Carbohydrate Antigen 19-9 (CA 19-9), Serum
Potentially useful adjunct for diagnosis and monitoring of pancreatic cancer
May be used for differentiating patients with cholangiocarcinoma and primary sclerosing cholangitis (PSC) from those with PSC alone
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Carbohydrate antigen 19-9 (CA 19-9) is a modified Lewis(a) blood group antigen. CA 19-9 may be elevated in patients with gastrointestinal malignancies such as cholangiocarcinoma, pancreatic cancer, or colon cancer.
Benign conditions such as cirrhosis, cholestasis, and pancreatitis also result in elevated serum CA 19-9 concentrations but in these cases values usually are <1,000 U/mL.
Individuals that are Lewis negative (5%-7% of the population) do not express CA 19-9 due to the lack of the enzyme fucosyltransferase needed for CA 19-9 production. In these individuals, a low or undetectable serum CA 19-9 concentration is not informative regarding cancer recurrence.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Serum markers are not specific for malignancy, and values may vary by method.
Serial monitoring of carbohydrate antigen 19-9 (CA 19-9) should begin prior to therapy to verify post-therapy decreases in CA 19-9 and to establish a baseline for evaluating possible recurrence. Single values of CA 19-9 are less informative.
Elevated values may be caused by a variety of malignant and nonmalignant conditions including cholangiocarcinoma, pancreatic cancer, and/or colon cancer.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Carbohydrate antigen 19-9 (CA 19-9) is neither specific nor sensitive enough to be used as a cancer screen.
Some individuals do not express CA 19-9. Consequently low values in these individuals are not informative regarding cancer recurrence.
Do not interpret serum CA 19-9 levels as absolute evidence of the presence or the absence of malignant disease. Use serum CA 19-9 in conjunction with information from the clinical evaluation of the patient and other diagnostic procedures.
Some patients who have been exposed to animal antigens, either in the environment or as part of treatment or imaging procedures, may have circulating antianimal antibodies present. These antibodies may interfere with the assay reagents to produce unreliable results.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
Torok N, Gores GJ: Cholangiocarcinoma. Semin Gastrointest Dis 2001 Apr;12(2):125-132