From the Guidelines
A pancreatic cancer workup typically includes laboratory tests such as complete blood count (CBC), comprehensive metabolic panel, coagulation studies, and tumor markers like CA 19-9, which is elevated in approximately 80% of pancreatic cancer patients, as noted in the study by 1. These tests aid in diagnosis and staging, but are not diagnostic on their own. The laboratory tests that are usually included are:
- Complete blood count (CBC) to assess for anemia or infection
- Comprehensive metabolic panel to evaluate liver function (AST, ALT, alkaline phosphatase, bilirubin) and kidney function (BUN, creatinine)
- Coagulation studies (PT/INR, PTT) to check for bleeding disorders
- Tumor markers such as CA 19-9, which is elevated in approximately 80% of pancreatic cancer patients but lacks specificity, as mentioned in the study by 1
- CEA (carcinoembryonic antigen) may also be measured, though it's less specific for pancreatic cancer
- Amylase and lipase are often included to assess for pancreatitis, which can sometimes mimic or accompany pancreatic cancer
- Glucose levels should be checked as new-onset diabetes can be an early sign of pancreatic cancer, as indicated in the guidelines by 1 These laboratory tests provide important information when combined with imaging studies like CT scans, MRIs, or endoscopic ultrasound, as recommended in the study by 1. The pattern of abnormalities, particularly elevated bilirubin with obstructive liver function tests in conjunction with elevated CA 19-9, raises suspicion for pancreatic cancer, though definitive diagnosis requires tissue sampling, as stated in the study by 1. It's worth noting that the most recent and highest quality study, 1, emphasizes the importance of a comprehensive workup, including staging laparoscopy, pancreatic protocol CT or MRI, and chest CT or x-ray, in the diagnosis and staging of pancreatic cancer.
From the Research
Labs for Pancreatic Cancer Workup
The following labs are included in a pancreatic cancer workup:
- Carbohydrate antigen 19-9 (CA19-9) 2, 3, 4, 5, 6
- Carcinoembryonic antigen (CEA) 3
- C-reactive protein (CRP) 3, 5
- Lactate dehydrogenase (LDH) 3
- Bilirubin levels 3, 5, 6
Serum Biomarkers
Serum biomarkers such as CA19-9, CEA, CRP, LDH, and bilirubin can provide prognostic information on time-to-progression (TTP) and overall survival (OS) in pancreatic cancer patients 3.
- CA19-9 is the only established tumor marker in pancreatic cancer, but it has limited specificity 2, 4
- A decline of ≥25% in CA19-9 levels during the first two chemotherapy cycles is predictive of TTP and OS 3
Liquid Biopsy
Liquid biopsy involving circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), microRNAs (miRNAs), and exosomes in blood, as well as biomarkers in urine and saliva, are being explored for pancreatic cancer diagnosis 2
Other Diagnostic Strategies
Other diagnostic strategies, including imaging, pathological examination, and serological examination, are also being developed and improved for pancreatic cancer diagnosis 2