Concerned about increase in CA 19 score during treatment

CA 19-9 can be affected by a lot of things including a cold, infection digestion problems or bile duct clogging. Histotripsy is also one of them. I have a friend that had histotripsy on his pancreas 6 months ago and his CA 19-9 has ben elevated ever since. This marker is unreliable all the time.

@mcharlesfrancis agreed. My husbands CA19-9 was very elevated after he developed jaundice, they discovered his bike duct was blocked with CT and saw the tumor only with MRI (MRCP). It then dropped again after stints were placed with ERCp, biopsy was positive for PADC. Since his stints were placed his CA9-19 has been normal. And CT scans do not show tumor. I often wonder why they only do CT scans when the tumor isn’t visible.

@wfs588wea, it's always concerning when lab tests are abnormal.
I like the information provided by the website Lab Tests Online (https://labtestsonline.org/) by the American Association for Clinical Chemistry (AACC). The information is trustworthy and easy to understand.

Here's the page about Cancer Antigen 19-9 (CA 19-9) https://www.testing.com/tests/cancer-antigen-19-9/
CA 19-9 is primarily used to monitor response to pancreatic cancer treatment and to watch for recurrence. In the section called "What does the test result mean?" it states:
"Levels of CA 19-9 that are initially high and then fall over time may indicate that the treatment is working and/or that the cancer was removed successfully during surgery. Levels that remain high or rise over time may indicate that treatment is not working and/or that the cancer is recurring."

It's important to remember that the CA 19-9 test is only one piece of the puzzle. Changes in levels may indicate when further investigation is needed. As @mcharlesfrancis mentioned, there are other things like inflammation or infection that can raise the levels.

How did the appointment with your wife's oncologist go? Was further testing ordered or further monitoring? How are you doing?

The testing site has been renamed. Here is the current link. Good information there.
https://www.testing.com/tests/cancer-antigen-19-9/

@ljojimo, thank you for the updated link. I revised my post. 🙂

@yellie You raise a good question about use of CT vs MRI regarding tumor detection and surveillance and it is a common point of confusion for the lay person.. I have spoken to several radiologists for their response.

CT is usually the first test because it’s fast, widely available (especially in the ER), and excellent for seeing things like bile duct blockage, liver spread, lymph nodes, and surgical anatomy. It’s also much less expensive and easier for very ill patients to tolerate. So when time is of the essence because the patient is experiencing acute pain and discomfort from symptoms, the CT is specified in diagnostic protocols.

MRI/MRCP is more sensitive for small pancreatic and bile duct tumors, but it takes longer, is more expensive, and isn’t always available urgently—so it’s often used after CT when more detail is needed.

Even when a tumor isn’t clearly visible on CT, CT is still very useful for monitoring spread, treatment response, and overall anatomy, which is why it remains the standard follow-up scan.

If a patient is stable and there’s no urgency, they absolutely can ask their team whether MRI/MRCP would add useful information.

@yellie Immediately get to a center that specializes in adenocarcinoma and have it removed. He is very lucky that it has been caught so soon. Dr. Evens at Froedtert in Wi is the best surgeon in US for pancreas cancer.

Thank you for the help. He did have a Whipple, so fortunately it’s been fully removed, the staging was posted was from his Whipple pathology. One of the bright spots in this journey is that it was caught so early. He also had 9 rounds of Neoadjuvant Flofirinox. The oncologist and oncology surgeon felt tumor had responded to chemo based off pathology and CT changes. The oncologist felt because of staging no further chemo was needed. He is interested in studies and they all ask about Genome testing. Not sure exactly why that hasn’t been completed but now have more information to request it clearly or seek second opinions. Thank you again for the helpful advice.