A jaundiced patient with pancreatic enlargement is most likely to have an elevated level of which tumor marker?

A jaundiced patient with pancreatic enlargement is most likely to have an elevated level of which tumor marker?

• A. AFP
• B. CA15-3
• C. CEA
• D. CA19-9

Answer: (D)

CA19-9 is the marker most closely associated with pancreatic cancer, especially pancreatic adenocarcinoma. When the pancreas enlarges and a patient becomes jaundiced, obstruction of the bile duct by a tumor in the pancreatic head is a common scenario, and CA19-9 levels tend to rise with tumor burden. This marker is routinely used to monitor disease status and response to therapy in pancreatic cancer. Other markers are less specific to the pancreas: AFP is linked to hepatocellular and some germ cell tumors, CA15-3 is more related to breast cancer, and CEA is elevated in colorectal and several other malignancies (and benign conditions). Keep in mind that biliary obstruction itself can elevate CA19-9, and a subset of individuals may not express it at all.

CA19-9 is the marker most closely associated with pancreatic cancer, especially pancreatic adenocarcinoma. When the pancreas enlarges and a patient becomes jaundiced, obstruction of the bile duct by a tumor in the pancreatic head is a common scenario, and CA19-9 levels tend to rise with tumor burden. This marker is routinely used to monitor disease status and response to therapy in pancreatic cancer. Other markers are less specific to the pancreas: AFP is linked to hepatocellular and some germ cell tumors, CA15-3 is more related to breast cancer, and CEA is elevated in colorectal and several other malignancies (and benign conditions). Keep in mind that biliary obstruction itself can elevate CA19-9, and a subset of individuals may not express it at all.