Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
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        CA 19-9 Test, Blood
CA 19-9 antigen, serum
This is one of the "mucin-type glycoproteins" carbohydrate (cancer) antigens which may circulate in the blood of patients with pancreatic and other adenocarcinomas...casually considered to be a "pancreatic cancer marker". An ovarian cancer (OC19-9) cell line is cultivated and maintained to produce cancer cells which are injected into mice to produce antibodies against the OC19-9 cells. The murine (mouse) lymphocytes are harvested and grown to produce the antibodies at commercial volumes2.It can be helpful in the initial evaluation of a newly discovered mass of the pancreas. If this test is really high in such a case, then the odds are very high that it is a non-resectable cancer. One would then perform a fine-needle biopsy to prove the malignant diagnosis. Whether or not to perform exploratory surgery for the possibility of performing a Whipple procedure to remove the tumor would depend on many additional factors.

Conditions Causing Elevations (>40U/mL) of this Marker:

  • pancreatic cancer 72-79%
    • but, 200g., 6cm SCC of pancreas with clear margins but growing into gastric wall (AJC stage IVA) preop. only 71 (nl<37)[LMC-01-4430]
  • biliary cancers 67%-73%
  • gastric cancers 42-62%
  • colorectal cancers 19-41%; when elevated preoperatively, this is a good follow-up marker for early evidence of recurrence
  • benign multicystic mesothelioma of peritoneum (BMMP)
  • may see a moderate elevation associated with collagen diseases, diabetes mellitus, alcoholic or non-alcoholic liver disease, and acute or chronic pancreatitis & combination CA125 & CA19-9 pretty specific for advanced fibrosis or cirrhosis 4.
  • other [warning]
situations wherein the level is not elevated:

  • some...particularly when small and curatively resectable...pancreatic cancers are present without elevation.
  • non-adenocarcinomatous malignant tumors of the pancreas
  • benign pancreatic tumors

PAM4 is another extra-hepatic, pancreaticobiliary antigen getting attention in late 2011 and early 20125. But, even combined with CA19-9, it does not really help that much in early detection of treatable disease. It has false positives and negatives.


  1. Seminars in Oncology, vol. 20, #3, page 255  June 1993
  2. The Handbook of Clinical Pathology [text], McKenna & Keffer, 2nd Ed., 2000.
  3. Interpretation of Diagnostic Tests, Wallach, 2000, 7th Ed.
  4. Etxagibel A, et. al., "Drug-induced hepatitis superimposed on the presence of anti-SLA antibody: a case report", J Med Case Reports 2:25, 2008.
  5. Medscape commentary (PAM4) January 2012 HERE.


  • pancreatic cancer antigen, carbohydrate antigen 19-9

(posted 7 April 2002; latest addition 13 February 2012)

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