Tumor Markers: CA 19-9 and Gastrointestinal Health - Gastroenterology and Hepatology

Tumor markers

Hello, on May 25th, I had a check-up with a colorectal specialist due to blood in my stool, and the cause of the bleeding was identified as an anal fissure.
I also requested a colonoscopy, which is scheduled for June 14th.
On May 25th, I had blood tests and an X-ray done, and I have checked my blood test results through the National Health Insurance app, where my CA 19-9 level is 44.99, which is above the normal range.
I would like to ask the doctor if I should schedule an abdominal ultrasound with a hepatobiliary and gastroenterology specialist first, or should I wait until after the colonoscopy to see how the doctor wants to proceed?

Wen, 30~39 year old female. Ask Date: 2024/05/29

Dr. Chen Shidian reply Gastroenterology and Hepatology

The accuracy of CA 19-9 is low (with many false positives), making it unsuitable for screening or diagnosis; it should only be used for postoperative monitoring, so there is no need to worry at this time.
You can proceed with the endoscopy first and then schedule an appointment with a gastroenterologist.

Reply Date: 2024/05/29

More Info

When it comes to understanding tumor markers such as CA 19-9, it's essential to recognize their role in the context of gastrointestinal health and potential malignancies. CA 19-9 is primarily associated with pancreatic cancer, but elevated levels can also indicate other conditions, including liver disease, gallbladder disease, and certain benign conditions.
In your case, with a CA 19-9 level of 44.99, which is above the normal range, it is important to approach this situation with a thorough understanding of the implications. While a high CA 19-9 level can be concerning, it is not definitive for cancer. Many factors can contribute to elevated levels, including inflammation, infection, or other benign conditions affecting the gastrointestinal tract.

Given that you have already experienced rectal bleeding due to a fissure and are scheduled for a colonoscopy, it is prudent to wait for the results of that procedure before proceeding with additional imaging, such as an abdominal ultrasound. The colonoscopy will provide valuable information regarding the health of your colon and rectum, and it may help identify any underlying issues that could explain the elevated CA 19-9 levels.

If the colonoscopy reveals any abnormalities, such as polyps or other lesions, further investigation may be warranted, which could include imaging studies or additional blood tests. On the other hand, if the colonoscopy results are normal, it may be appropriate to monitor your CA 19-9 levels over time, especially if there are no other symptoms or risk factors present.

In the meantime, it is advisable to consult with a gastroenterologist who can provide a comprehensive evaluation of your symptoms and lab results. They may recommend additional tests based on your clinical presentation and history. For instance, if there are concerns about liver function or biliary tract issues, an abdominal ultrasound could be beneficial to assess the liver, gallbladder, and pancreas.

In summary, while your elevated CA 19-9 level warrants attention, it is crucial to interpret it in conjunction with your clinical findings and the results of your upcoming colonoscopy. It is often best to wait for the colonoscopy results before deciding on further imaging, as this will provide a clearer picture of your gastrointestinal health and help guide any necessary follow-up actions. Always keep an open line of communication with your healthcare provider to ensure that you receive the most appropriate care based on your individual circumstances.

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