Elevated CA19-9 Levels: Causes and Concerns - Gastroenterology and Hepatology

A 20-year-old with significantly elevated CA 19-9 levels?

Recently, I visited a gastroenterologist due to unexplained pain in my right abdomen.
After three days, my previously distended abdomen suddenly deflated (suspected seroma).
Then, over the next five days, I lost one kilogram each day.
I hurried back for a follow-up appointment, and an abdominal ultrasound revealed at least a 17 cm fluid-filled sac and some ascites.
The doctor referred me to a hospital for further examination.
The wait for an appointment was a bit long, and after reviewing my blood test results, I became even more anxious as my levels were nearly 1800.
I don’t smoke or drink; what is the likelihood of having cancer? What could be the possible symptoms associated with weight loss? The day before, I ate three normal meals and maintained my weight, but if I eat less, I lose weight the next day.
Although I am slightly overweight, I have never experienced such rapid weight loss despite my past efforts to lose weight.
I am really scared.

Zeng, 20~29 year old female. Ask Date: 2023/08/28

Dr. Chen Shidian reply Gastroenterology and Hepatology

Follow up with a gastroenterologist for examination; the indicators are for reference only.

Reply Date: 2023/08/28

More Info

Elevated CA19-9 levels can indeed be concerning, especially when accompanied by symptoms such as abdominal pain, weight loss, and the presence of fluid accumulation (ascites) in the abdomen. CA19-9 is a tumor marker primarily associated with pancreatic cancer, but it is not exclusive to it. Elevated levels can also indicate other conditions, both malignant and benign.

Firstly, it’s important to understand that CA19-9 is not a definitive diagnostic tool for cancer. While a level above 37 U/mL is considered elevated, levels significantly higher than this, such as the 1800 U/mL you mentioned, warrant further investigation. Elevated CA19-9 can be seen in various conditions, including:
1. Pancreatic Cancer: This is the most common association, especially with significantly elevated levels.

2. Biliary Tract Cancers: Cancers affecting the bile ducts can also lead to increased CA19-9 levels.

3. Colorectal Cancer: This type of cancer can also cause elevations in CA19-9.

4. Chronic Pancreatitis: Inflammation of the pancreas can lead to elevated levels.

5. Liver Diseases: Conditions such as cirrhosis or hepatitis can also cause increases in CA19-9.

6. Benign Conditions: Conditions like cholangitis (infection of the bile duct), gallstones, and even cystic fibrosis can elevate CA19-9 levels.

Given your symptoms of right abdominal pain, significant weight loss, and the discovery of a large fluid-filled cyst (possibly an abdominal cyst or ascites), it is crucial to follow up with your healthcare provider. The combination of these symptoms and the elevated CA19-9 level raises the concern for a serious underlying condition, including malignancy.

Weight Loss: The unintentional weight loss you are experiencing can be attributed to several factors. In the context of abdominal issues, it could be due to:
- Malabsorption: If there is a blockage or inflammation in the gastrointestinal tract, your body may not be absorbing nutrients effectively.

- Increased Metabolism: Conditions such as cancer can increase metabolic demands, leading to weight loss.

- Fluid Shifts: The presence of ascites can cause fluctuations in weight, as fluid accumulation can mask actual weight loss.

Next Steps: It is essential to pursue further diagnostic evaluations. Here are some recommendations:
1. Imaging Studies: A CT scan or MRI of the abdomen can provide detailed information about the pancreas, liver, and other abdominal organs. This can help identify any masses, cysts, or other abnormalities.

2. Endoscopic Ultrasound (EUS): This procedure can provide a closer look at the pancreas and surrounding structures and may allow for biopsy if necessary.

3. Repeat CA19-9 Testing: Monitoring the levels over time can provide insight into whether the levels are rising or falling, which can help in assessing the situation.

4. Consultation with Specialists: Depending on the findings, you may need to see a gastroenterologist, oncologist, or a surgeon for further evaluation and management.

In conclusion, while elevated CA19-9 levels can be alarming, they do not automatically indicate cancer. However, given your symptoms and the significant elevation in your CA19-9 level, it is critical to pursue further evaluation promptly. Early diagnosis and intervention can significantly impact outcomes, especially in cases of malignancy. Stay proactive in your healthcare, and ensure you follow up with your medical team for the best possible care.

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