CA 19-9 levels in patients with acute pancreatitis due to gallstone and metabolic/toxic reasons

SUMMARY OBJECTIVE Acute pancreatitis (AP) is an important clinical event with an increased frequency due to increased life expectancy, obesity, and alcohol use. There are some data about the elevation of carbohydrate antigen (CA) 19-9 levels in benign and malignant pancreaticobiliary events in the literature, but in AP they are limited. The aim of this study was to evaluate the CA 19-9 level in patients with AP and determine its relationship according to the cause. METHODS Between 2010-2018, 173 patients evaluated with CA 19-9 levels as well as by standard laboratory tests were included in the study. CA 1 9-9 levels and laboratory findings were compared in patients with pancreatitis due to gallstone (group 1) and metabolic/toxic reasons such as hyperlipidemia, alcohol, or drug use (group 2). RESULTS There were 114 (66%) patients in the group 1 and 59 (34%) patients in the group 2. The majority of patients with high CA 19-9 level were in group 1 (92.1% vs 6.8%). CA 19-9 level, as well as amylase, lipase, AST, ALT and bilirubin levels were found to be statistically higher in patients with AP due to gallstone compared to patients with metabolic/toxic AP. CONCLUSIONS Patients with AP due to gallstone, were found to have a high level of CA 19-9 at admission. Early stage CA 19-9 levels may contribute to standard laboratory tests in the etiology of the disease in patients diagnosed with AP.

RESUMO OBJETIVO A pancreatite aguda (PA) é um evento clínico importante e cada vez mais frequente devido ao aumento da expectativa de vida, obesidade e do consumo de álcool. Existem alguns dados na literatura sobre a elevação dos níveis do antígeno carboidrato (CA) 19-9 em eventos pancreato-biliares benignos e malignos, mas eles são limitados em relação à PA. O objetivo deste estudo foi avaliar o nível de CA 19-9 em pacientes com PA e determinar sua relação com a causa da doença. PACIENTES E MÉTODOS Entre 2010 e 2018, 173 pacientes submetidos a uma avaliação dos níveis de CA 19-9, bem como testes laboratoriais padrão, foram incluídos no estudo. Os níveis de CA 19-9 e os achados laboratoriais foram comparados em pacientes com pancreatite devido a cálculos biliares (grupo 1) e razões metabólicas/tóxicas, como hiperlipidemia, álcool, ou uso de drogas (grupo 2). RESULTADOS Um total de 114 (66%) pacientes foi incluído no grupo 1 e 59 (34%) no grupo 2. A maioria dos pacientes com alto nível de CA 19-9 estavam no grupo 1 (92,1% versus 6,8%). O CA 19-9, bem como os níveis de amilase, lipase, AST, ALT e bilirrubina foram estatisticamente mais altos em pacientes com PA devido a cálculos biliares em comparação àqueles com PA devido a alterações metabólicas/tóxicas. CONCLUSÃO Pacientes com PA devido a cálculos biliares apresentaram um alto nível de CA 19-9 no momento da internação. O nível de CA 19-9 na fase inicial pode contribuir para testes laboratoriais padrão na etiologia da doença em pacientes com diagnóstico de PA.

Rendimiento diagnóstico de marcadores tumorales séricos convencionales en pacientes con sospecha clínica de cáncer primario metastásico a hígado / Conventional serum tumor markers in liver cancer. Retrospective analysis of 118 patients

Background: Conventional serum tumor markers (CSTM) are widely used for monitoring patients with cancer. However, their usefulness as a diagnostic tool is controversial in primary or metastatic liver cancer (PMLC). Aim: To evaluate the diagnostic performance of the most commonly requested CSTM in the diagnostic approach of PMLC. Material and Methods: Review of medical records of patients aged over 18 years with a liver biopsy, attended from 2005 to 2017 in a tertiary hospital and a regional cancer center in Colombia. The results of liver biopsies were compared with tumor markers such as carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), CA 19-9, CA 125 and prostate specific antigen (PSA) using a receiver operating characteristic (ROC) curve analysis. Results: We reviewed 2063 medical records and retrieved 118 eligible patients (59 cases and 59 controls, 70% males). Thirty percent had obstructive jaundice. There was heterogeneity in the amount of tumor markers requested according to medical criteria. Only CA 19-9 showed discriminative capacity (> 17.6 U/m), with a cut-off point lower than that reported in the literature and a sensitivity of 69.5%, specificity of 91.6%, a positive likelihood ratio (LR) of 8.32, and a negative LR of 0.33. Conclusions: Except for CA 19-9, tumor markers were not useful for the initial diagnostic approach in patients with suspected primary or metastatic malignant liver tumors.

