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==== CA 19-9 ====
==== CA 19-9 ====
* In cancer patients, [[CA 19-9|CA 19-9 antigen]] is an [[oligosaccharide]] found on circulating [[Mucin|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 [[Bile duct|biliary]] disease as it is produced within the cells of the [[Bile duct|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.<ref name="pmid19829841">{{cite journal |vauthors=Marcouizos G, Ignatiadou E, Papanikolaou GE, Ziogas D, Fatouros M |title=Highly elevated serum levels of CA 19-9 in choledocholithiasis: a case report |journal=Cases J |volume=2 |issue= |pages=6662 |year=2009 |pmid=19829841 |pmc=2740064 |doi=10.4076/1757-1626-2-6662 |url=}}</ref>
* 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.<ref name="pmid17060676">{{cite journal |vauthors=Locker GY, Hamilton S, Harris J, Jessup JM, Kemeny N, Macdonald JS, Somerfield MR, Hayes DF, Bast RC |title=ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer |journal=J. Clin. Oncol. |volume=24 |issue=33 |pages=5313–27 |year=2006 |pmid=17060676 |doi=10.1200/JCO.2006.08.2644 |url=}}</ref>
* Three fourths of the patients with [[Pancreatic cancer|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 [[Cholestasis|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]].<ref name="pmid17060676">{{cite journal |vauthors=Locker GY, Hamilton S, Harris J, Jessup JM, Kemeny N, Macdonald JS, Somerfield MR, Hayes DF, Bast RC |title=ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer |journal=J. Clin. Oncol. |volume=24 |issue=33 |pages=5313–27 |year=2006 |pmid=17060676 |doi=10.1200/JCO.2006.08.2644 |url=}}</ref>
Role in [[prognosis]]:
Role in [[prognosis]]:<ref name="pmid18040617">{{cite journal |vauthors=Fujioka S, Misawa T, Okamoto T, Gocho T, Futagawa Y, Ishida Y, Yanaga K |title=Preoperative serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels for the evaluation of curability and resectability in patients with pancreatic adenocarcinoma |journal=J Hepatobiliary Pancreat Surg |volume=14 |issue=6 |pages=539–44 |year=2007 |pmid=18040617 |doi=10.1007/s00534-006-1184-3 |url=}}</ref><ref name="pmid17418869">{{cite journal |vauthors=Kang CM, Kim JY, Choi GH, Kim KS, Choi JS, Lee WJ, Kim BR |title=The use of adjusted preoperative CA 19-9 to predict the recurrence of resectable pancreatic cancer |journal=J. Surg. Res. |volume=140 |issue=1 |pages=31–5 |year=2007 |pmid=17418869 |doi=10.1016/j.jss.2006.10.007 |url=}}</ref><ref name="pmid2930108">{{cite journal |vauthors=Pleskow DK, Berger HJ, Gyves J, Allen E, McLean A, Podolsky DK |title=Evaluation of a serologic marker, CA19-9, in the diagnosis of pancreatic cancer |journal=Ann. Intern. Med. |volume=110 |issue=9 |pages=704–9 |year=1989 |pmid=2930108 |doi= |url=}}</ref><ref name="pmid17043274">{{cite journal |vauthors=Cwik G, Wallner G, Skoczylas T, Ciechanski A, Zinkiewicz K |title=Cancer antigens 19-9 and 125 in the differential diagnosis of pancreatic mass lesions |journal=Arch Surg |volume=141 |issue=10 |pages=968–73; discussion 974 |year=2006 |pmid=17043274 |doi=10.1001/archsurg.141.10.968 |url=}}</ref><ref name="pmid8799418">{{cite journal |vauthors=van den Bosch RP, van Eijck CH, Mulder PG, Jeekel J |title=Serum CA19-9 determination in the management of pancreatic cancer |journal=Hepatogastroenterology |volume=43 |issue=9 |pages=710–3 |year=1996 |pmid=8799418 |doi= |url=}}</ref><ref name="pmid2834038">{{cite journal |vauthors=Paganuzzi