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Cancer

Cancer in Common Bile Duct

11/24/2009

Question:

My father is 53 years old and has been diagnosed with obstructive jaundice. He has been advised to undergo a ca 19-9 test and the result was initially >1000. After about a week he had undergone the test again and the result was >25000. Then a stent was successfully placed in his bile duct to facilitate the flow of bile which had caused his bilirubin to rise to 15. While the stenting was being done the doctor found a stone struck in his bile duct and also found the bile duct narrower than it should be, so he took a brushing from the region which was sent for a histo-pathology test the result to which was negative. We were then advised to discharge him and bring him back for further treatment after a month and go for regular ca 19-9 and bilirubin tests during the period. As advised we had his blood sample tested and the result showed bilirubin to be 4.2 and ca 19-9 to be >5500 which is less than the previous value. I would be ever indebted if you find time out of your busy schedule to reply me and tell me what inference can be drawn from the above mentioned facts. Thank you

Answer:

Based upon the markedly high CA 19-9, one would be led to the conclusion that he has a cancer of his bile ducts, called cholangiocarcinoma. Usually, any CA 19-9 value over 150 or so, we define that as being a bile duct cancer.

He needs to be evaluated for bile duct cancer. Often, this entails a high resolution CT, a procedure called an EUS. Just because the ERCP brushing were negative, does not mean that there is not a cancer. The brushings are only positive in a relatively minority of cases.

I would take these findings very seriously. That level of elevated CA 19-9 would not be indicative of biliary obstruction, without having a superimposed cancer.

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Response by:

Steven  M Rudich, MD, PhD, FACS Steven M Rudich, MD, PhD, FACS
Formerly
Professor of Surgery, Director of Liver Transplat and Hepatobiliary Surgery
College of Medicine
University of Cincinnati