Mature Cystic Teratoma of Ovary with Abnormally High Levels of Ca19-9: A Case Report / Teratoma maduro cístico do ovário com níveis aberrantes de Ca19-9: caso clínico

Abstract Mature cystic teratomas, or dermoid tumors, are the most common benign ovarian neoplasms in young women. Malignant transformation is rare, and occurs in less than 2% of the cases. The heterogeneous histological composition of these tumors may be responsible for the occasional elevation of various tumor markers, such as Ca19-9 and Ca125. We describe one case of mature cystic teratoma in a 50-year old woman with the second highest level of Ca19-9 (8922.76 UI/mL) described in the literature. We concluded that abnormal levels of Ca19-9 are not necessarily associated with ovarian malignancy, and may lead to unnecessary medical intervention and patient anxiety. Therefore, the clinical features, imaging studies and antigen testing should be interpreted carefully, and should not limit the surgical approach.

Resumo Os teratomas maduros císticos do ovário, ou tumores dermoides, são as neoplasias benignas mais frequentes em mulheres jovens. A sua transformação maligna é rara, e ocorre emmenos de 2% dos casos. A composição histológica heterogénea destes tumores pode ser responsável pela ocasional elevação de marcadores tumorais, como o Ca19-9 e o Ca125. Descrevemos umcaso de teratoma maduro cístico do ovário numa paciente de 50 anos com o segundo valor mais elevado de Ca19-9 (8922,76 UI/mL) descrito na literatura. Concluímos que níveis anormalmente elevados de Ca19-9 não estão necessariamente associados a tumores malignos, e podem conduzir a intervenções médicas desnecessárias e contribuir para o aumento da ansiedade da paciente. Portanto, as características clínicas, os estudos imagiológicos e os marcadores tumorais devem ser interpretados cuidadosamente, e não devem limitar o tipo de conduta cirúrgica.

Postoperative Carcinoembryonic Antigen as a Complementary Tumor Marker of Carbohydrate Antigen 19-9 in Pancreatic Ductal Adenocarcinoma

The role of carcinoembryonic antigen (CEA) in pancreatic cancer remains poorly understood. Therefore, this study aimed to determine whether CEA is complementary to carbohydrate antigen 19-9 (CA19-9) in prognosis prediction after pancreatic cancer curative resection. We retrospectively reviewed records of 144 stage II curatively resected pancreatic cancer patients with preoperative and postoperative CEA and CA19-9 levels. Patients with normal preoperative CA19-9 were excluded. R0 resection margin, adjuvant treatment, and absence of angiolymphatic invasion were associated with better overall survival. There was no significant difference in median survival according to preoperative CEA levels. However, patients with normal postoperative CA19-9 (59.8 vs.16.2 months, P < 0.001) and CEA (29.4 vs. 9.3 months, P = 0.001) levels had longer overall survival than those with elevated levels. Among 76 patients with high postoperative CA19-9 levels, a better prognosis was observed in those with normal postoperative CEA levels than in those with elevated levels (19.1 vs. 9.3 months, P = 0.004). Postoperative CEA and CA19-9 levels are valuable prognostic markers in resected pancreatic cancer. Normal postoperative CEA levels indicate longer survival, even in patients with elevated postoperative CA19-9.

