Pancreatic cancer laboratory tests: Difference between revisions
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{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}};{{PSD}} | {{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}};{{PSD}} | ||
==Overview== | ==Overview== | ||
Laboratory findings in pancreatic [[cancer]] patients are often non specific and include abnormal [[liver function tests|liver function tests,]] elevated serum bilirubin levels (conjugated and total), elevated alkaline phosphatase levels and mild normocytic normochromic anemia. Patients may have evidence of malnutrition and elevated [[CA 19-9]] levels. | Laboratory findings in [[Pancreatic cancer|pancreatic]] [[cancer]] patients are often non specific and include abnormal [[liver function tests|liver function tests,]] elevated [[Bilirubin|serum bilirubin]] levels ([[Bilirubin|conjugated]] and total), elevated [[alkaline phosphatase]] levels and mild [[Anemia|normocytic normochromic anemia]]. Patients may have evidence of [[malnutrition]] and elevated [[CA 19-9]] levels. | ||
==Laboratory Findings== | ==Laboratory Findings== | ||
* Routine laboratory tests in pancreatic cancer patients are often non specific. | * Routine laboratory tests in [[pancreatic cancer]] patients are often non specific. | ||
* Common abnormalities include: | * Common abnormalities include: | ||
** Elevated serum bilirubin (conjugated and total) | ** Elevated [[Bilirubin|serum bilirubin]] (conjugated and total) | ||
** Elevated alkaline phosphatase levels | ** Elevated [[alkaline phosphatase]] levels | ||
** Elevated gamma-glutamyl transpeptidase levels | ** Elevated [[gamma-glutamyl transpeptidase]] levels | ||
** Normal/elevated aspartate aminotransferase and alanine aminotransferase | ** Normal/elevated [[Aspartate transaminase|aspartate aminotransferase]] and [[Alanine transaminase|alanine aminotransferase]] | ||
** Serum amylase and/or lipase levels are normal/elevated | ** [[Amylase|Serum amylase]] and/or [[lipase]] levels are normal/elevated | ||
** CBC shows: | ** [[Complete blood count|CBC]] shows: | ||
*** mild normocytic normochromic anemia | *** mild [[Anemia|normocytic normochromic anemia]] | ||
*** Thrombocytosis | *** [[Thrombocytosis]] | ||
** Laboratory evidence of malnutrition: | ** [[Medical laboratory|Laboratory]] evidence of [[malnutrition]]: | ||
*** Low serum albumin | *** Low serum [[albumin]] | ||
*** Low cholesterol level | *** Low [[cholesterol]] level | ||
==== CA 19-9 ==== | ==== CA 19-9 ==== | ||
* In cancer patients, CA 19-9 antigen is an oligosaccharide found on circulating mucins. | * In cancer patients, [[CA 19-9|CA 19-9 antigen]] is an [[oligosaccharide]] found on circulating [[Mucin|mucins]]. | ||
* CA 19-9 is elevated in case of biliary disease as it is produced within the cells of the biliary tract. | * [[CA 19-9]] is elevated in case of [[Bile duct|biliary]] disease as it is produced within the cells of the [[Bile duct|biliary]] tract. | ||
* The reference range of CA 19-9 is less than 35 U/mL. | * The reference range of [[CA 19-9]] is less than 35 U/mL. | ||
* Three fourths of the patients with pancreatic carcinoma have elevated CA 19-9 levels. | * Three fourths of the patients with [[Pancreatic cancer|pancreatic carcinoma]] have elevated [[CA 19-9]] levels. | ||
* CA 19-9 value of greater than 100 U/mL is highly specific for pancreatic cancer, in the absence of intrinsic liver disease or biliary obstruction. | * [[CA 19-9]] value of greater than 100 U/mL is highly specific for [[pancreatic cancer]], in the absence of intrinsic [[liver]] disease or [[Cholestasis|biliary obstruction]]. | ||
Role in prognosis | Role in [[prognosis]]: | ||
* Preoperative values above 50 U/mL have higher recurrence. | |||
* High levels indicate poorer outcome and low chance of resectability | |||
Role in treatment: | |||
Role in treatment | * To determine the resectability potential, [[CA 19-9]] levels are used as an adjunct to [[imaging]] studies. | ||
* To determine the resectability potential, CA 19-9 levels are used as an adjunct to imaging studies. | * Staging laproscopy prior to resection is not required in [[Patient|patients]] presenting with low levels of [[CA 19-9]] (< 100 IU) as they are unlikely to have occult [[Metastasis|metastatic]] disease. | ||
* Staging laproscopy prior to resection is not required in patients presenting with low levels of CA 19-9 (< 100 IU) as they are unlikely to have occult metastatic disease. | Role in assessing response to treatment: | ||
Role in assessing response to treatment | * A falling [[CA 19-9]] level is indicative of clinical response to [[therapy]] during treatment of [[pancreatic cancer]]. | ||
* A falling CA 19-9 level is indicative of clinical response to therapy during treatment of pancreatic cancer. | |||
==References== | ==References== | ||
Revision as of 21:25, 15 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2];Parminder Dhingra, M.D. [3]
Overview
Laboratory findings in pancreatic cancer patients are often non specific and include abnormal liver function tests, elevated serum bilirubin levels (conjugated and total), elevated alkaline phosphatase levels and mild normocytic normochromic anemia. Patients may have evidence of malnutrition and elevated CA 19-9 levels.
Laboratory Findings
- Routine laboratory tests in pancreatic cancer patients are often non specific.
- Common abnormalities include:
- Elevated serum bilirubin (conjugated and total)
- Elevated alkaline phosphatase levels
- Elevated gamma-glutamyl transpeptidase levels
- Normal/elevated aspartate aminotransferase and alanine aminotransferase
- Serum amylase and/or lipase levels are normal/elevated
- CBC shows:
- Laboratory evidence of malnutrition:
- Low serum albumin
- Low cholesterol level
CA 19-9
- In cancer patients, CA 19-9 antigen is an oligosaccharide found on circulating mucins.
- CA 19-9 is elevated in case of biliary disease as it is produced within the cells of the biliary tract.
- The reference range of CA 19-9 is less than 35 U/mL.
- Three fourths of the patients with pancreatic carcinoma have elevated CA 19-9 levels.
- CA 19-9 value of greater than 100 U/mL is highly specific for pancreatic cancer, in the absence of intrinsic liver disease or biliary obstruction.
Role in prognosis:
- Preoperative values above 50 U/mL have higher recurrence.
- High levels indicate poorer outcome and low chance of resectability
Role in treatment:
- To determine the resectability potential, CA 19-9 levels are used as an adjunct to imaging studies.
- Staging laproscopy prior to resection is not required in patients presenting with low levels of CA 19-9 (< 100 IU) as they are unlikely to have occult metastatic disease.
Role in assessing response to treatment:
- A falling CA 19-9 level is indicative of clinical response to therapy during treatment of pancreatic cancer.