M, Onetto M, Marroni P, Barone D, Conio M, Aste H, Pugliese V |title=CA 19-9 and CA 50 in benign and malignant pancreatic and biliary diseases |journal=Cancer |volume=61 |issue=10 |pages=2100–8 |year=1988 |pmid=2834038 |doi= |url=}}</ref><ref name="pmid22203495">{{cite journal |vauthors=Molina V, Visa L, Conill C, Navarro S, Escudero JM, Auge JM, Filella X, Lopez-Boado MA, Ferrer J, Fernandez-Cruz L, Molina R |title=CA 19-9 in pancreatic cancer: retrospective evaluation of patients with suspicion of pancreatic cancer |journal=Tumour Biol. |volume=33 |issue=3 |pages=799–807 |year=2012 |pmid=22203495 |doi=10.1007/s13277-011-0297-8 |url=}}</ref>
* Preoperative values above 50 U/mL have higher recurrence.  
* Preoperative values above 50 U/mL have higher recurrence.  
* High levels indicate poorer outcome and low chance of resectability
* High levels indicate poorer outcome and low chance of resectability
Role in treatment:
Role in treatment:<ref name="pmid17060676">{{cite journal |vauthors=Locker GY, Hamilton S, Harris J, Jessup JM, Kemeny N, Macdonald JS, Somerfield MR, Hayes DF, Bast RC |title=ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer |journal=J. Clin. Oncol. |volume=24 |issue=33 |pages=5313–27 |year=2006 |pmid=17060676 |doi=10.1200/JCO.2006.08.2644 |url=}}</ref><ref name="pmid2183589">{{cite journal |vauthors=Steinberg W |title=The clinical utility of the CA 19-9 tumor-associated antigen |journal=Am. J. Gastroenterol. |volume=85 |issue=4 |pages=350–5 |year=1990 |pmid=2183589 |doi= |url=}}</ref><ref name="pmid17097848">{{cite journal |vauthors=Goonetilleke KS, Siriwardena AK |title=Systematic review of carbohydrate antigen (CA 19-9) as a biochemical marker in the diagnosis of pancreatic cancer |journal=Eur J Surg Oncol |volume=33 |issue=3 |pages=266–70 |year=2007 |pmid=17097848 |doi=10.1016/j.ejso.2006.10.004 |url=}}</ref>
* 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 [[Patient|patients]] presenting with low levels of [[CA 19-9]] (< 100 IU)  as they are unlikely to have occult [[Metastasis|metastatic]] disease.  
Role in assessing response to treatment:
Role in assessing response to treatment:<ref name="pmid18040617">{{cite journal |vauthors=Fujioka S, Misawa T, Okamoto T, Gocho T, Futagawa Y, Ishida Y, Yanaga K |title=Preoperative serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels for the evaluation of curability and resectability in patients with pancreatic adenocarcinoma |journal=J Hepatobiliary Pancreat Surg |volume=14 |issue=6 |pages=539–44 |year=2007 |pmid=18040617 |doi=10.1007/s00534-006-1184-3 |url=}}</ref><ref name="pmid10579989">{{cite journal |vauthors=DiMagno EP, Reber HA, Tempero MA |title=AGA technical review on the epidemiology, diagnosis, and treatment of pancreatic ductal adenocarcinoma. American Gastroenterological Association |journal=Gastroenterology |volume=117 |issue=6 |pages=1464–84 |year=1999 |pmid=10579989 |doi= |url=}}</ref><ref name="pmid2183589">{{cite journal |vauthors=Steinberg W |title=The clinical utility of the CA 19-9 tumor-associated antigen |journal=Am. J. Gastroenterol. |volume=85 |issue=4 |pages=350–5 |year=1990 |pmid=2183589 |doi= |url=}}</ref><ref name="pmid10436809">{{cite journal |vauthors=Lamerz R |title=Role of tumour markers, cytogenetics |journal=Ann. Oncol. |volume=10 Suppl 4 |issue= |pages=145–9 |year=1999 |pmid=10436809 |doi= |url=}}</ref>
* 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]].  