Prognostic Factors in Patients with Advanced Pancreatic Cancer Treated with Gemcitabine Chemotherapy: Clinical Characteristics of Long-term Survivors / 대한소화기학회지

BACKGROUND/AIMS: Gemcitabine-based chemotherapy has been used as a standard treatment in patients with unresectable pancreatic cancer. However, the clinical outcomes of this regimen are still unsatisfactory in prolonging survival. We retrospectively analyzed clinical characteristics of patients with advanced pancreatic cancers who received gemcitabine-based chemotherapy and showed long-term survival. METHODS: We enrolled 49 patients who underwent treatment with more than three cycles of gemcitabine-based chemotherapy. Long-term survivor was defined as patient who has survived more than 12 months after diagnosis. The clinical characteristics were analyzed to compare the differences between long-term and short-term survivors. Univariate or multivariate analyses were performed to identify prognostic factors associated with chemo-responses. RESULTS: Twenty patients (41%) survived more than 12 months. Long-term survivors had smaller tumor size (OR 2.190, p=0.049, 95% CI 1.005-4.773) and higher serum BUN level (OR 0.833, p=0.039, 95% CI 0.701-0.990) compared to short-term survivors. Overall median and progression-free survivals were 11 and 4 months, respectively. Presence of distant metastasis (hazard ratio 1.441, p=0.035, 95% CI 1.002-2.908) was a significant independent predictor of progression-free survival. Tumor size (hazard ratio 1.534, p=0.004, 95% CI 1.150-2.045) was associated with overall survival. CONCLUSIONS: Gemcitabine chemotherapy may be more effective and allow longer survivals in patients with clinical characters of smaller tumor size and normal serum BUN level at diagnosis. We suggest a well-designed large controlled study to evaluate the prognostic factors such as clinical characteristics and molecular biological features in patients with advanced pancreatic cancers who receive gemcitabine-based chemotherapy.

Is a Preoperative Assessment of the Early Recurrence of Pancreatic Cancer Possible after Complete Surgical Resection?

BACKGROUND/AIMS: The prognosis of pancreatic adenocarcinoma (PAC) is poor. The serum carbohydrate antigen 19-9 (CA 19-9) level has been identified as a prognostic indicator of recurrence and reduced overall survival. The aim of this study was to identify preoperative prognostic factors and to create a prognostic model able to assess the early recurrence risk for patients with resectable PAC. METHODS: A series of 177 patients with PAC treated surgically at the St. Andrea Hospital of Rome between January 2003 and December 2011 were reviewed retrospectively. Univariate and multivariate analyses were utilized to identify preoperative prognostic indicators. RESULTS: A preoperative CA 19-9 level >228 U/mL, tumor size >3.1 cm, and the presence of pathological preoperative lymph nodes statistically correlated with early recurrence. Together, these three factors predicted the possibility of an early recurrence with 90.4% accuracy. The combination of these three preoperative conditions was identified as an independent parameter for early recurrence based on multivariate analysis (p=0.0314; hazard ratio, 3.9811; 95% confidence interval, 1.1745 to 15.3245). CONCLUSIONS: PAC patient candidates for surgical resection should undergo an assessment of early recurrence risk to avoid unnecessary and ineffective resection and to identify patients for whom palliative or alternative treatment may be the treatment of choice.

