Pancreatic cancer laboratory tests
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2];Parminder Dhingra, M.D. [3]
Overview
Laboratory findings consistent with the diagnosis of pancreatic cancer include abnormal liver function tests and elevated CA 19-9 and CEA levels.
Laboratory Findings
- Routine laboratory tests are often non specific Common abnormalities include an: elevated serum bilirubin (conjugated and total) elevated alkaline phosphatase levels elevated gamma-glutamyl transpeptidase elevated aspartate aminotransferase and alanine aminotransferase to a lesser extent CBC shows a mild normochromic anemia Thrombocytosis Serum amylase and/or lipase levels are normal/elevated laboratory evidence of malnutrition: low serum albumin or cholesterol level). CA 19-9 antigen is a sialylated oligosaccharide that is most commonly found on circulating mucins in cancer patients. null 39 It is also normally present within the cells of the biliary tract and can be elevated in acute or chronic biliary disease The reference range of CA 19-9 is less than 33-37 U/mL in most laboratories. Of patients with pancreatic carcinoma, 75-85% have elevated CA 19-9 levels. In the absence of biliary obstruction, intrinsic liver disease, or benign pancreatic disease, a CA 19-9 value of greater than 100 U/mL is highly specific for malignancy, usually pancreatic. Evaluation of CA 19-9 levels has been used as an adjunct to imaging studies for helping to determine the resectability potential of pancreatic carcinoma. An elevated Patients presenting with low levels of CA 19-9 (< 100 IU) are unlikely to have occult metastatic disease and therefore may not need a staging laparoscopy prior to resection if other imaging shows no advanced disease. Additionally, during surgical, chemotherapeutic, and/or radiotherapeutic treatment for pancreatic cancer, a falling CA 19-9 seems to be a useful surrogate finding for clinical response to the therapy. If biliary obstruction is not present, a rising CA 19-9 suggests progressive disease. Preoperative CA 19-9 levels may be of prognostic value, with high levels indicating poorer outcome and less chance of resectability.[[null 40], [null 41]] Preoperative values above 50 U/mL have been shown to be associated with higher chances of recurrence.