CA 19.9 level of 38.1

[wabbit66]

My test showed a CA 19.9 level of 38.1.  My lipase levels have been in the mid 400's for several months.  The ultra sound showed just a "fatty " pancreas.  I have had mid-left back discomfort for months.  No pain. No jaundice.  Appetite seems ok.

What is my next step?   Doctor said come back to be retested in two months.  After checking the web, I realized I could be dead in two months (unlikely, but let's play this safe)

I live in Europe.  I hope you can give me advice.  Female, age 62, family history breast, ovarian & prostate cancer.  Renal insufficiency.  

Many thanks,

[Fernando Roque, MD]

Hi.  CA 19.9 cannot be used as a screening procedure for detecting pancreatic cancer in people who don't have any symptoms which would point to a possible cancer (e.g. weight loss, mass in pancreas detected on ultrasound or CT).  Several studies have already been done which proves that CA 19.9 can't be used for screening.  There's a Japanese study involving 12,840 people without symptoms aside from an elevated CA 19.9.  In this group, only 4 were found to have pancreatic cancer. Another study done by Kim, et. al (J Gastroenterol Hepatol 19(2):182-186, 2004) involving 70,940 asymptomatic patients with elevated CA 19.9 also detected only 4 people positive for pancreatic cancer.  

The proper use of CA 19.9 is in monitoring response to treatment of a known case of pancreatic cancer.  The levels usually come down after surgery or chemotherapy.

So in all probability, you don't have pancreatic cancer.  CA 19.9 levels can also increase due to some non-cancerous conditions like gallstones, pancreatitis and liver cirrhosis.

If you wish, you can have it retested after two months just to see if the elevated level is persistent, but personally, I don't think this is even necessary.

[mahendra9]

Dear Dr. Fernando,
I went for a full health check in a Pathology Lab. I was shocked when the Patholgist told me that I may be having pancreatic Cancer as the Tumour Marker CA 19.9 shows a result of 51.7 (the normal being <31.0).
I was shocked. So I requested the Pathologist for another test. He told me to come back again in 2 weeks time to repeat the CA 19.9 test.
This time the CA 19.9 level reading was 43, a drop of 7.7. The Pathologist told me to come back again in one months time.
For your information I feel normal from the time I walked in for the above health test. Even now I am feeling normal. Could you please advice me
should my level go down to below normal, should I go for another CT Scan or just ignore the whole process of repeating the CA 19.9 test
again.
Please advice, as I do not any form of sign as I feel normal.
Thank you.

K. Mahendra Malaysia

[Fernando Roque, MD]

Hi.  Again, I wish to emphasize that CA 19-9 cannot be used as an initial screening tool for pancreatic cancer in a previously asymptomatic individual.  If, for example, you had an  abdominal CT scan and a mass was found at or near the area of the pancreas, then subsequently doing serial determinations of CA 19-9 may be justified.  But if an initial imaging procedure does not prove the presence of a mass, testing for CA 19-9 afterwards is useless since it is not sensitive or specific enough to detect cancer which has not been detected by a more sensitive test (the CT scan).  

So my question for you is: what was the result of your initial CT scan? (since you're asking to go for another one, I'm assuming you already had an initial scan).  If your initial abdominal CT scan did not show any abnormalities, then I think you should stop having further CA 19-9 tests.  The results are meaningless and will only serve to confuse you.

[mahendra9]

Dear Doctor Fernando,

Thank you so much for your prompt reply.
I have NOT DONE  the CT scan yet. The Pathologist asked me to go for a CT Scan
but after reading a few of the articles re Tumour Markers, I was trying to seek medical
advice from professional medias  and I was fortunate to read some of your valuable articles re this Tumour Marker. Until todate I have NOT GONE FOR ANY CT SCAN YET.
I am feeling normal and I do not have any symptoms. I CASUALLY went for a  helath
check and was surprised that my tumuor marker level was 51.7 . I requested for the Tumour Marker level to be repeated and after 2 weeeks the Level went down to 43.0.
What I am upset is - AM I SUFFERING FROM PANCREATIC CANCER.
SHOULD I GO FOR A CT SCAN? I feel normal as all the other tests are normal
except for this CA 19.9 level. I am also curious to know as to why the CA 19.9 level should fall from 51.7 to 43.0 in 2 weeks time.IS IT NECESSARY FOR ME TO GO FOR A CT SCAN since I notice that the Tumour Level is falling, hopefully to < 37.0 level.
Please advice.

With appreciation and gratitute to you.

Thank you.
Yours truly,
Mahendra - Malaysia

[Fernando Roque, MD]

Hi.  Based on those CA 19-9 results alone, I really don't think you're suffering from pancreatic cancer.  The CA 19-9 should not have been done in the first place if you don't have any symptoms which would make the doctor suspect pancreatic cancer! If you've read my earlier post closely, I've already cited two studies involving thousands of people without symptoms, but with elevated CA 19-9.  If you take the Japanese study and compute the probability of an asymptomatic person with elevated CA 19-9 having pancreatic cancer: that's 4/70,940 or a 0.005% (less than a hundredth of one percent) chance of having pancreatic cancer!

If you're really anxious about the whole thing, then you may wish to have an abdominal CT scan done.  But I don't think this is even necessary, given the very low probability of pancreatic cancer in your case.  I think the CA 19-9 test was unnecessary, and has only caused you needless anxiety and confusion.  I repeat, CA 19-9 is not useful as a screening tool!

[mahendra9]

Dear Doctor Fernando,

Thank you very much for your clarification.
My family and I are most grateful for the immediate response you have furnished
to the mental agony my family and I was undergoing on this CA 19.9 Tumour Marker
Issue.
I now understand the validity of CA 19.9 in relation to healthy individuals.

I would also be grateful if you could enlighten me as to the signs I have to look forward
to suspect that I may have a Pancreatic Cancer