Clinical predictors of resectability of pancreatic adenocarcinoma

Identifying patient-related factors as well as symptoms and signs that can predict pancreatic cancer at a resectable stage, which could be used in an attempt to identify patients at an early stage of pancreatic cancer that would be appropriate for surgical resection and those at an unresectable stage be sparred unnecessary surgery. A retrospective chart review was conducted at a major tertiary care, university hospital in Riyadh, Saudi Arabia. The study population included individuals who underwent a computed tomography and a pancreatic mass was reported as well as the endoscopic reporting database of endoscopic procedures where the indication was a pancreatic mass, between April 1996 and April 2012. Any patient with a histologically confirmed diagnosis of adenocarcinoma of the pancreas was included in the analysis. We included patients' demographic information [age, gender], height, weight, body mass index, historical data [smoking, comorbidities], symptoms [abdominal pain and its duration, anorexia and its duration, weight loss and its amount, and over what duration, vomiting, abdominal distention, itching and its duration, change in bowel movements, change in urine color], jaundice and its duration. Other variables were also collected including laboratory values, location of the mass, the investigation undertaken, and the stage of the tumor. A total of 61 patients were included, the mean age was 61.2 +/- 1.51 years, 25 [41%] were females. The tumors were located in the head [83.6%], body [10.9%], tail [1.8%], and in multiple locations [3.6%] of the pancreas. Half of the patients [50%] had Stage four, 16.7% stages two B and three, and only 8.3% were stages one B and two A. On univariable analysis a lower hemoglobin level predicted resectability odds ratio 0.65 [95% confidence interval, 0.42-0.98], whereas on multivariable regression none of the variables included in the model could predict resectability of pancreatic cancer. A CA 19-9 cutoff level of 166 ng/mL had a sensitivity of 89%, specificity of 75%, positive likelihood ratio of 3.6, and a negative likelihood ratio of 0.15 for resectability of pancreatic adenocarcinoma. This study describes the clinical characteristics of patients with pancreatic adenocarcinoma in Saudi Arabia. None of the clinical or laboratory variables that were included in our study could independently predict resectability of pancreatic adenocarcinoma. Further studies are warranted to validate these results.

A Comparative Study on Serum Immunoglobulin and Tumor Marker Levels in the Patients with Autoimmune Pancreatitis and Pancreatobiliary Malignancies / 대한소화기학회지

BACKGROUND/AIMS: Autoimmune pancreatitis (AIP) often occurs with obstructive jaundice in old age in cases of weight loss, mimicking pancreatobiliary cancer. This study aimed to determine the sensitivity and specificity serum IgG, IgG4 and CEA, CA 19-9 levels for the diagnosis of AIP and their ability to distinguish AIP from pancreatobiliary cancer. METHODS: The level of serums IgG, IgG4 and CEA, CA 19-9 were measured in 413 patients including 125 with AIP, 201 with pancreatic cancer, and 87 with cholangiocarcinoma. RESULTS: Among AIP patients, 43.2% (54/125) showed elevated IgG levels (> or =1,800 mg/dL) and 52% (65/125) showed elevated IgG4 levels (> or =135 mg/dL). Sensitivity and specificity of elevated serum IgG for diagnosis AIP were 43% and 88% respectively, and 52% and 97%, respectively for elevated serum IgG4. When the cut-off value of serum IgG4 was raised to 270 mg/dL (twice the upper limit of normal), the specificity improved to 100%. About 25% of the AIP patients showed an increased level of CA 19-9 at >37 U/mL and about 12.2% of them showed an increased level of CA 19-9 at >100 U/mL. On the contrary, only 1.8% of the AIP patients showed an increased level of CEA at >6.0 ng/mL. CONCLUSIONS: To avoid unnecessary surgeries resulting from a misdiagnosed pancreatobiliary cancer as opposed to AIP, it is necessary to consider both serum immunoglobulin and tumor marker. In particular, because high level of IgG4 (> or =270 mg/dL) and CA19-9 (>100 U/mL) are relatively rare in pancreatobiliary cancer and AIP, respectively, they will be helpful in differential diagnosis.

Evaluation of the UniCel(TM) DxI 800 Immunoassay Analyzer in Measuring Five Tumor Markers

