CA-125 level. Recently I had a shingles shot and soon thereafter, my CA-125 level was high. An extensive workup showed up nothing significant, and a repeat CA-125 level was back down to normal. Could the shingles shot have elevated my CA-125 level? -- K.R.
ANSWER: CA-125 is a tumor marker most commonly used for ovarian cancer. Although not all ovarian cancers have a high CA-125 level, the measure of this marker can be useful in following women with ovarian cancer and in evaluating women with a possible ovarian mass.
CA-125 is not specific for ovarian cancer. Many other conditions can increase the level. I could not find any reports of a vaccine causing a temporary increase in CA-125. One of the most common reasons for the CA-125 level to increase temporarily is menstruation, but there are others, including urine infection, diverticulitis and pneumonia. It's possible it was the vaccine, but it also might have been some other condition that resolved on its own.
Because the CA-125 level is neither sensitive nor specific, it is not recommended for screening for ovarian cancer in average-risk women.
DEAR DR. ROACH: My son lost his spleen in an accident several years ago, and I understand his immune system is therefore compromised.
I have never heard of, and can find no evidence of, transplanting a spleen. He is very conscientious in doing what he can to avoid exposure at this dangerous time, but I am wondering what he and others with his condition can do to further protect themselves. -- B.S.
ANSWER: The spleen is an organ that removes damaged blood cells, but it is also an important part of the immune system, and acts as a kind of super lymph node -- a place where white blood cells congregate and become activated. People without spleens are primarily at risk due to the immune system effects, as the liver takes over the job of removing worn-out blood cells.
Spleen transplants have been tried, but are not likely to be successful as a single organ transplant. However, in people who are undergoing a multiple visceral organ transplant (stomach, intestine, pancreas, with or without liver), spleen transplants have been done successfully at the same time. You haven't heard much about these kinds of transplants as they are quite uncommon compared with kidney, liver or heart transplants.
People without spleens are particularly at risk from infections from bacteria with capsules, such as streptococcus pneumoniae and salmonella species. Whenever possible, people are immunized for encapsulated organisms (including haemophilus influenzae type B and neisseria meningitidis in addition to the pneumonia vaccines) before the spleen is removed. In people who lose their spleen to trauma, this is often impossible, so the vaccines are given at least 14 days after the spleen is removed.
In addition to vaccination, I recommend a medical alert identifier (such as a wallet card or jewelry) with his information about the splenectomy, and he and his doctors should treat any fever over 38.3 C (101 F) as a medical emergency. Some doctors prescribe antibiotics to use in certain circumstances while awaiting medical care. Your son should be very careful with international travel, as some infections (especially malaria) are quite dangerous to people without a spleen. Consultation with a travel expert is wise. Animal and tick bites pose a greater threat, and he should likewise seek prompt evaluation and treatment.