In a postmenopausal patient with an ovarian cyst, which test helps assess risk of malignancy?

• A. CA-125
• B. Serial pelvic ultrasound
• C. Biopsy
• D. Observation

Answer: (A)

CA-125 helps assess risk of ovarian malignancy in a postmenopausal patient with an ovarian cyst. This tumor marker tends to be elevated in epithelial ovarian cancers, and in postmenopause elevations are more concerning because benign causes are less common. A CA-125 level above the normal threshold raises suspicion and helps stratify patients for further evaluation or referral for surgical assessment, especially when imaging shows a complex or solid cyst. Interpret the result alongside ultrasound findings, since a simple cyst with a normal CA-125 is less worrisome, while a complex cyst with an elevated CA-125 increases the likelihood of malignancy. Serial ultrasound monitors size and features but does not provide a direct risk assessment, and biopsy is not routinely used for ovarian masses due to risks and the need for surgical pathology for diagnosis. Observation alone is not appropriate when malignancy risk exists.