PURPOSE: Tumor marker concentrations in a given specimen measured by different analyzers vary according to assay methods, epitopes for antibodies used, and reagent specificities. Although great effort in quality assessment has been instituted, discrepancies among results from different analyzers are still present. We evaluated the assay performance of the UniCel(TM) DxI 800 automated analyzer in measuring the alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 125, CA 15-3 and CA 19-9 tumor markers. MATERIALS AND METHODS: The linearity and precision performance of the five tumor marker assays were evaluated, and concentrations of the respective markers as measured by DxI were compared to those measured by other conventional analyzers (ADVIA Centaur(TM) and Vitros(TM) ECi) using 200 specimens collected from 100 healthy persons and 100 patients with respective cancers. RESULTS: The linear fits for all five tumor markers were statistically acceptable (F=4648 for AFP, F=15846 for CEA, F=6445 for CA 125, F=2285 for CA 15-3, F=7459 for CA 19-9; p<0.0001 for all). The imprecision of each tumor marker assay was less than 5% coefficient of variation, except for low and high concentrations of AFP. The results from UniCel(TM) DxI 800 were highly correlated with those from other analyzers. CONCLUSION: Our results demonstrate that UniCel(TM) DxI 800 has good linearity and precision performance for the tumor markers assayed in this study. However, there were discrepancies between assaying methods. Efforts to standardize tumor marker assays should be undertaken, and the redetermination of cut-off levels is necessary when developing methods of analyzing tumor markers.

Do serum CA 19-9 and CA 125 levels predict the severity of HCV-related liver fibrosis?

To study the value of measurement of serum tumor markers CA 19-9 and CA 125 as predictors of severity of liver fibrosis in patients with chronic hepatitis C. Fifty patients with chronic hepatitis C were recruited from the Hepatology and Gastroenterology Department at Ain Shams University Hospital. They were 31 men and 19 women, with ages ranging from 18 to 50 years. Participants were subjected to full clinical examination, liver function tests, viral markers [hepatitis B surface antigen, hepatitis C virus antibody], a fetoprotein, autoimmune markers, assay of serum levels of CA 19-9 and CA 125, abdominal ultrasonography, and ultrasound-guided liver biopsy. Histopathological examination for staging of liver fibrosis was performed using the Ishak scoring system. There was a highly significant positive correlation between serum levels of CA 19-9 and CA 125 and the stage of liver fibrosis [P<0.01]. There was also a difference in the mean values of serum CA 19-9 among different stages of liver fibrosis. Similar differences were seen for CA 125. The best cut-off value for CA 19-9 in predicting severe liver fibrosis and cirrhosis [stages 5, 6] was found to be 33.87 U/ml with sensitivity of 93.8% and specificity of 88.2%, whereas the best cut-off value for CA 125 in predicting severe liver fibrosis and cirrhosis [stages 5, 6] was found to be 25 U/ml with sensitivity of 93.8% and specificity of 82.4%. Combined elevation of CA 19-9 and CA 125 above the cut-off value showed less sensitivity [87.5%] than that of each of CA 19-9 [93.8%] and CA 125 [93.8%], and a better specificity [88.24%] than that of CA 19-9 [88.2%] and CA 125 [82.4%]. Serum CA 19-9 and CA 125 may be used as noninvasive markers of severe hepatitis C virus-related liver fibrosis. This needs to be validated by more studies

Primary Adenosquamous Cell Carcinoma of the Pancreas: A Case Report with a Review of the Korean Literature

The most common pancreatic cancer is adenocarcinoma. Primary adenosquamous cell carcinoma of the pancreas is very rare and aggressive. A 46-year-old man presented with a 3-month history of dyspepsia and a 7-kg weight loss. The physical examination showed tenderness of the right upper quadrant of the abdomen. There was no jaundice. Amylase and lipase were elevated. CA 19-9 was elevated to 566.7 U/mL. Gastroduodenoscopy showed a hard ulceroinfiltrative mass with a yellowish exudate that bled readily on touch in the second portion of the duodenum. Abdominal computed tomography showed a 7.1 x 6.3-cm heterogeneously enhancing mass in the pancreatic head. The pancreatic mass had invaded the duodenum wall, gastric antrum, and gastroduodenal artery sheath. Fine-needle aspiration biopsy of the pancreatic mass revealed adenosquamous cell carcinoma, anaplastic type. We concluded that an adenosquamous cell carcinoma of pancreas had invaded the duodenal mucosa causing ulceration.

