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What is CA 19.9 and why should we test this in pancreas cancer?

CA 19.9 is an essential part of the evaluation of pancreatic cancer.

CA stands for Carbohydrate antigen. This CA19.9 is normally produced in two sources in the human body - pancreatic parenchymal cells and the biliary epithelial cells. We still don't know the connection points between the tissue production of CA19.9 and the blood levels.

This protein was discovered in the research for large intestinal cancers, but we have found that it is very useful in pancreatic malignancies. A level of > 1000 has a very high chance (around 99%) of pancreatic cancer. The normal level is around 37 U/L and usually the other cutoffs that pancreatic surgeons remember is 100 U/l and 500 u/L, to assess cancer diagnosis and features of advancing disease.

It is important to check your CA 19.9 levels after the jaundice is relieved by ERCP and stenting. High levels in the presence of jaundice or cholangitis (infection of the bile ducts) is not useful to assess advanced disease.

At PCRRC, we keep 500 u/L as our limit to define borderline resectable disease (it means there is a high chance of missing microscopic disease). We use a lot of local protocols to control the disease in these patients and so far we are very happy with our patient results.

NCCN recommends this tumour marker testing in every pancreatic cancer after decreasing the jaundice. So after the CT scan, we always do the jaundice reduction and check CA 19.9 levels.

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