Incidental raised Ca 19.9: is long term followup beneficial?

Abstract

Introduction: CA 19-9 is a useful marker for prognostication and management of patients with pancreatic tumour. However its value as a screening tool for pancreatic cancer in asymptomatic patients is limited due to its low positive predictive value. In Singapore, patients are referred to tertiary centre for incidentally raised Ca 19.9 detected on screening packages in primary care. We aim to evaluate if long term followup is required. Methods: This is a prospective study whereby 34 patients who were referred from primary care to the specialist outpatient clinic of Tan Tock Seng Hospital, Departement of General Surgery for the period of 2006e2015 for incidental raised Ca 19.9 on screening were followup. All patients had dedicated imaging of the pancreas via CT or MRI scan and serial Ca 19.9 and clinical examination on repeat outpatient visits. Results: There were 34 patients recruited for this study. Mean age was 59.9 years (range 27e86). Twenty four (70.6%) were female patients. Three (8.8%) were diabetic. Mean level of Ca19.9 at presentation was 86.4 U/mL (Range 36e698). Nine (26.5%) patients showed an uptrend of Ca 19.9 levels on followup. Ten (29.4%) patients revealed pathology on further investigation, of which only 1 was malignant (gastric cancer). Mean duration of followup was 20.6 months (Range 2e106). Conclusion:The followup of incidental raised Ca 19.9 requires much healthcare resources and time of the surgeon. Our preliminary results show that none has a malignant pancreatic pathology on long term followup.