CA 19-9 in Pancreatic Cancer

Serum CA 19-9 as a Biomarker for Pancreatic Cancer—A Comprehensive Review

“…Despite multiple clinical applications for CA 19-9 serum levels in pancreatic cancer patients, the diagnostic utility of CA 19-9 is often limited due to a low or modest sensitivity (79-81%) in symptomatic patients [12,14,15]. Moreover, a very low PPV (0.9%) makes CA 19-9 serum levels a suboptimal test to screen asymptomatic populations [16][17][18].…”

“…Moreover, a very low PPV (0.9%) makes CA 19-9 serum levels a suboptimal test to screen asymptomatic populations [16][17][18]. Even among individuals at higher risk of pancreatic cancer (hereditary pancreatitis, family history of pancreatic cancer, Peutz-Jeghers syndrome), CA 19-9 serum levels fail to identify early/small tumors or precancerous lesions in 10-15% of patients [68] and is elevated in only 80-85% of pancreatic cancer patients [12,14,20]. As noted earlier, CA 19-9 serum levels may be elevated in a variety of nonpancreatic neoplastic conditions resulting in a high false positive rate (10-30%).…”

“…Hyperbilirubinemia is also a significant confounding factor since it is associated with an increased CA 19-9 serum level in cases of both benign and malignant biliary obstruction [8,9,12,20]. Although CA 19-9 serum levels in the presence of obstructive jaundice may have higher sensitivity, it is at the cost of decreased specificity and accuracy.…”

“…Le (α-β-) phenotypes occur in 5-10% of population which lack the enzyme 1,4-fucosyl transferase required for antigen epitope production, and as such limits the use of CA 19-9 as a universally applicable biomarker [12][13][14][15].…”

Improved Targeting of Pancreatic Cancer

“…A major focus has been the generation of monoclonal antibodies (MAbs) that are able to distinguish cancer from normal and benign disease tissues and fluids. The CA19 -9 immunoassay is the "gold standard," and although useful for management of the patient, it does not provide sufficient sensitivity or specificity to be used as a stand-alone diagnostic tool (2)(3)(4). Another more recent focus is the use of proteomics to identify a profile map in the serum, or other bodily fluid, that will distinguish pancreatic cancer from normal and other disease conditions (5,6).…”