Literature Search And Data Extraction Strategy
A computerised search was made of the MEDLINE database for the period from January 1990 to December 2005 inclusive. The OVID search engine was employed. The MESH headings Pancreatic neoplasm, diagnosis, CA19-9, CA 50, CEA, Dupan-2, Span-1, Serum tumour markers were used. The search was restricted to articles in English and documents relating to humans. This resulted in 348 hits. The abstracts of these reports were then retrieved and studied. At
What Is This Test
This test looks for the antigen called cancer antigen 19-9 in your blood.
Antigens are substances that stimulate your body’s immune system. Some types of cancer cells send CA 19-9 into the blood, where it can be measured with this test.
A high amount of CA 19-9 is most often caused by pancreatic cancer. But it can also be caused by other types of cancer. And it can be caused by infections in your liver, gallbladder, and pancreas.
Antigens like CA 19-9 that give information about cancer are called tumor markers. This test is not used as a screening test for cancer.
Predicting Adverse Pathologic Features And Clinical Outcomes Of Resectable Pancreas Cancer With Preoperative Ca 19
- 1Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
- 2Department of Pathology, Mayo Clinic, Rochester, MN, United States
- 3Department of Statistics, Mayo Clinic, Rochester, MN, United States
- 4Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States
- 5Department of Pancreas Surgery, Mayo Clinic, Rochester, MN, United States
Background: We evaluated preoperative CA 19-9 levels in patients with resected pancreatic cancer to analyze whether they were predictive of clinical outcomes and could help select patients for additional therapy. We hypothesized that elevated CA 19-9 would be associated with worse pathologic findings and oncologic outcomes.
Methods: This study assessed 509 patients with non-metastatic pancreatic adenocarcinoma who underwent resection at our institution from 1995-2011 and had preoperative CA 19-9 recorded. No patients received neoadjuvant therapy. CA 19-9 level was analyzed as a continuous and a dichotomized variable using logistic and Cox models.
Elevated preoperative CA 19-9 level was associated with adverse pathologic features, incomplete resection, and inferior clinical outcomes. Neither tumor size nor bilirubin confound an elevated CA 19-9 level. Preoperative CA 19-9 level may help select patients for additional therapy.
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What Do The Ca 19
The normal CA 19-9 range in a healthy person is 0-37 units per milliliter. CA 19-9 levels can be higher in patients with pancreatic cancer.
In general:
- Rising CA 19-9 values mean the tumor is growing.
- If the values stay the same, the disease may be stable.
- A decline in CA 19-9 levels after treatment followed by a rise later may suggest that the tumor has come back or grown.
What Is A Ca 19
This test measures the amount of a protein called CA 19-9 in the blood. CA 19-9 is a type of tumor marker. Tumor markers are substances made by cancer cells or by normal cells in response to cancer in the body.
Healthy people can have small amounts of CA 19-9 in their blood. High levels of CA 19-9 are often a sign of pancreatic cancer. But sometimes, high levels can indicate other types of cancer or certain noncancerous disorders, including cirrhosis and gallstones.
Because high levels of CA 19-9 can mean different things, the test is not used by itself to screen for or diagnose cancer. It can help monitor the progress of your cancer and the effectiveness of cancer treatment.
Other names: cancer antigen 19-9, carbohydrate antigen 19-9
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Ongoing Challenges And Limitations
There are a number of limitations that can confound the interpretation of CA 19-9 as a biomarker. Despite its remarkable contribution in clinical practice, the efficacy of CA 19-9 to be exploited as a biomarker remains controversial as it is not exclusively specific to this disease as numerous benign aetiologies can also deceptively increase the levels of CA 19-9. In addition, this tumour biomarker has been shown to have a modest and low sensitivity in symptomatic patients. This also limits its diagnostic utility, keeping CA 19-9 in the category of those clinical biomarkers whose implications need to be precisely considered as a screening tool keeping other limitations in place.
Patients With Normalrange Ca199 Levels Represent A Distinct Subgroup Of Pancreatic Cancer Patients
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Abstract
Introduction
Although marked progress in recent decades has beenmade in the treatment of cancer, pancreatic cancer remains alethal disease, with a 5-year survival rate of < 6%.Personalized medicine and surgery is tailored to the individualpatient, and has the potential to improve the management ofpancreatic cancer . As pancreatic cancer is a malignant tumorthat exhibits heterogeneous biological characteristics, it may besusceptible to treatment with personalized medicine . Global genomic analyses have revealedvarious core signaling pathways in pancreatic cancer that mayrepresent ideal targets for personalized treatment, includingK-Ras, transforming growth factor , c-Jun N-terminal kinases,integrin, Wnt/Notch, Hedgehog, control of G1/S phase, apoptosis,DNA damage control, small GTPases, invasion and homophilic celladhesion . It is necessary toidentify distinct pancreatic cancer subgroups with uniquecharacteristics in order to allow the selection of personalizedtreatments.
