What do my high CA 19-9 blood test levels indicate?

Question

Hi doctor,

I want a second opinion and clarification on what to do with abnormal laboratory reports. I had a routine annual health check-up. Unfortunately, this lab panel included a CA19-9. However, my CA19-9 was noted to be a little high.

This past month, I had other laboratory tests, including CBC, chemistry panel, glucose, TSH, CEA, C-reactive protein, sedimentation rate, liver function tests (including bilirubin), amylase, and lipase. I also had an MRI of the abdomen, a CT of the pelvis, and even an MRCP, and all were normal.

I repeated an MRI of the abdomen yesterday, and it was again normal. Furthermore, I ended up getting a Cologuard colon cancer test and something called a Galleri Cancer Blood test (which tests DNA fragments for 50 cancers), and they both came back normal.

I also had a home H. pylori test kit, which was normal. My doctor thinks I should follow the CA19-9 level in three to four months. What should I do? I am only on Norvasc 5 mg for hypertension and Melatonin for sleep. There is no significant past medical history. My vital signs are all normal.

Thanks.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

I understand you are very concerned about the elevated levels of CA 19-9. Please note that cancer antigen 19-9 (CA 19-9, also known as carbohydrate antigen 19-9) is a tumor-associated mucin glycoprotein antigen related to the Lewis blood group protein.

This antigen is present in epithelial tissues of the pancreas, biliary ductular cells, stomach, gallbladder, colon and endometrium, salivary glands, and prostate, meaning that this can increase above its reference level if the above tissues are disrupted or damaged. Since you had dental procedures, salivary glands are usually disrupted, which can explain your raised levels of CA19-9.

Also, the literature says that CA19-9 is neither a sensitive nor a specific marker for pancreatic cancer nor a particular marker for other malignancies. This antigen is more helpful in follow-up with patients post-surgery among subjects who already have proven cancers.

Since your radiological cross-sectional imaging studies do not suggest any space-occupying lesion in the pancreas or bile duct system, this rules out the possibility of pancreatic cancers.

So, I mean the same as your first clinician suggests, to follow CA 19-9. Ideally, this should be tested once your dental problem goes away. As for your salivary glands and the area surrounding them, if inflamed or in recovery, this antigen may come up.

Finally, I suggest you ignore these values. Tumor markers like this are always relevant in a clinical context, and in your context, given all other testing is negative, it does not suggest pancreatic cancer.

I hope this information will help you.

Answer 2

Hi,

Welcome back to icliniq.com.

I understand your concern.

Generally, the microscopic inflammation settles in three to four weeks. It is not the dental procedure that has led to the disruption of the linings of salivary glands and adjacent areas, but it might be the same problem for which you went for the procedure in the first place. So your dentist can guide you regarding that? If your dentist has cleared that issue, I suggest you take a break for at least two months and repeat the test. I also believe it is likely due to this dental procedure since the first blood test was near the normal range. If it had been high in the first place, we would have interpreted this raised level differently, but thankfully, it was not the case.
No, I do not think so. Some discomfort in the upper abdomen, particularly after meals or otherwise, can be due to gas. The peptic ulcer causes pain, and the patient has pain-predominant symptoms. Does the acid suppressant you were taking help with your discomfort? If yes, then this can be acidity only, often brought on by the use of spices, taking junk, or just reflux, which is common and considerably benign to anybody.
You are not supposed to undergo any more testing. For CA 19-9, yes, you can repeat it after two months, and preferably after a resolution of your oral or dental condition.
Suppose you have a particular risk of developing pancreatic cancer. In that case, if that happens to a person with a strong family history of pancreatic cancers or other abdominal cancers, like colon and duodenum cancers, then we can consider screening with endoscopic ultrasound (EUS) of the pancreas. Since you have no history in the family, I do not think that you are predisposed to develop pancreatic cancer at this age. Secondly, there are national guidelines for screening EUS for pancreatic cancers; you should check with your physician or in a local or referral hospital. But I believe if you do not have a positive family history, then you would likely decline this request since EUS is an invasive procedure and is done with special equipment.
The probability in your case, given all radiological tests, which are negative, with only three to four times elevated CA 19-9 levels, which is not a specific and accurate marker, and the temporality of elevated levels with dental procedures, it seems you have no evidence of pancreatic cancer. This blood test is not the sole marker to detect pancreatic cancer in a person, nor does it suggest that you have an increased probability of developing pancreatic cancer.

I hope this information will help you.

Thanks.