Cholangiocarcinoma laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2] [3] [4], Suveenkrishna Pothuru, M.B,B.S. [5]

## Overview

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Laboratory tests for cholangiocarcinoma include aspartate aminotransferase (AST) and alanine aminotransferase (ALT), prothrombin time, albumin and total protein, bilirubin, L-Lactate dehydrogenase and alkaline phosphatase.

## Laboratory Findings

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* Laboratory findings consistent with the diagnosis of cholangiocarcinoma include:

### Liver function tests

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* Patients with cholangiocarcinoma have elevated concentration of following tests, which is usually suggestive of cholestatic pattern:[1][2]
* Prothrombin time
* Albumin and total protein
* Bilirubin
* L-Lactate dehydrogenase
* Alkaline phosphatase
* Gamma glutamyl transferase
* Alpha-fetoprotein
* Transaminase levels (aspartate aminotransferase (AST), and alanine aminotransferase (ALT)) may initially be normal among patients with cholangiocarcinoma.

### Carcinoembryonic antigen

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* Serum levels of carcinoembryonic antigen (CEA) are often elevated, but not sensitive or specific enough to be used as a screening test.
* It may be useful in association with imaging findings for suspected diagnosis of cholangiocarcinoma.[3][4]

### Carbohydrate antigen 19-9 (CA 19-9)

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* CA 19-9 is a protein released by cancers of the pancreas and bile ducts.[5]
* An elevated concentration of CA 19-9 is suggestive of pancreatic cancer and cholangiocarcinoma.
* CA 19-9 levels are not specific enough to be used as a screening test.[6]
* It can be used as a tumor marker to determine response to chemotherapy.

## References

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1. ↑ Van Beers BE (2008). "Diagnosis of cholangiocarcinoma". HPB (Oxford). 10 (2): 87–93. doi:10.1080/13651820801992716. PMC 2504383. PMID 18773062.
2. ↑ Patel T (2011). "Cholangiocarcinoma--controversies and challenges". Nat Rev Gastroenterol Hepatol. 8 (4): 189–200. doi:10.1038/nrgastro.2011.20. PMC 3888819. PMID 21460876.
3. ↑ Studies of the performance of serum markers for cholangiocarcinoma (such as carcinoembryonic antigen and CA19-9) in patients with and without primary sclerosing cholangitis include the following:
* Nehls O, Gregor M, Klump B (2004). "Serum and bile markers for cholangiocarcinoma". Semin Liver Dis. 24 (2): 139–54. PMID 15192787.CS1 maint: Multiple names: authors list (link)
* Siqueira E, Schoen R, Silverman W, Martin J, Rabinovitz M, Weissfeld J, Abu-Elmaagd K, Madariaga J, Slivka A, Martini J (2002). "Detecting cholangiocarcinoma in patients with primary sclerosing cholangitis". Gastrointest Endosc. 56 (1): 40–7. PMID 12085033.CS1 maint: Multiple names: authors list (link)
* Levy C, Lymp J, Angulo P, Gores G, Larusso N, Lindor K (2005). "The value of serum CA 19-9 in predicting cholangiocarcinomas in patients with primary sclerosing cholangitis". Dig Dis Sci. 50 (9): 1734–40. PMID 16133981.CS1 maint: Multiple names: authors list (link)
* Patel A, Harnois D, Klee G, LaRusso N, Gores G (2000). "The utility of CA 19-9 in the diagnoses of cholangiocarcinoma in patients without primary sclerosing cholangitis". Am J Gastroenterol. 95 (1): 204–7. PMID 10638584.CS1 maint: Multiple names: authors list (link)
4. ↑ Chen CY, Shiesh SC, Tsao HC, Lin XZ (2002). "The assessment of biliary CA 125, CA 19-9 and CEA in diagnosing cholangiocarcinoma--the influence of sampling time and hepatolithiasis". Hepatogastroenterology. 49 (45): 616–20. PMID 12063953.
5. ↑ Jang JY, Kim SW, Park DJ, Ahn YJ, Yoon YS, Choi MG, Suh KS, Lee KU, Park YH (2005). "Actual long-term outcome of extrahepatic bile duct cancer after surgical resection". Ann. Surg. 241 (1): 77–84. PMC 1356849. PMID 15621994.
6. ↑ Qin XL, Wang ZR, Shi JS, Lu M, Wang L, He QR (2004). "Utility of serum CA19-9 in diagnosis of cholangiocarcinoma: in comparison with CEA". World J. Gastroenterol. 10 (3): 427–32. PMC 4724921. PMID 14760772.

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