Comparison of CEA and CA 19-9 with CA 72-4 in patients with upper gastrointestinal carcinomas in local population

Gastrointestinal carcinomas are amongst the most common malignancy showing an annual increase globally. In our population, there is an increase in GIT carcinomas over the years and these are occurring at a much younger age. Tumour markers are molecular substances produced by all tumour cells which are excreted in body fluids or present on the surface of the cells. CEA, CA 19-9 and CA 72-4 are tumour markers for GIT carcinomas. The study included patients of upper GIT carcinoma and controls of both sexes and all ages. Each category included about 30 blood samples. Serum of each sample was evaluated for tumour markers CEA, CA 19-9 and CA 72-4. The estimations were made by using ELISA/EIA. The t-test and ANOVA were performed for comparison of means, specificity and sensitivity of each marker were also calculated. Showed that in our population GIT carcinoma is common in younger age group. Sensitivity of CEA, CA 19-9 and CA 72-4 is 63.33%, 50% and 63.33% respectively whereas specificity of these markers are 60%, 93.33% and 100% respectively in upper GIT carcinoma. CA 19-9 is tumour marker of choice for pancreatic carcinoma and CA 72-4 for gastric carcinoma

A Case of Cholangiocarcinoma Suspected by Continuous Elevation of CA 19-9 after Surgery of Xanthogranulomatous Cholecystitis / 대한소화기학회지

Xanthogranulomatous cholecystitis (XGC) is an unusual and destructive inflammatory process that is characterized by thickening of the gallbladder (GB) wall with a tendency to adhere to neighboring organs. XGC is often mistaken for GB carcinoma, and the frequency of the coexistence of these two lesions is approximately 10%. Therefore, in case of severe XGC, there is chance of either overlooking the carcinoma or other significant lesions. CA 19-9 is commonly measured in the serum of patients with hepatobiliary malignancies. Although CA 19-9 can be elevated in benign conditions such as cholestasis, pancreatitis, tuberculosis, thyroid disease etc., malignancy should be considered at first in setting of its significant and persistent elevation. We report a case of a 62-year-old man who showed continuously rising level of CA19-9 over 2000 U/mL after cholecystectomy for xanthogranulomatous cholecystitis and finally was diagnosed as cholangiocarcinoma by short-term follow up.

The Relationship between Lewis/Secretor Genotypes and Serum Carbohydrate Antigen 19-9 Levels in a Korean Population / 대한진단검사의학회지

BACKGROUND: The Lewis histo-blood group system consists of 2 major antigens-Lea and Leb-and a sialyl Lewis antigen-carbohydrate antigen (CA) 19-9. We investigated the distribution of Lewis genotypes and evaluated the relationship between the Lewis/Secretor genotypes and the serum level of CA 19-9 in a Korean population to identify whether the serum CA 19-9 levels are influenced by the Lewis/Secretor genotypes. METHODS: The study included 242 individuals who had no malignancies. Lewis genotyping was performed for the 59T>G, 508G>A and 1067T>A polymorphic sites. The Secretor genotype was determined through analysis of the 357C>T and 385A>T polymorphic sites and the fusion gene. Serum CA 19-9 level was analyzed using an electrochemiluminescence immunoassay. RESULTS: Individuals carrying the 3 common genotypes-Le/Le, Le/le(59,508), and Le/le(59,1067)-accounted for 95% of the study population. In the Korean population, the allelic frequencies of Le, Le(59), le(59,508), and le(59,1067) were 0.731, 0.010, 0.223, and 0.035, respectively. We found a significant difference in serum CA 19-9 concentrations among the 9 Lewis/Secretor genotype groups (P<0.001). The serum CA 19-9 levels in subjects with genotype groups 1 and 2 (Le/- and se/se) were higher than those with genotype groups 3-6 (Le/- and Se/-; 15.63 vs 6.64 kU/L, P<0.001). CONCLUSIONS: Le/Le, Le/le(59,508), and Le/le(59,1067) are frequent Lewis genotypes in Koreans. Because serum CA 19-9 levels are significantly influenced by the Lewis/Secretor genotypes, caution is suggested when interpreting the serum CA 19-9 levels.