In the present multicenter study, an extensiveanalysis of the clinical, pathological and biological features ofpatients with various stages of pancreatic cancer, who werestratified by normal and elevated baseline serum CA19-9 levels, wasperformed.
Materials and methods
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Limitations That Undermine The Utility Of Ca 19
Despite multiple clinical applications for CA 19-9 serum levels in pancreatic cancer patients, the diagnostic utility of CA 19-9 is limited due to a low or modest sensitivity in symptomatic patients and a low PPV which makes it suboptimal screening test . Even among individuals at higher risk of pancreatic cancer , CA 19-9 serum levels fail to identify early/small tumors or precancerous lesions in 10-15% of patients , is elevated in only 80-85% of pancreatic cancer patients . The CA 19-9 serum levels are not predictive of tumor location or differentiation. As noted earlier, CA 19-9 serum levels may be elevated in a variety of non-pancreatic neoplastic conditions resulting in a high false positive rate . Benign conditions associated with elevated serum CA 19-9 levels include ovarian cyst, heart failure, hashimoto’s thyroiditis, rheumatoid arthritis and diverticulitis . Marked elevations in CA 19-9 serum levels have also been reported in numerous benign and malignant biliary conditions such as choledocholithiasis, gallbladder cancer and cholangiocarcinoma. Finally, CA 19-9 serum levels alone cannot differentiate between benign, precursor lesions and malignant pancreatic conditions such as acute and chronic pancreatitis, intraductal pancreatic mucinous neoplasms , pancreatic intra-epithelial neoplasia and pancreatic cancer, as the former are also associated with elevated CA 19-9 serum levels in 10-50% of cases .
How Much Does The Test Cost
The cost of CA 19-9 testing depends on a variety of factors, such as a patients health insurance coverage, where the test is performed, and any additional testing that is conducted at the same time. Total costs may include those associated with obtaining and analyzing the test sample as well as charges for an office visit.
CA 19-9 testing may be covered by health insurance. It could help to contact the health insurance provider or the hospital or laboratory conducting the test for more information about out-of-pocket costs, such as copays or deductibles.
For patients without health insurance, or for whom insurance doesnt cover the cost of testing, a doctor or hospital administration can further discuss the out-of-pocket cost of CA 19-9 testing.
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When Is The Ca 19
Levels of CA 19-9 may be measured as part of a panel of biomarkers to detect the disease early from a blood test. Patients may also get the test after a confirmed pancreatic cancer diagnosis. If the CA 19-9 level was raised before treatment, patients may be tested during and after treatment to judge success.
What Do The Results Mean
If you are being treated for pancreatic cancer or other type of cancer, you may be tested several times throughout your treatment. After repeated tests, your results may show:
- Your levels of CA 19-9 are increasing. This may mean your tumor is growing, and/or your treatment is not working.
- Your levels of CA 19-9 are decreasing. This may mean your tumor is shrinking and your treatment is working.
- Your levels of CA 19-9 have not increased or decreased. This may mean your disease is stable.
- Your CA 19-9 levels decreased, but then later increased. This may mean your cancer has come back after you’ve been treated.
If you do not have cancer and your results show a higher than normal level of CA 19-9, it may be a sign of one of the following noncancerous disorders:
- Pancreatitis, a noncancerous swelling of the pancreas
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Advantages Of Serum Ca 19
Given that the CA 19-9 levels were positively correlated with the OS, several studies evaluated an association between CA 19-9 and tumour resectability. While surgical resection remains one of the potential curative options for PDAC, many cases are not amenable to surgical resection at the time of evaluation. For that reason, identifying unresectable patients preoperatively is vital to avoid undesired surgery. For this reason, the use of serum CA 19-9 levels pre-operatively has been extensively evaluated to determine resectability in pancreatic cancer patients.
Notably, these findings appear to be consistent with the studies by van Veldhuisen et al., who evaluated the diagnostic accuracy of serum CA 19-9 in combination with RECIST-response on CT imaging to predict the resectability of locally advanced pancreatic cancer following induction chemotherapy. The authors reported that all patients with RECIST-regressive disease exhibited a significant decrease in the serum levels of CA 19-9 following induction chemotherapy, which indicated a positive correlation between CA 19-9 levels and RECIST-regressive disease. Importantly, an elevation in the CA 19-9 level was also found to be significantly associated with decreased survival.
Benefits of serum CA 19-9 levels as a biomarker for determining the surgical resectability in PDAC patients with jaundice
Clinical Significance And Revisiting The Meaning Of Ca 19
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Contributed equally to this work with: Joo Kyung Park, Woo Hyun Paik
Affiliation Departments of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Contributed equally to this work with: Joo Kyung Park, Woo Hyun Paik
Affiliation Departments of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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* E-mail:
Affiliation Departments of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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* E-mail:
Affiliation Departments of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Affiliation Departments of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Affiliation Departments of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Affiliation Departments of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Affiliation Departments of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Questions For Your Doctor About Test Results
When reviewing your CA 19-9 test with your doctor, some of the following questions may help you best understand the tests significance in your case:
- How do the results of my CA 19-9 test relate to my diagnosis and care?
