Pancreatic cancer laboratory tests
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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 consistent with the diagnosis of pancreatic cancer 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:
- mild normocytic normochromic anemia
- Thrombocytosis
- 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
- CA 19-9 levels are of prognostic value:
- 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.