Comparison of serum CA 19.9, CA 125 and CEA levels with severity of chronic obstructive pulmonary disease

To investigate serum levels of CA 19.9, CA 125 and carcinoembryonic antigen [CEA] in patients with different stages of chronic obstructive pulmonary disease [COPD]. Fifty-three consecutive patients [50 males, 3 females, mean age 67.6 +/- 10.1 years] with COPD were included in this study. Serum levels of CA 19.9, CA 25 and CEA were determined by the chemiluminescent immunometric method. Based on values obtained from pulmonary function tests, the patients were divided into 3 groups: moderate [21], severe [18] and very severe [14]. Data were analyzed with a Kruskal-Wallis one-way analysis of variance test and Mann-Whitney U test The mean serum levels of CA 125 and CA 19.9 were significantly higher in patients with very severe COPD [p = 0.013 and p = 0.017, respectively] than in patients with severe and moderate COPD [p < 0.05]. Patients with cor pulmonale had significantly high mean serum levels of CEA, CA 19.9 and CA 125 [p < 0.05]. Patients using a long-acting -agonist and theophylline showed significantly higher mean serum levels of CA 125 than patients who were not [p < 0.05]. Data showed that the increased serum tumor markers in patients with COPD might be due to the severity of COPD, medication and cor pulmonale

Combined hepatocellular and cholangiocarcinoma: CT findings with emphasis on multiphasic helical CT.

OBJECTIVE: To describe CT findings of patients with combined hepatocellular carcinoma and cholangiocarcinoma (HCC-CC) in correlation with clinical data and histopathological results. MATERIAL AND METHOD: Ten from 31 cases whose CT study was available were reviewed retrospectively in the aspect of imaging findings, clinical data, and pathological results. RESULTS: Most of the tumors were hypodense solitary mass with gradually enhanced after contrast administration. Bile duct dilatation was observed in two cases. The overall CT findings were more similar to CC rather than HCC despite the pathological result showing predominant HCC component. Serum alpha-fetoprotein level was normal or mildly elevated while an elevated concentration of carbohydrate antigen 19-9 was observed. Hepatitis profiles showed positive to hepatitis B virus infection in four cases and hepatitis C virus infection in one case. CONCLUSION: The diagnosis of combined HCC-CC should be considered if the tumor has similar findings to CC without bile duct dilatation on cirrhotic liver and the patient has normal or low rising of the AFP level with or without elevated CA 19-9 level. In non-cirrhotic liver, the finding is non-specific.

Prognostic value of pre-operative assessment of serum carcino-embryonic antigen and carbohydrate antigen 19-9 levels in colorectal carcinoma

Colorectal cancer [CRC] is one of the most frequent and aggressive neoplasms. It is the second leading cause of death from cancer in the United States and is a significant overall health problem. Tumor markers are substances synthesized amid excreted by tumor tissues that can be detected in abnormal concentrations in serum, urine, and other body fluids. Two such markers, Carcino-embryonic antigen [CEA] and Carbohydrate antigen 19-9 [CA 19-9], are useful in the diagnosis, prognosis and management of colorectal carcinoma. This study attempted to evaluate the clinical and prognostic value of the two markers using forty patients with CRC and ten healthy persons as a control group. All patients with CRC showed highly significant increases in CEA and CA -19-9 compared to the control group [p < 0.001], and there was a highly significant increase in the level of CEA in more advanced tumor stages. [p<0.01]. Regression analysis showed a significant correlation between CEA and CA-19-9 [p <0.05; r = 0.35] and significant increases in CEA in rectal tumors compared to those located in the colon; in males compared to females [p <0.05]; and also a highly significant increase in patients over 60 years of age [p <0.01] but no relation between CA 19-9 level and age, sex, and site of tumor. These data suggest that serum levels of CEA and CA -19-9 can be clinically useful in the diagnosis and staging of colorectal carcinoma

Diagnostic value of serum CA-125, CA 19-9, IL-13 and TNF-alpha in endometriosis and prediction of its severity

