Skip to main content
SpringerLink
Log in

The Role of CA 19-9 in Pancreatic Adenocarcinoma

  • Chapter
  • First Online:
Textbook of Pancreatic Cancer

  • 2647 Accesses

Abstract

Carbohydrate antigen 19.9 (CA 19-9) is a ganglioside synthesized by epithelial cells of different organs and is therefore not organ-specific. It is most commonly found elevated in malignant disease but benign causes like biliary obstruction may increase CA 19-9 values. There are rare cases however, like in patients with a negative Lewis system, that CA19-9 is never elevated. Unsuitable for screening in pancreatic adenocarcinoma, CA19-9 may have a prognostic value in preoperative assessment, high values (>1000 U/mL) often being associated with micro-metastatic disease. Moreover, it is useful in evaluating response to treatment with decreasing values being an indicator of increased survival. Finally, postoperative surveillance can facilitate early detection of recurrence and in cases of unresectable pancreatic adenocarcinoma CA 19-9 appears to be a good indicator of overall survival.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Koprowski H, Steplewski Z, Mitchell K, Herlyn M, Herlyn D, Fuhrer P. Colorectal carcinoma antigens detected by hybridoma antibodies. Som Cell Genet. 1979;5(6):957–71.

    Article  CAS  Google Scholar 

  2. Pavai S, Yap SF. The clinical significance of elevated levels of serum CA 19-9. Med J Malaysia. 2003;58(5):667–72.

    CAS  PubMed  Google Scholar 

  3. Steinberg W. The clinical utility of the CA 19-9 tumor-associated antigen. Am J Gastroenterol. 1990;85(4):350–5.

    CAS  PubMed  Google Scholar 

  4. Van Heerde MJ, Buijs J, Hansen BE, de Waart M, van Eijck CHJ, Kazemier G, et al. Serum level of Ca 19-9 increases ability of IgG4 test to distinguish patients with autoimmune pancreatitis from those with pancreatic carcinoma. Dig Dis Sci. 2014;59(6):1322–9.

    PubMed  Google Scholar 

  5. Chang M-C, Liang P-C, Jan S, Yang C-Y, Tien Y-W, Wei S-C, et al. Increase diagnostic accuracy in differentiating focal type autoimmune pancreatitis from pancreatic cancer with combined serum IgG4 and CA19-9 levels. Pancreatology. 2014;14(5):366–72.

    Article  CAS  PubMed  Google Scholar 

  6. Aoki Y, Yanagisawa Y, Ohfusa H, Kawa S, Oguchi H, Furuta S. Elevation of serum CA 19-9 in parallel with HbA1c in a diabetic female with the Lewis(a+b-) blood group. Diabetes Res Clin Pract. 1991;13(1-2):77–81.

    Article  CAS  PubMed  Google Scholar 

  7. Nakamura N, Aoji O, Yoshikawa T, Mori K, Kajiyama S, Kitagawa Y, et al. Elevated serum CA19-9 levels in poorly controlled diabetic patients. Jpn J Med. 1986;25(3):278–80.

    Article  CAS  PubMed  Google Scholar 

  8. Tempero MA, Uchida E, Takasaki H, Burnett DA, Steplewski Z, Pour PM. Relationship of carbohydrate antigen 19-9 and Lewis antigens in pancreatic cancer. Cancer Res. 1987;47(20):5501–3.

    CAS  PubMed  Google Scholar 

  9. Vestergaard EM, Hein HO, Meyer H, Grunnet N, Jørgensen J, Wolf H, et al. Reference values and biological variation for tumor marker CA 19-9 in serum for different Lewis and secretor genotypes and evaluation of secretor and Lewis genotyping in a Caucasian population. Clin Chem. 1999;45(1):54–61.

    CAS  PubMed  Google Scholar 

  10. Homma T, Tsuchiya R. The study of the mass screening of persons without symptoms and of the screening of outpatients with gastrointestinal complaints or icterus for pancreatic cancer in Japan, using CA19-9 and elastase-1 or ultrasonography. Int J Pancreatol. 1991;9:119–24.

