What is cancer antigen 72‑4 (CA72‑4) and how is it used clinically?

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Last updated: February 13, 2026 • View editorial policy

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What is Cancer Antigen 72-4 (CA72-4)?

CA72-4 is a tumor-associated glycoprotein (TAG-72) that serves as a serum tumor marker primarily used for monitoring gastrointestinal malignancies, particularly gastric adenocarcinoma, and to a lesser extent ovarian cancer. 1, 2

Biochemical Characteristics

  • CA72-4 is a mucin-like, high-molecular-weight glycoprotein identified by two monoclonal antibodies (CC49 and B72.3) that recognize specific glycochain epitopes: Galβ(1-3) sialyl-Tn and sialyl-Tn antigens 3
  • The marker is measured using immunoradiometric assay systems with a standard cut-off value of 4.0 U/mL 2
  • Modern automated chemiluminescent immunoassays demonstrate high sensitivity with limits of detection at 0.18 U/mL and quantitation at 0.95 U/mL 3

Primary Clinical Applications

Gastric Adenocarcinoma (Highest Utility)

  • CA72-4 demonstrates optimal diagnostic performance in gastric cancer with sensitivity of 59-68% and specificity of 91-98% 1
  • Combining CA72-4 with CA19-9 increases detection rates to 70% of gastric cancers 1
  • Positive rates in gastric cancer patients reach 52% 2
  • Elevated levels correlate with advanced disease stages, lymph node involvement, and recurrence 2

Other Gastrointestinal Malignancies

  • Colorectal cancer shows 55% positivity rate with approximately 40% sensitivity 2, 4
  • Pancreatic adenocarcinoma demonstrates 46% positivity rate 2
  • In pancreatic cancer, elevated CA72-4 predicts lymph node metastasis (P<0.001) and poor prognosis, with hazard ratio of 2.34 (95% CI: 1.46-3.73) compared to normal levels 5
  • Cholangiocarcinoma may show elevation, though CA72-4 is not the primary marker for this malignancy 1

Hepatic Cystic Lesions (Specialized Application)

  • CA72-4 in cyst fluid >25 U/mL provides superior diagnostic capability for distinguishing malignant from benign hepatic cysts, with sensitivity 79%, specificity 97%, and AUC 0.98 1
  • This performance exceeds that of CEA and CA19-9 for hepatic cyst differentiation 1

Gynecological Malignancies

  • Ovarian cancer shows 50-67% positivity rate 2, 4
  • Breast cancer demonstrates 39% positivity rate 2
  • Overall sensitivity in ovarian cancer approximates 50% with specificity exceeding 95% 4

Clinical Monitoring Strategy

Disease Surveillance

  • CA72-4 is most valuable for longitudinal monitoring of known gastrointestinal and gynecological malignancies, where significant elevations predict recurrent disease 4
  • Serial measurements in patients with advanced disease correlate with clinical activity 6
  • Higher levels associate with advanced stages and recurrence compared to early-stage disease 2

Combination Marker Approach

  • Combining CA72-4 with CEA and CA19-9 for gastrointestinal cancers, or with CA125 for ovarian cancer, increases sensitivity without substantially compromising specificity 4
  • This multi-marker strategy improves monitoring capabilities in these patient populations 4

Diagnostic Algorithm for Elevated CA72-4

When CA72-4 is elevated (particularly >25-50 U/mL):

  1. Obtain contrast-enhanced CT of chest, abdomen, and pelvis to evaluate for gastric mass/wall thickening, peritoneal carcinomatosis, hepatic metastases, and lymphadenopathy 1

  2. Perform gastroscopy with multiple biopsies when gastrointestinal primary is suspected 1

  3. Measure concurrent tumor markers: CEA, CA19-9, and CA125 1

  4. If hepatic cysts are identified on imaging, consider cyst fluid aspiration for CA72-4 measurement (>25 U/mL suggests malignancy) 1

Specificity and Benign Conditions

  • Overall specificity exceeds 95% across malignancies 4
  • Only 10% of patients without malignancy show levels >4.0 U/mL 2
  • Average serum level in cancer patients (38.6 U/mL) significantly exceeds that in non-malignant conditions (2.7 U/mL) 2

Prognostic Implications

  • Elevated CA72-4 at diagnosis suggests advanced disease with likely lymph node involvement, possible peritoneal or hepatic metastases, and poor prognosis 1
  • In pancreatic adenocarcinoma post-radiation therapy, elevated CA72-4 predicts significantly shorter median overall survival (10.0 vs 14.0 months, P<0.001) 5

References

1
Guideline

Elevated CA 72-4: Clinical Significance and Diagnostic Approach

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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