Elevated CA 19.9 levels

[achanks]

Hi All

Two years ago I had a blood test and the result on the CA 19.9 marker was 30.6.  Two years on today, I had another test and the reading was 34.  I am worried and had the specialist refer me to do a CT Scan on the abdomen area. We are organising this now.

After the original blood test 2 years ago, I have since had a colonoscope and two gastroscopes performed. Two polyps were removed during colonoscopy and two polyps from the first gastroscope and another one during the second.  All were found to be benign after the biopsies.  However after the first procedure they found focal intestinal metaplasia, no dysplasia and no evidence of malignancy.  That was why I did the second scope to track this metaplasia and intend to scope every year.

What can be causing my CA 19.9 marker to be slowly increasing from 30.6 to 34 over the last 2 years? Some indication of the development of cancer coming up somewhere eg pancreas?

[Fernando Roque, MD]

Hi.  CA 19-9 is not used as a screening test to detect the presence of gastrointestinal (e.g. pancreatic) malignancy.  Elevations in CA 19-9 levels are not specific enough (there are a lot of false positive results) to definitively rule in a diagnosis of cancer.  Its proper use is to confirm a diagnosis of pancreatic cancer, in the presence of some other findings (e.g. CT scan finding of a mass in the area of the pancreas).  CA 19-9 levels above 37 units/ml are considered abnormal. In pancreatic cancer, CA 19-9 levels are typically in the range of hundreds or even thousands of units/ml.  Since your levels are below that, I really don't think you should worry too much about it.  In the absence of symptoms, I don't think that your CA 19-9 results warrant a CT scan of your abdomen.  It's not necessary at this point.

[achanks]

Thank you.

But would it be right to say that some activity is happening in the body to give an elevated CA19-9 reading? Or do some people in the population just have naturally slightly high readings?

Do we know whether people with elevated levels in the abnormal zone just off the normal levels (say hovering around high 30s and 40s) will eventually find themselves diagnosed with either benign or malignant conditions of the gastrointestinal tract, gallstones, liver or pancreas going forward as they perform yearly blood tests and find it rising a few points yearly?  I am referring to people in their 50s and 60s.....

  

[Fernando Roque, MD]

Hi.  Because CA 19-9 is a test which is not specific or sensitive enough, it cannot be used as an initial screening tool for detecting cancer or any other condition.  So repeated yearly testing for this tumor marker, in the absence of symptoms is an incorrect use of this test and will only lead to misleading results.

[mrsdaffodil]

Is a count of 302 CA 19-9 to be concerned about?