CA 19-9 and pancreatic cancer: What do the numbers mean?

Very helpful, we are in a similar situation with my husband and will look into this!

I have recently diagnosed advanced neuroendocrine pancreatic cancer (mass in tail, locally spread and mets to liver and distal esophagus). Completed first course of high dose chemo. 3 weeks later, Ca-19-9 has gone from 23,000 to 43,000. Is chemo a failure? Should I start second course?
Thanks

When chemo is first started, the tumor burden is large. That means there is malignancy with a lot of surface area for chemotherapy and radiation to have contact with. And that equates with a lot of available CA19-9 being released into the circulation. A rise is not uncommon for several sessions and is a frequent observation. As the tumor shrinks, the surface area is reduced as there are less cells available to release CA19-9.

ThemCA19-9 is used between scans to get a general picture of what is going on. Early measurements don’t necessarily reflect whether the chemo is effective.And with radiation, it’s effects linger for weeks afterward in causing cell death. This is why oncologists usually don’t order CA19-9 testing during and after radiation treatment for several weeks following.

A CT or MRI is the definitive method oncologists use to determine chemotherapy effectiveness. A current scan is compared to the prior scan by measuring the diameter of the tumor(s).They look for shrinkage, stability or increase in size and make adjustments accordingly.

CA19-9 Treatment and Effectiveness

The link below is to a scientific publication that elaborates further.

Diagnosed in May of 2022, I have inoperable stage IV (tumor is in tail and involves veins and arteries with tiny spot initially seen in liver) and have had 17 sessions of Folfirinox-sometimes minus ironiteacan and as of recently minus oxiliaplatin. Except for chemo days and the overall reduced stamina, I feel healthy and keep myself busy and have no other health issues. Pet scans and CT scans which initially showed shrinkage (tumor is very small and no longer is there evidence detectable in liver) currently shows "stable". However, my CA19-9 is slowly creeping upwards-highest was 2558 and dropped to 65 in Nov of 2022, but now is 402. Should i be more worried than the oncologist lets on?? I am not at a pancreatic cancer center for oncology but have been advocating for myself with info I find on medical sites at JH, Mayo, and MSK. I will be traveling to MSK to receive MRI guided SBRT next month. I often feel I am only given standard treatment locally unless I present other options–it is so frustrating. Any advice/suggestions would be helpful.

I think going to MSK & or Mayo will give you all the answers you need .I have heard they don't believe the CA-19 is full proof .Go get second & third opinion.!♥️🙏

My experience has been that CA 9-19 can be affected by benign conditions like gallstones. After recently finishing 12 Folferinox treatments, my CA 9-19 was 411. It was 552 before my distal pancreatectomy, and 74 after surgery. I am stage 1b. I have an appointment today with my oncologist, and I will ask him how definitive the CA 9-19 test is and what can throw it off.

I agree with all here. It seems after 15 months of living this, that they are more indicative of a trend so a few points either way don’t concern people. It’s when you have an upward trend or a big jump. Mine were trending up after my distal P, so we decided it was time to get liver Mets out even though they were appearing stable. It’s a good thing, because one tumor was “waking up”
My number dropped 300 points to below 100 at last check two weeks after surgery.

Pls post what you hear from MSK!

My Husband 's started out at 675, now even starting chemo 2 cycles has rose to 2360, petrified, hoping they go down he has 3 more to go before they can see if they can operate.

Since my diagnosis of pancreatic cancer in January, my CA19-9 levels always been reported as under 2. My oncologist has told me that my pancreas is not secreting any antigen to measure and therefore the CA19-9 marker is not meaningful. This seems to be highly unusual but he says that 20 – 30% of patients with pancreatic adenoca have a normal CA19-9 level. If this were as frequent as he says, why isn't there more of a discussion around the absence of this critical measurement marker?

In my case … the scans showed the pancreas to be clear but Mets in the liver. The ca-19 is in the normal range (27) but the CEA has risen to 29. Started the Gensar+Abraxane today. Guessing we’re watching the scans and the CEA going forward … it would be nice to something definitive to track. Instead of Wack-A-Mole were playing Wack_a_Cancer !!!