    Article  CAS  PubMed  Google Scholar 

  11. Ballehaninna UK, Chamberlain RS. The clinical utility of serum CA 19-9 in the diagnosis, prognosis and management of pancreatic adenocarcinoma: an evidence based appraisal. J Gastrointest Oncol. 2012;3(2):105–19.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Kim J-E, Lee KT, Lee JK, Paik SW, Rhee JC, Choi KW. Clinical usefulness of carbohydrate antigen 19-9 as a screening test for pancreatic cancer in an asymptomatic population. J Gastroenterol Hepatol. 2004;19(2):182–6.

    Article  PubMed  Google Scholar 

  13. Chang C-Y, Huang S-P, Chiu H-M, Lee Y-C, Chen M-F, Lin J-T. Low efficacy of serum levels of CA 19-9 in prediction of malignant diseases in asymptomatic population in Taiwan. Hepato-Gastroenterology. 2006;53(67):1–4.

    PubMed  Google Scholar 

  14. Zubarik R, Gordon SR, Lidofsky SD, Anderson SR, Pipas JM, Badger G, et al. Screening for pancreatic cancer in a high-risk population with serum CA 19-9 and targeted EUS: a feasibility study. Gastrointest Endosc. 2011;74(1):87–95.

    Article  PubMed  Google Scholar 

  15. Goonetilleke KS, Siriwardena AK. Systematic review of carbohydrate antigen (CA 19-9) as a biochemical marker in the diagnosis of pancreatic cancer. Eur J Surg Oncol. 2007;33(3):266–70.

    Article  CAS  PubMed  Google Scholar 

  16. Iishi H, Yamamura H, Tatsuta M, Okuda S, Kitamura T. Value of ultrasonographic examination combined with measurement of serum tumor markers in the diagnosis of pancreatic cancer of less than 3 cm in diameter. Cancer. 1986;57(10):1947–51.

    Article  CAS  PubMed  Google Scholar 

  17. Malesci A, Montorsi M, Mariani A, Santambrogio R, Bonato C, Bissi O, et al. Clinical utility of the serum CA 19-9 test for diagnosing pancreatic carcinoma in symptomatic patients: a prospective study. Pancreas. 1992;7(4):497–502.

    Article  CAS  PubMed  Google Scholar 

  18. Satake K, Chung YS, Umeyama K, Takeuchi T, Kim YS. The possibility of diagnosing small pancreatic cancer (less than 4.0 cm) by measuring various serum tumor markers. A retrospective study. Cancer. 1991;68(1):149–52.

    Article  CAS  PubMed  Google Scholar 

  19. Morris-Stiff G, Teli M, Jardine N, Puntis MC. CA19-9 antigen levels can distinguish between benign and malignant pancreaticobiliary disease. Hepatobil Pancreat Dis Int HBPD INT. 2009;8(6):620–6.

    CAS  PubMed  Google Scholar 

  20. Kim HJ, Kim MH, Myung SJ, Lim BC, Park ET, Yoo KS, et al. A new strategy for the application of CA19-9 in the differentiation of pancreaticobiliary cancer: analysis using a receiver operating characteristic curve. Am J Gastroenterol. 1999;94(7):1941–6.

    Article  CAS  PubMed  Google Scholar 

  21. Benamouzig R, Buffet C, Fourre C, Ink O, Moati F, Etienne JP. Serum levels of carbohydrate antigenic determinant (CA 19.9) in obstructive jaundice. Dig Dis Sci. 1989;34(10):1640–2.

    Article  CAS  PubMed  Google Scholar 

  22. Marrelli D, Caruso S, Pedrazzani C, Neri A, Fernandes E, Marini M, et al. CA19-9 serum levels in obstructive jaundice: clinical value in benign and malignant conditions. Am J Surg. 2009;198(3):333–9.

    Article  CAS  PubMed  Google Scholar 

  23. Rudnicki J, Agrawal AK, Grzebieniak Z, Zukrowski P, Zyśko D, Jelen M, et al. Prognostic value of CA 19-9 level in resectable pancreatic adenocarcinoma. Folia Histochem Cytobiol. 2010;48(2):249–61.

