Pancreatic cancer laboratory tests

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

## Overview

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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

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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

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* 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

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1. ↑ Kaur, Sukhwinder; Baine, Michael J; Jain, Maneesh; Sasson, Aaron R; Batra, Surinder K (2012). "Early diagnosis of pancreatic cancer: challenges and new developments". Biomarkers in Medicine. 6 (5): 597–612. doi:10.2217/bmm.12.69. ISSN 1752-0363.
2. ↑ . doi:10.3978/j.issn.1000-9604.2015.07.03. Missing or empty `|title=` (help)
3. ↑ Zhao, Xiao-Yan (1998). "A clinical evaluation of serological diagnosis for pancreatic cancer*". World Journal of Gastroenterology. 4 (2): 147. doi:10.3748/wjg.v4.i2.147. ISSN 1007-9327.
4. ↑ 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.
5. ↑ 5.0 5.1 5.2 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.
6. ↑ 6.0 6.1 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.
7. ↑ 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.
8. ↑ 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.
9. ↑ 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.
10. ↑ 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.
11. ↑ 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.
12. ↑ 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.
13. ↑ 13.0 13.1 Steinberg W (1990). "The clinical utility of the CA 19-9 tumor-associated antigen". Am. J. Gastroenterol. 85 (4): 350–5. PMID 2183589.
14. ↑ 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.
15. ↑ 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.
16. ↑ Lamerz R (1999). "Role of tumour markers, cytogenetics". Ann. Oncol. 10 Suppl 4: 145–9. PMID 10436809.

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