Revision as of 21:39, 15 November 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Sudarshana Datta, MD [2]

Overview

Laboratory findings in pancreatic cancer patients are often non specific and include abnormal liver function tests such as elevated serum bilirubin levels (conjugated and total), elevated alkaline phosphatase and gamma-glutamyl transpeptidase levels. Patients may have evidence of malnutrition, mild normocytic normochromic anemia and elevated CA 19-9 levels.

Laboratory Findings

CA 19-9

Role in prognosis:[3][4][5][6][7][8][9]

  • Preoperative values above 50 U/mL have higher recurrence.
  • High levels indicate poorer outcome and low chance of resectability

Role in treatment:[2][10][11]

  • 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:[3][12][10][13]

References

  1. ↑ Marcouizos G, Ignatiadou E, Papanikolaou GE, Ziogas D, Fatouros M (2009). "Highly elevated serum levels of CA 19-9 in choledocholithiasis: a case report". Cases J. 2: 6662. doi:10.4076/1757-1626-2-6662. PMC 2740064. PMID 19829841.
  2. ↑ 2.0 2.1 2.2 Locker GY, Hamilton S, Harris J, Jessup JM, Kemeny N, Macdonald JS, Somerfield MR, Hayes DF, Bast RC (2006). "ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer". J. Clin. Oncol. 24 (33): 5313–27. doi:10.1200/JCO.2006.08.2644. PMID 17060676.
  3. ↑ 3.0 3.1 Fujioka S, Misawa T, Okamoto T, Gocho T, Futagawa Y, Ishida Y, Yanaga K (2007). "Preoperative serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels for the evaluation of curability and resectability in patients with pancreatic adenocarcinoma". J Hepatobiliary Pancreat Surg. 14 (6): 539–44. doi:10.1007/s00534-006-1184-3. PMID 18040617.
  4. ↑ Kang CM, Kim JY, Choi GH, Kim KS, Choi JS, Lee WJ, Kim BR (2007). "The use of adjusted preoperative CA 19-9 to predict the recurrence of resectable pancreatic cancer". J. Surg. Res. 140 (1): 31–5. doi:10.1016/j.jss.2006.10.007. PMID 17418869.
  5. ↑ Pleskow DK, Berger HJ, Gyves J, Allen E, McLean A, Podolsky DK (1989). "Evaluation of a serologic marker, CA19-9, in the diagnosis of pancreatic cancer". Ann. Intern. Med. 110 (9): 704–9. PMID 2930108.
  6. ↑ Cwik G, Wallner G, Skoczylas T, Ciechanski A, Zinkiewicz K (2006). "Cancer antigens 19-9 and 125 in the differential diagnosis of pancreatic mass lesions". Arch Surg. 141 (10): 968–73, discussion 974. doi:10.1001/archsurg.141.10.968. PMID 17043274.
  7. ↑ van den Bosch RP, van Eijck CH, Mulder PG, Jeekel J (1996). "Serum CA19-9 determination in the management of pancreatic cancer". Hepatogastroenterology. 43 (9): 710–3. PMID 8799418.
  8. ↑ Paganuzzi M, Onetto M, Marroni P, Barone D, Conio M, Aste H, Pugliese V (1988). "CA 19-9 and CA 50 in benign and malignant pancreatic and biliary diseases". Cancer. 61 (10): 2100–8. PMID 2834038.
  9. ↑ Molina V, Visa L, Conill C, Navarro S, Escudero JM, Auge JM, Filella X, Lopez-Boado MA, Ferrer J, Fernandez-Cruz L, Molina R (2012). "CA 19-9 in pancreatic cancer: retrospective evaluation of patients with suspicion of pancreatic cancer". Tumour Biol. 33 (3): 799–807. doi:10.1007/s13277-011-0297-8. PMID 22203495.
  10. ↑ 10.0 10.1 Steinberg W (1990). "The clinical utility of the CA 19-9 tumor-associated antigen". Am. J. Gastroenterol. 85 (4): 350–5. PMID 2183589.
  11. ↑ Goonetilleke KS, Siriwardena AK (2007). "Systematic review of carbohydrate antigen (CA 19-9) as a biochemical marker in the diagnosis of pancreatic cancer". Eur J Surg Oncol. 33 (3): 266–70. doi:10.1016/j.ejso.2006.10.004. PMID 17097848.
  12. ↑ DiMagno EP, Reber HA, Tempero MA (1999). "AGA technical review on the epidemiology, diagnosis, and treatment of pancreatic ductal adenocarcinoma. American Gastroenterological Association". Gastroenterology. 117 (6): 1464–84. PMID 10579989.
  13. ↑ Lamerz R (1999). "Role of tumour markers, cytogenetics". Ann. Oncol. 10 Suppl 4: 145–9. PMID 10436809.


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