In this study, CA 19-9 levels were found significantly
higher in patient group than the control group. CA 19-9
levels were higher than upper limits in 36% of patients
with acute pancreatitis. In acute pancreatitis group, there
was no difference between both genders according to the
CA 19-9 levels. When etiologic causes were classified as
gall stone and others, it was seen that the increment of CA 19-9 levels were not different in various etiologic causes.
It was seen that ranson scores were positively correlated
with CA 19-9.
CA 19-9 is produced by adenocarcinomas of the pancreas,
stomach, gall bladder, colon, ovary and lung. Serum
CA 19-9 is considered the most sensitive marker for pancreatic
cancer, being elevated in 75% or more of patients
with pancreatic cancer [20]. CA 19-9 is produced by several
normal human tissues, with the highest concentrations
produced by biliary and pancreatic ductal cells.
Benign conditions such as cirrhosis, cholestasis, cholangitis,
and pancreatitis also result in CA 19-9 elevations
[21-24]. In a previous study, an elevation of CA 19-9 was
detected in 5 cases of total 52 patients with benign pancreas
lesion [25]. Markocka-Maczka [26] suggested optimal
value of 150 U/ml for CA 19-9 level for differential diagnosis
of pancreas cancer and inflammatory process of pancreas.
In the present study only one patient’s CA 19-9 level was
found as 153 U/ml.
In our study we found CA 19-9 level significantly higher
in acute pancreatitis than the control group. CA 19-9 levels
were above the upper limits in 22 patients. There was no
pancreas or other organ cancers in our patients. From this
aspect, the elevation in CA 19-9 levels in patient group
rather than control group shows that without cancer etiology,
CA 19-9 levels could be elevated in acute pancreatitis.
Cholestasis was present in 97.1% of patients with highly
elevated CA 19-9, independent of their primary disease.
50% of patients with non-malignant diseases and increased
CA 19-9 levels showed liver cirrhosis, cholecystitis, pancreatitis
and/or hepatitis [27]. In present study, CA 19-9
was found increased in 36% patients with acute pancreatitis.
CEA, an oncofetal glycoprotein, is expressed in normal mucosal cells and overexpressed in adenocarcinoma, especially
colorectal cancer [28-30]. CEA elevation also occurs
with other malignancies. Non-neoplastic conditions associated
with elevated CEA levels include cigarette smoking,
peptic ulcer disease, inflammatory bowel disease, pancreatitis,
hypothyroidism, biliary obstruction, and cirrhosis.
Anyway, levels exceeding 10 ng/mL are rarely due to
benign disease [30].
In a previous study, CEA was found to be increased in
51% of patients with pancreatic cancer; it was also abnormal
in 22% of chronic pancreatitis and 31% of extra-pancreatic
diseases [31]. In a previous study it was shown that CA19-
9 has more sensitivity than CEA in diagnosis of acute
pancreatitis [17]. In a previous study, CEA levels were
examined in malignant and benign disorders of pancreas
and there were not any differences found [32]. In the present
study CEA was not found to be increased in acute pancreatitis
compared to the control group.
Tumor markers are being used for screening in some
clinics. Like previous studies, this study shows that tumor
markers could increase in benign disorders. Using tumor
markers in monitoring a patient with cancer or patients
with suspicion of cancer could decrease false positive
diagnoses and unnecessary examinations.
In conclusion, CA 19-9 levels could increase in acute
pancreatitis at moderate ranges. This increment of CA 19-
9 levels was not different in both genders and etiologic
causes of acute pancreatitis. CA 19-9 levels were positively
correlated with severity of acute pancreatitis. CA 19-9
levels could be increased in acute pancreatitis like many
of other benign disorders. For this reason tumor markers
should not be used for screening but they should be used
for only specific indications.
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