Thursday, April 24, 2014
CA19-9 Test for Pancreatic Cancer
Three years ago my 68 year old sister died and the reason given on her death certificate was cholangiocarcinoma. The cancer was very agressive and the length of time between diagnosis and death was 3 weeks. On December 24, 2000 my 66 year year old sister was dignosed with pancreatic carcinoma. She underwent surgery and will shortly begin chemo and radiation therapy. During January, I had a CA19-9 test ran and the result was 8 - in the normal range of 0-37. Because there is pancreatic cancer in my family, how often should I repeat the test if I am willing to pay for it. Every six months or every year? More often?
1) Cholangiocarcinoma is not the same thing as pancreatic carcinoma even though both are in close proximity in the body. Cholangiocarcinoma is a cancer of the bile duct, the tube which carries bile and runs from the gall bladder, through the head of the pancreas, and empties into the part of the small intestine known as the duodenum. It is a rare cancer with an incidence of 1-2 cases per 100,000 people in the United States.
Cholangiocarcinoma may rarely be seen along with pancreatic cancer in a family but usually the family has several individuals with colon or endometrial (uterine) cancer. This combination is part of the hereditary cancer susceptibility syndrome `Hereditary Nonpolyposis Colon Cancer` or HNPCC.
2) There are no recommended screening studies for cholangiocarcinoma.
3) Pancreatic cancer usually is not hereditary in nature but in approximately 5% of cases there may be a familial tendency for it to occur.
4) There is no proven method to screen for pancreatic cancer in at-risk family members. Performing a CA19-9 blood test by itself is a poor screening test because only about half the individuals with a tumor 1 inch or less in diameter have an increased level. [Lynch et al, Familial pancreatic cancer: a review. Seminars in Oncology 23:251-275, April, 1996.]
TA Brentnall of the University of Washington (Seattle) recently published recommendations for screening. [Cancer surveillance of patients from familial pancreatic cancer kindreds. Medicine Clinics of North America 84(3):707-18, May,2000.] `Surveillance should be started at least 1 decade before the earliest age of pancreatic cancer in the family. EUS is the basic, least-invasive surveillance tool; however, findings are similar to those seen in chronic pancreatitis. All patients who have a positive EUS or who have symptoms warrant ERCP.`
EUS is endoscopic ultrasonography (an ultrasound of the pancreas performed via an endoscopic procedure). If the EUS is abnormal, than an ERCP (endoscopic retrograde cholangiopancreatography) is performed. The ERCP is reserved for the second line because it requires dye to be injected into the pancreas. It is considered invasive and may produce complications such as pancreatitis 2-10% of the time.
Judith A Westman, MD
Associate Professor, Clinical Internal Medicine, Pediatrics and Medical Biochemistry
College of Medicine
The Ohio State University