From the Guidelines
Elevated Carbohydrate Antigen 19-9 (CA 19-9) levels can be caused by various malignant and benign conditions, including pancreatic cancer, biliary tract cancers, colorectal cancer, gastric cancer, and benign conditions such as pancreatitis, cholangitis, and liver cirrhosis, as supported by the most recent study 1. The causes of elevated CA 19-9 levels are diverse and can be attributed to both malignant and benign conditions.
- Malignant causes include:
- Pancreatic cancer
- Biliary tract cancers (cholangiocarcinoma, gallbladder cancer)
- Colorectal cancer
- Gastric cancer
- Ovarian and lung cancers
- Benign causes include:
- Pancreatitis (both acute and chronic)
- Cholangitis
- Cholecystitis
- Liver cirrhosis
- Inflammatory bowel diseases like ulcerative colitis and Crohn's disease
- Non-gastrointestinal conditions such as endometriosis, pneumonia, and pleural effusions It is essential to note that approximately 5-10% of the population cannot produce CA 19-9 due to genetic factors (Lewis antigen-negative individuals), which can lead to false negatives 1. The degree of elevation often correlates with disease severity, with malignancies typically causing higher elevations than benign conditions, though there is significant overlap 1. In clinical practice, it is crucial to interpret CA 19-9 levels in the context of the patient's overall clinical presentation and medical history, and to consider further diagnostic testing and evaluation by an experienced multidisciplinary team when CCA is suspected, as recommended by the most recent guidelines 1.
From the Research
Causes of Elevated Carbohydrate Antigen 19-9 (CA 19.9)
Elevated CA 19.9 levels can be caused by various conditions, including:
- Malignant diseases such as pancreatic, gastric, and hepatobiliary cancers 2, 3, 4
- Benign diseases of the hepatobiliary system, including cholangitis, cholestasis, and choledocholithiasis 2, 5, 6
- Other benign conditions such as pneumonia, pleural effusion, renal failure, and systemic lupus erythematosus (SLE) 4
- Non-malignant and non-cholestatic diseases, as seen in a study where 10 patients with elevated CA 19-9 levels had no evidence of malignant disease 3
- Xanthogranulomatous cholecystitis, a rare benign condition that can cause significantly elevated CA 19-9 levels 6
Benign Conditions Associated with Elevated CA 19-9
Some benign conditions that can cause elevated CA 19-9 levels include:
- Cholangitis, which can cause elevated CA 19-9 levels, especially in patients with choledocholithiasis 5
- Cholestasis, which can also cause elevated CA 19-9 levels 2
- Choledocholithiasis, which can cause elevated CA 19-9 levels, especially in patients with cholangitis 5
- Pulmonary fibrosis, diabetes, non-ulcer dyspepsia, obesity, acute diarrhea, colon diverticula, and gastric ulcer, which were seen in a study of 10 patients with elevated CA 19-9 levels and no evidence of malignant disease 3
Importance of Clinical Context
It is essential to interpret elevated CA 19-9 levels in the context of the patient's clinical presentation, as elevated levels can be found in both malignant and benign conditions 2, 4, 6.