Endometriosis is one of the most common benign gynecological disorders affecting more than 10% of women of reproductive age A non-surgical diagnostic approach would be of great benefit to both physicians and women alike. To test the diagnostic potential of serum biochemical markers: CA-125, CA 19-9, IL-13 and TNF-alpha conditions as well as to predict its severity. Cross- sectional study. Obstetric and Gynecology Department, Kasr El-Aini hospital - Cairo University. Ninety one consecutive non-pregnant female patients in the reproductive age undergoing laparoscopy for infertility and/or chronic pelvic pain. Serum biochemical markers: CA-125, CA 19-9, IL-13 and TNF-alpha were measured using specific kits and techniques for each in the 91 patients. According to the results of laparoscopic and histopathological examination the study population were divided into 4 groups: early endometnosis, advanced endometrosis, non-endometriotic pelvic inflammations/adhesions and patients with normal findings respectively. Accuracy of the study markers in differentiating between the various pathological situations was calculated, to predict the specificity of each marker, to distinguish endometriosis from other clinical conditions and to predict its severity. Serum CA 125 in group of patients with early endometriosis [26 patients] showed significant difference when compared to the control group [16 patients]. Also significant difference of serum CA125, CA 19-9 and TNF- between cases of advanced endometriosis [14 patients] compared to PID and control groups, [51 patients]. This same significant difference was also detected with TNF-alpha between group of early endometriosis and compared to PID and control groups. CA 19-9 showed significant difference in its level in group of early endometriosis compared to other groups. After combining cases with endometriosis, the three serum biochemical markers which slowed significant difference when compared to other groups were CA-125, CA 19-9 and TNF-alpha while JL-B showed no significant difference. The accuracy of the serum biochemical markers CA-125, CA 19-9 and TNF-alpha regarding the sensitivity and specificity were 79.962, 75.82 and 93.4 respectively. TNF-alpha is characterized by perfect sensitivity while both CA-125 ed CA 19-9 have perfect specificity. Combining the results of assaying serum TNF-alpha plus any of the other markers CA 125 or CA 19-9 will have 100 accuracy in distinguishing cases with endometriosis from those with non-endometriotic lesions. Only serum level of CA 19-9 can distinguish between cases with early and advanced endometriosis

Serum tumor markers

With the advent of new generations of chemotherapeutic agents and advances in radiation therapy in the management of malignancies, an understanding of tumor markers is becoming increasingly important. These soluble molecules in the blood are usually glycoproteins detected by monoclonal antibodies. Each tumor marker has a variable profile of usefulness for screening, determining diagnosis and prognosis, assessing response to therapy, and monitoring for cancer recurrence. Monoclonal antibodies are used to detect serum antigens associated with specific malignancies. These tumor markers are most useful for monitoring response to therapy and detecting early relapse. With the exception of Prostate-Specific Antigen [PSA], tumor markers do not have sufficient sensitivity or specificity for use in screening. Cancer Antigen [CA] 27.29 most frequently is used to follow response to therapy in patients with metastatic breast cancer. Carcinoembryonic antigen is used to detect relapse of colorectal cancer, and CA 1.9-9 may be helpful in establishing the nature of pancreatic masses. CA 125 is useful for evaluating pelvic masses in postmenopausal women, monitoring response to therapy in women with ovarian cancer, and detecting recurrence of this malignancy. Alpha-fetoprotein [AFP], a marker for hepatocellular carcinoma, sometimes is used to screen highly selected populations and to assess hepatic masses in patients at particular risk for developing hepatic malignancy. Testing for the beta subunit of human chorionic gonadotropin [b-hCG] is an integral part of the diagnosis and management of gestational trophoblastic disease. Combined AFP and b-hCG testing is an essential adjunct in the evaluation and treatment of nonseminomatous germ cell tumors, and in monitoring the response to therapy. AFP and b-hCG also may be useful in evaluating potential origins of poorly differentiated metastatic cancer. PSA is used to screen for prostate cancer, detect recurrence of the malignancy, and evaluate specific syndromes of adenocarcinoma of unknown primary. This review article describes the use of common tumor markers in primary care practice. Particular emphasis is given to when these tests should be ordered and to common factors that influence the interpretation of tumor marker levels