- Should I have any other tests in addition to the CA 19-9 test?
- How frequently will I have CA 19-9 testing after I complete treatment?
- What happens if my CA 19-9 levels increase after treatment?
- Will all of my CA 19-9 tests use the same laboratory method?
How Often Is The Test Given
The doctor decides how often the CA 19-9 tests are performed. If the tumor seems to be growing during treatment, the CA 19-9 test may be repeated weekly or after each round of treatment is completed.
If a patient is not receiving treatment now, the CA 19-9 test may be used occasionally to decide if that patient should restart treatment or have more testing. People who had surgery might have CA 19-9 tests as part of their follow-up care.
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What Do My Test Results Mean
Test results may vary depending on your age, gender, health history, and other things. Your test results may be different depending on the lab used. They may not mean you have a problem. Ask your healthcare provider what your test results mean for you.
Results are given in units per milliliter . Normal results are less than 37 U/mL.
It’s important to know that higher levels of CA 19-9 may not mean you have cancer. Conditions other than cancer can cause higher levels. These conditions include an infection of your pancreas, liver disease, gallstones, and cystic fibrosis.
Here is what your results may mean:
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If your CA 19-9 is less than 37 U/mL, you may not have cancer.
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If your CA 19-9 is above 37 U/mL, you may have cancer of the pancreas, gallbladder, lung, or colon.
If you have been diagnosed with pancreatic cancer and your healthcare provider is using this test as part of your treatment, here is what your results may mean:
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If your CA 19-9 is going up during treatment, it may mean that the treatment is not working yet.
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If your CA 19-9 is going down during treatment, it may mean that the treatment is helping you.
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If your CA 19-9 went down after treatment but later goes back up, it may mean that your cancer has come back.
Demographic And Clinicopathological Characteristics
One hundred and twenty patients were included in this study. Table lists the demographic and clinicopathological characteristics of these 120 patients. The median age was 60 years , and 67 of the patients were men. The tumors of 92 patients were primarily located at the pancreas head, and 28 tumors were located at the pancreas body or tail. The median size of the tumors was 4.0 cm . Regarding the histological differentiation, 41 patients had a well-differentiated tumor, 68 patients had a moderately differentiated tumor, and 11 had a poorly differentiated tumor. One hundred and fourteen patients had negative surgical margins, and 39 patients were positive for nodal metastasis. Sixty-two patients had tumors that extended beyond the pancreas.
Table 1 The relationship between serum CA19-9 levels and clinicopathological factors in 120 cases of PDAC treated by surgical resection
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How Do I Get Ready For This Test
You don’t need to prepare for this test. Be sure your healthcare provider knows about all medicines, herbs, vitamins, and supplements you are taking. This includes medicines that don’t need a prescription and any illegal drugs you may use.
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What Is Ca 19
Antigens are substances that cause the immune system to respond. Carbohydrate antigen 19-9 is a type of antigen released by pancreatic cancer cells. It can also be referred to as a tumor marker.
The CA 19-9 Radioimmunoassay is a blood test that measures the CA 19-9 level in the blood.
There are blood tests commercially available that may be able to detect pancreatic cancer. A test measuring CA 19-9 cannot detect the presence of pancreatic cancer by itself, but it can be used on a panel with other biomarkers that can signal the presence of the disease. After diagnosis, the CA 19-9 Radioimmunoassay blood test can also be used for some patients to watch the diseases development.
Note:
- Not every patient with pancreatic cancer will have a high CA 19-9 level.
- Some conditions other than cancer can cause high CA 19-9 levels.
- The CA 19-9 test cannot be used to diagnose or screen for pancreatic cancer by itself. Instead, doctors often use it to judge a treatments success.
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Why Do I Need A Ca 19
You may need a CA 19-9 blood test if you’ve been diagnosed with pancreatic cancer or other type of cancer related to high levels of CA 19-9. These cancers include bile duct cancer, colon cancer, and stomach cancer.
Your health care provider may test you on a regular basis to see if your cancer treatment is working. You may also be tested after your treatment is complete to see if the cancer has come back.
Why Do I Need This Test
You may need this test if your healthcare provider thinks you might be at risk for cancer. This may be because of your symptoms or because you have a family history of cancer. You may need this test as part of your diagnosis along with other tests.
You may also need this test if you are having cancer treatment. It may be done every week or so to see how well treatment is working.
You may also need this test if you have already been treated for cancer and your healthcare provider wants to see if your cancer has come back.
This test works best to help diagnose or make decisions about treatment for pancreatic cancer. But it may also be used for other cancers.
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Can Tumor Markers Be Wrong
Theres a chance that a tumor marker test can give a false positive. That means the results suggest a person has cancer or that the cancer is growing, even when its not. A tumor marker can also give a false negative, which means the results suggest a person doesnt have cancer when they actually do.
