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CA 9-19 bloodwork fluctuates: Should I be worried?

Posted by djfone @djfone, Jul 17 9:32am

The CA 9-19 bloodwork has steadily been going down, from 232 to 50 over 4 months. 2 weeks ago it climbed to 70. This week it's 114. No changes in chemo treatment for pancreatic cancer. My husband has been on Folfirinox, minus the Irinotecan because of intolerance, every 2 weeks. He is at cycle #6 of 12. The oncologist says he's not concerned. Could be inflammation? He's had CT scan & all other bloodwork are negative. Anybody have this experience?

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mcharlesfrancis | @mcharlesfrancis | Jul 18 8:08am

can understand why that would make you anxious, but I also understand why his oncologist isn't overly concerned yet.

CA 19-9 is a very useful marker, but it's only one piece of the puzzle. It can fluctuate from week to week, and increases can occur because of inflammation, infection, biliary irritation, or even normal biological variation. The overall trend and, more importantly, what the CT scans show are what most oncologists rely on.

Your husband's CA 19-9 has come down dramatically—from 232 to 50—which suggests he has responded well to treatment. While the rise to 70 and now 114 is something to watch, it doesn't necessarily mean the cancer is growing, especially if his CT scan is stable and the rest of his blood work looks good.

I would also ask his oncologist whether a circulating tumor DNA (ctDNA) blood test, such as Guardant360 or Signatera (when appropriate), might provide additional information. These tests can sometimes detect molecular changes or help monitor disease alongside imaging and tumor markers, although they don't replace CT scans or CA 19-9 and aren't appropriate for every patient or every stage of treatment.

I've learned over the years not to panic over a single CA 19-9 result. Mine has bounced around while my scans remained stable. My oncologist always reminds me to treat the patient, not just the number.

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djfone | @djfone | Jul 18 10:19am
In reply to @mcharlesfrancis "can understand why that would make you anxious, but I also understand why his oncologist isn't..." + (show)
Profile picture for mcharlesfrancis @mcharlesfrancis

can understand why that would make you anxious, but I also understand why his oncologist isn't overly concerned yet.

CA 19-9 is a very useful marker, but it's only one piece of the puzzle. It can fluctuate from week to week, and increases can occur because of inflammation, infection, biliary irritation, or even normal biological variation. The overall trend and, more importantly, what the CT scans show are what most oncologists rely on.

Your husband's CA 19-9 has come down dramatically—from 232 to 50—which suggests he has responded well to treatment. While the rise to 70 and now 114 is something to watch, it doesn't necessarily mean the cancer is growing, especially if his CT scan is stable and the rest of his blood work looks good.

I would also ask his oncologist whether a circulating tumor DNA (ctDNA) blood test, such as Guardant360 or Signatera (when appropriate), might provide additional information. These tests can sometimes detect molecular changes or help monitor disease alongside imaging and tumor markers, although they don't replace CT scans or CA 19-9 and aren't appropriate for every patient or every stage of treatment.

I've learned over the years not to panic over a single CA 19-9 result. Mine has bounced around while my scans remained stable. My oncologist always reminds me to treat the patient, not just the number.

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@mcharlesfrancis
Thanks so much for your detailed response! The info helps me understand a lot better how to process the whole picture. Thanks so very much for your time and support!
Donna

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