A 70-year-old man with painless jaundice and a pancreatic mass is most likely to have elevation of which tumor marker?

A 70-year-old man with painless jaundice and a pancreatic mass is most likely to have elevation of which tumor marker?

• A. CEA
• B. CA 19-9
• C. AFP
• D. CA-125

Answer: (A)

Pancreatic ductal adenocarcinoma most classically raises CA 19-9. This marker is produced by pancreaticobiliary epithelial cells and tends to be elevated when a pancreatic mass obstructs the biliary tract, as seen with painless jaundice from a tumor in the head of the pancreas. CA 19-9 is used to monitor treatment response and recurrence, though it isn’t perfect for screening because some people never express it and biliary conditions can also raise levels. Other markers have different typical associations: CEA can be elevated in several cancers but is less specific for pancreatic cancer; AFP is linked to hepatocellular carcinoma and some germ cell tumors; CA-125 is associated with ovarian cancer. So CA 19-9 best fits the scenario of a pancreatic mass with painless jaundice.

Pancreatic ductal adenocarcinoma most classically raises CA 19-9. This marker is produced by pancreaticobiliary epithelial cells and tends to be elevated when a pancreatic mass obstructs the biliary tract, as seen with painless jaundice from a tumor in the head of the pancreas. CA 19-9 is used to monitor treatment response and recurrence, though it isn’t perfect for screening because some people never express it and biliary conditions can also raise levels. Other markers have different typical associations: CEA can be elevated in several cancers but is less specific for pancreatic cancer; AFP is linked to hepatocellular carcinoma and some germ cell tumors; CA-125 is associated with ovarian cancer. So CA 19-9 best fits the scenario of a pancreatic mass with painless jaundice.