CA19-9 normal with pancreatic cancer?
My dad had a chest CT 3 months ago (for a persistent cough). He’s healthy. Exercises daily. He was losing weight but he is always losing and gaining weight. He’s always within a healthy range. That Ct came back clear- it covered upper abdomen too. Lymphs came back clear. All bloodwork on point. Total CBC done. A week ago he’s puking blood, goes to the ER and is told he has a 4cm mass on the tail of his pancreas and lesions on lymphs. Blood work is poor and he had a bleeding varicies by the spleen. Doctor says he has Pancreatic cancer and was shocked my dad had no idea.
They transported him to another hospital and did emergency surgery to stop the bleeding and did another CT. Mass confirmed but now another doctor is saying it could be a cyst? But he does have spots on the lymphs. Biopsy scheduled for two weeks from now. And we wait…. Could a 4cm mass grow that quickly in the tail? I’m looking over my father’s bloodwork and it says the CA 19–9 is in the normal range. Isn’t that a good thing? He was 6.8.
Around 20% of pancreatic cancers are in the normal range for CA-19-9 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5351346/) with 1/2 of those patients being Le negative, meaning the body can't manufacture large amounts of CA-19-9 (https://ar.iiarjournals.org/content/38/10/5883).
That said, 80% of pancan patients have high CA-19-9 and I really hope that it turns out to be a cyst or some other non-cancer cause (it is clear that he has been through so much already). If it turns out to be cancer, be sure that his doctors get the tumor analyzed for gene changes (called Next Gen Sequencing). The results can sometimes determine treatments that will really help.
Until the biopsy, I hope you will be able to spend time together, keeping his nutrition and healing (from the emergency surgery) going strong. Best wishes to you and him both!
Jason Sager, MD