    Article  CAS  PubMed  Google Scholar 

  24. Ferri MJ, Saez M, Figueras J, Fort E, Sabat M, López-Ben S, et al. Improved pancreatic adenocarcinoma diagnosis in jaundiced and non-jaundiced pancreatic adenocarcinoma patients through the combination of routine clinical markers associated to pancreatic adenocarcinoma pathophysiology. PLoS One. 2016;11(1):e0147214.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Liu J, Gao J, Du Y, Li Z, Ren Y, Gu J, et al. Combination of plasma microRNAs with serum CA19-9 for early detection of pancreatic cancer. Int J Cancer. 2012;131(3):683–91.

    Article  CAS  PubMed  Google Scholar 

  26. Sivarman A, Muthukrishnan A, Boopathy Senguttvan N, Anil Suchak S, Kannan U. Predictors of malignancy in pancreatic head mass: a prospective study. Pan Afr Med J. 2011;9:30. Accessed 9 Sept 2019. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3215552/.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Zhang Y, Yang J, Li H, Wu Y, Zhang H, Chen W. Tumor markers CA19-9, CA242 and CEA in the diagnosis of pancreatic cancer: a meta-analysis. Int J Clin Exp Med. 2015;8(7):11683–91.

    PubMed  PubMed Central  Google Scholar 

  28. Hasan S, Jacob R, Manne U, Paluri R. Advances in pancreatic cancer biomarkers. Oncol Rev. 2019;13(1):410.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kim YC, Kim HJ, Park JH, Park DI, Cho YK, Sohn CI, et al. Can preoperative CA19-9 and CEA levels predict the resectability of patients with pancreatic adenocarcinoma? J Gastroenterol Hepatol. 2009;24(12):1869–75.

    Article  CAS  PubMed  Google Scholar 

  30. Hartwig W, Strobel O, Hinz U, Fritz S, Hackert T, Roth C, et al. CA19-9 in potentially resectable pancreatic cancer: perspective to adjust surgical and perioperative therapy. Ann Surg Oncol. 2013;20(7):2188–96.

    Article  PubMed  Google Scholar 

  31. Hartwig W, Hackert T, Hinz U, Gluth A, Bergmann F, Strobel O, et al. Pancreatic cancer surgery in the new millennium: better prediction of outcome. Ann Surg. 2011;254(2):311–9.

    Article  PubMed  Google Scholar 

  32. Alexakis N, Gomatos IP, Sbarounis S, Toutouzas K, Katsaragakis S, Zografos G, et al. High serum CA 19-9 but not tumor size should select patients for staging laparoscopy in radiological resectable pancreas head and peri-ampullary cancer. Eur J Surg Oncol. 2015;41(2):265–9.

    Article  CAS  PubMed  Google Scholar 

  33. Takahashi H, Ohigashi H, Ishikawa O, Eguchi H, Gotoh K, Yamada T, et al. Serum CA19-9 alterations during preoperative gemcitabine-based chemoradiation therapy for resectable invasive ductal carcinoma of the pancreas as an indicator for therapeutic selection and survival. Ann Surg. 2010;251(3):461–9.

    Article  PubMed  Google Scholar 

  34. Maithel SK, Maloney S, Winston C, Gönen M, D’Angelica MI, Dematteo RP, et al. Preoperative CA 19-9 and the yield of staging laparoscopy in patients with radiographically resectable pancreatic adenocarcinoma. Ann Surg Oncol. 2008;15(12):3512–20.

    Article  PubMed  Google Scholar 

  35. Heger U, Sun H, Hinz U, Klaiber U, Tanaka M, Liu B, Sachsenmaier M, et al. Induction chemotherapy in pancreatic cancer: CA 19-9 may predict resectability and survival. HPB (Oxford). 2019;22:224. pii: S1365-182X (19)30599-4.

