RE: CA 19-9 ???

June 29, 2005

Barb,

According to my last blood work report (6/7/05) the normal range is from 0-36. I don't really know the answer to your other questions, but I do know that my CA-19-9, and Alpha Fetoprotein have been elevated continuously for 3 (or more years). Docs are aware of it, but haven't freaked out. I don't know if that's comforting to you, or if it should be terrifying for me.

Good luck, I hope you some answers.

June 29, 2005

Hi Barb;

I've read that a " normal " CA 19-9 is less than (<) 40 [and I think

the units are in ng/ml]. These papers indicate that " normal " is <37

ng/ml, but note that it's not a very reliable marker for

cholangiocarcinoma in PSC patients (it can go up in association with

alkaline phosphatase):

___________________

Liver. 1999 Dec;19(6):501-8.

CA 19-9 and CEA are unreliable markers for cholangiocarcinoma in

patients with primary sclerosing cholangitis.

Bjornsson E, Kilander A, Olsson R.

Department of Gastroenterology and Hepatology, Sahlgrenska University

Hospital, Goteborg, Sweden.

AIMS/BACKGROUND: Diagnosis of early cholangiocarcinoma (CC) in

patients with primary sclerosing cholangitis with available

radiological methods is very difficult. This type of tumor is the

second most common cause of mortality after liver failure in these

patients. The recognition of CC is important for the selection of

patients for, and the results of, liver transplantation (Ltx). In

this study our aim was to investigate the value of measuring cancer

markers (CA 19-9 and CEA) in patients with PSC for early diagnosis of

CC. METHODS: 72 PSC patients who were followed at our institution for

a long period were included in the study; 9 with CC and 63 without

CC. Furthermore, nine patients with CC but without concomitant PSC

were included, as well as 24 patients with various cholestatic liver

diseases. Serum levels of CA 19-9 and CEA were measured, in 39 PSC

patients without CC, on multiple occasions. Moreover, bile was

collected during a diagnostic ERCP from 20 patients for measurements

of CA 19-9 and CEA. RESULTS: In those PSC patients without CC during

the follow-up and with more than one year of follow-up, 15 patients

had increased values of CA 19-9 (>37 ng/ml) on some of the occasions.

Four of them demonstrated large fluctuations (more than 100 ng/ml

difference at different occasions) in serum levels of Ca 19-9. A

significant correlation between high CA 19-9 values and serum

alkaline phosphatase levels was observed in these patients. The

sensitivity of CA 19-9 in detecting CC in PSC patients was only 63%.

The sensitivity of CEA and the combination of CA 19-9 and CEA (marker

product; King's College formula) were still lower (33%) although the

specificity was relatively high (85%). Bile levels of the tumor

markers did not demonstrate any clinically useful differences between

the different patient groups. CONCLUSIONS: Tumor markers as a

diagnostic tool in diagnosing CC in patients with PSC are

unfortunately not as valuable as previously reported. The serum

levels of CA 19-9 can rise temporarily in association with

a " biochemical relapse " of PSC (increased values of serum alkaline

phosphatase). The marker product of CA 19-9 and CEA has a low

sensitivity but a relatively high specificity for the detection of CC

in PSC patients.

PMID: 10661684

____________________

Liver Transpl Surg. 1995 Mar;1(2):94-8.

CA19-9 does not predict cholangiocarcinoma in patients with primary

sclerosing cholangitis undergoing liver transplantation.

Fisher A, Theise ND, Min A, Mor E, Emre S, Pearl A, Schwartz ME,

CM, Sheiner PA.

Department of Surgery, Mount Sinai Medical Center, New York, NY

10029, USA.

The results of liver transplantation in patients with

cholangiocarcinoma have been poor. It has been suggested that

elevated serum CA19-9 levels predict cholangiocarcinoma in patients

with primary sclerosing cholangitis. We analyzed the predictive value

of CA19-9 antigen as a marker of cholangiocarcinoma in patients with

primary sclerosing cholangitis evaluated for liver transplantation.

We reviewed the charts of 26 patients with primary sclerosing

cholangitis (stage IV) in whom preoperative serum CA19-9 levels were

determined; 22 of 26 underwent liver transplant. Explant specimens

were serially sectioned and examined for tumor. In 3 of the 26

patients, cholangiocarcinoma was diagnosed during pretransplantation

evaluation; exploratory laparotomy on the last patient showed no

evidence of cholangiocarcinoma, and this patient is awaiting

transplantation. Twelve of the 26 patients had CA19-9 levels more

than double the laboratory reference range (0-37 U/mL) (mean 183.1 +/-

103 U/mL, range 77-415 U/mL). Two of the 12 patients with elevated

CA19-9 levels had cholangiocarcinoma. Of the 14 patients with normal

levels, two had cholangiocarcinoma. No correlation between elevated

CA19-9 and bile duct dysplasia was noted. Sensitivity for serum CA19-

9 levels more than twice the reference range is 50%, specificity is

54.5%, positive predictive value is 16.6%. An elevated serum CA19-9

level in a patient with stage IV primary sclerosing cholangitis does

not reliably predict coexisting cholangiocarcinoma. Persistently high

or rising serum CA19-9 levels do not indicate more urgent need for

liver transplantation.

PMID: 9346547

_____________________

Best regards,

Dave

(father of (20); PSC 07/03; UC 08/03)

> Does anyone know what a " normal " CA 19-9 count should be?

>

> At what number should someone be concerned?

>

> Assuming these counts go up & down, how many elevated counts in a

row should be addressed?

>

> Thanks in advance,

>

> Barb in Texas - son Ken (31) UC 91 PSC 99

June 29, 2005

Thanks , Ken’s

was 8.2. So I won’t worry now.

Barb

in Texas - son Ken (31) UC 91 PSC 99

-----Original Message-----

On Behalf Of I've read that a

" normal " CA 19-9 is less than (<) 40

June 29, 2005

Barb,

My hep does this test every year even though it isn't very reliable. Mine has been slightly above normal for a few years and then this year was near 100. I have been having lots of infections and this marker seems to go up when I have an infection so I don't worry about the numbers anymore. My hep just did an ERCP in early June and ballooned some of the ducts with another ERCP planned on July 12th to reballoon the same ducts to keep them enlarged. My numbers have come down tremendously already and I'm hoping this ballooning will keep them low.

I'm glad Ken's Ca19-9 is so low. He's been hanging in there with this for a long time.

Good to see you on the board again.

Barby -KSUC - 1965, ileostomy - 1972, BCIR (continent pouch) 1994, PSC - 1995 married 25 years, 5 sons, 1 daugher in law and 2 golden retrievers

June 30, 2005

Mark,

AMEN!!!!!! Are you close to the top of

the list there?????

Bobby & Anne

June 30, 2005

I have about 8 folks ahead of me. I have been told to expect about a year and a

half wait. I am heading down to Mayo ville where my brother is waiting

for his liver. I think the wait may be shorter for me there.