Pancreatic cancer laboratory tests

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

Overview[edit | edit source]

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. CA 19-9 levels play an important role in prognosis, treatment and assessment of the efficacy of therapy in pancreatic cancer patients.

Laboratory Findings[edit | edit source]

Routine laboratory tests in pancreatic cancer patients are often non-specific.

• Common abnormalities include:^[1][2][3]

• • 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[edit | edit source]

• 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.^[4]
• The reference range of CA 19-9 is less than 35 U/mL.^[5]
• 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.^[5]

Role in prognosis:^{[6][7][8][9][10][11][12]}

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

Role in treatment:^[5][13][14]

• To determine the respectability 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:^{[6][15][13][16]}

• A falling CA 19-9 level is indicative of clinical response to therapy during treatment of pancreatic cancer.

References[edit | edit source]

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