    Article  Google Scholar 

  36. Perri G, Prakash L, Wang H, Bhosale P, Varadhachary GR, Wolff R, et al. Radiographic and serologic predictors of pathologic major response to preoperative therapy for pancreatic cancer. Ann Surg. 2019; https://doi.org/10.1097/SLA.0000000000003442.

  37. Aoki S, Motoi F, Murakami Y, Sho M, Satoi S, Honda G, et al. Decreased serum carbohydrate antigen 19-9 levels after neoadjuvant therapy predict a better prognosis for patients with pancreatic adenocarcinoma: a multicenter case-control study of 240 patients. BMC Cancer. 2019;19(1):252.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Boone BA, Steve J, Zenati MS, Hogg ME, Singhi AD, Bartlett DL, et al. Serum CA 19-9 response to neoadjuvant therapy is associated with outcome in pancreatic adenocarcinoma. Ann Surg Oncol. 2014;21(13):4351–8.

    Article  PubMed  Google Scholar 

  39. Hata S, Sakamoto Y, Yamamoto Y, Nara S, Esaki M, Shimada K, et al. Prognostic impact of postoperative serum CA 19-9 levels in patients with resectable pancreatic cancer. Ann Surg Oncol. 2012;19(2):636–41.

    Article  PubMed  Google Scholar 

  40. van Veldhuisen E, Vogel JA, Klompmaker S, Busch OR, van Laarhoven HWM, van Lienden KP, et al. Added value of CA19-9 response in predicting resectability of locally advanced pancreatic cancer following induction chemotherapy. HPB. 2018;20(7):605–11.

    Article  PubMed  Google Scholar 

  41. Takagi C, Kikuchi Y, Shirakawa H, Hoshimoto S, Tomikawa M, Ozawa I, et al. Predictive factors for elevated postoperative carbohydrate antigen 19-9 levels in patients with resected pancreatic cancer. Anticancer Res. 2019;39(6):3177–83.

    Article  CAS  PubMed  Google Scholar 

  42. Rieser CJ, Zenati M, Hamad A, Al Abbas AI, Bahary N, Zureikat AH, et al. CA19-9 on postoperative surveillance in pancreatic ductal adenocarcinoma: predicting recurrence and changing prognosis over time. Ann Surg Oncol. 2018;25(12):3483–91.

    Article  PubMed  Google Scholar 

  43. Kondo N, Murakami Y, Uemura K, Hayashidani Y, Sudo T, Hashimoto Y, et al. Prognostic impact of perioperative serum CA 19-9 levels in patients with resectable pancreatic cancer. Ann Surg Oncol. 2010;17(9):2321–9.

    Article  PubMed  Google Scholar 

  44. Humphris JL, Chang DK, Johns AL, Scarlett CJ, Pajic M, Jones MD, et al. The prognostic and predictive value of serum CA19.9 in pancreatic cancer. Ann Oncol. 2012;23(7):1713–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Ferrone CR, Finkelstein DM, Thayer SP, Muzikansky A, Fernandez-delCastillo C, Warshaw AL. Perioperative CA19-9 levels can predict stage and survival in patients with resectable pancreatic adenocarcinoma. J Clin Oncol Off J Am Soc Clin Oncol. 2006;24(18):2897–902.

    Article  CAS  Google Scholar 

  46. Sakamoto T, Saito H, Amisaki M, Tokuyasu N, Honjo S, Fujiwara Y. Combined preoperative platelet-to-lymphocyte ratio and serum carbohydrate antigen 19-9 level as a prognostic factor in patients with resected pancreatic cancer. Hepatobil Pancreat Dis Int HBPD INT. 2019;18(3):278–84.

    Article  PubMed  Google Scholar 

  47. Negoi I, Beuran M, Hostiuc S, El-Hussuna A, de Madaria E. Platelet-to-lymphocyte ratio and CA19-9 are simple and informative prognostic factors in patients with resected pancreatic cancer. Hepatobil Pancreat Dis Int HBPD INT. 2019;18(3):203–5.

    Article  PubMed  Google Scholar 

  48. Hess V, Glimelius B, Grawe P, Dietrich D, Bodoky G, Ruhstaller T, et al. CA 19-9 tumour-marker response to chemotherapy in patients with advanced pancreatic cancer enrolled in a randomised controlled trial. Lancet Oncol. 2008;9(2):132–8.

    Article  CAS  PubMed  Google Scholar 

  49. Usón Junior PLS, Callegaro-Filho D, Bugano DDG, Moura F, Maluf FC. Predictive value of serum carbohydrate antigen 19-9 (CA19-9) for early mortality in advanced pancreatic cancer. J Gastrointest Cancer. 2018;49(4):481–6.

    Article  PubMed  Google Scholar 

  50. Katz A, Hanlon A, Lanciano R, Hoffman J, Coia L. Prognostic value of CA 19-9 levels in patients with carcinoma of the pancreas treated with radiotherapy. Int J Radiat Oncol Biol Phys. 1998;41(2):393–6.

    Article  CAS  PubMed  Google Scholar 

  51. Ikeda M, Okada S, Tokuuye K, Ueno H, Okusaka T. Prognostic factors in patients with locally advanced pancreatic carcinoma receiving chemoradiotherapy. Cancer. 2001;91(3):490–5.

    Article  CAS  PubMed  Google Scholar 

  52. Micke O, Bruns F, Kurowski R, Horst E, de Vries AF, Hausler JW, et al. Predictive value of carbohydrate antigen 19-9 in pancreatic cancer treated with radiochemotherapy. Int J Radiat Oncol Biol Phys. 2003;57(1):90–7.

    Article  CAS  PubMed  Google Scholar 

  53. Saad ED, Machado MC, Wajsbrot D, Abramoff R, Hoff PM, Tabacof J, et al. Pretreatment CA 19-9 level as a prognostic factor in patients with advanced pancreatic cancer treated with gemcitabine. Int J Gastrointest Cancer. 2002;32:35–41.

    Article  CAS  PubMed  Google Scholar 

  54. Diaz CL, Cinar P, Hwang J, Ko AH, Tempero MA. CA 19-9 response: a surrogate to predict survival in patients with metastatic pancreatic adenocarcinoma. Am J Clin Oncol. 2019;42(12):898–902.

    Article  CAS  PubMed  Google Scholar 

  55. Bernhard J, Dietrich D, Glimelius B, Hess V, Bodoky G, Scheithauer W, et al. Estimating prognosis and palliation based on tumour marker CA 19-9 and quality of life indicators in patients with advanced pancreatic cancer receiving chemotherapy. Br J Cancer. 2010;103(9):1318–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pancreatic and Endocrine Surgery, Cochin Hospital, APHP, Paris, France

    Clémence Guyard, Stylianos Tzedakis, Elisabeth Hain, Justine Guyard & Sébastien Gaujoux

  2. Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, Paris, France

    Stylianos Tzedakis, Elisabeth Hain, Vincent Mallet & Sébastien Gaujoux

  3. Department of Hepatology, APHP, Paris, France

    Vincent Mallet

  4. Department of Digestive and Endocrine Surgery, Cochin Hospital, APHP, Paris, France

    Sébastien Gaujoux

Authors
  1. Clémence Guyard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stylianos Tzedakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elisabeth Hain
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Justine Guyard
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vincent Mallet
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sébastien Gaujoux
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sébastien Gaujoux .

Editor information

Editors and Affiliations

  1. Stavanger University Hospital, The University of Bergen, Bergen, Norway

    Kjetil Søreide

  2. Chirurgie (VTT), Innsbruck Medical University, Innsbruck, Tirol, Austria

    Stefan Stättner

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Guyard, C., Tzedakis, S., Hain, E., Guyard, J., Mallet, V., Gaujoux, S. (2021). The Role of CA 19-9 in Pancreatic Adenocarcinoma. In: Søreide, K., Stättner, S. (eds) Textbook of Pancreatic Cancer. Springer, Cham. https://doi.org/10.1007/978-3-030-53786-9_30

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-53786-9_30

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-53785-2

  • Online ISBN: 978-3-030-53786-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation