To be or not to be: a two years surveillance for a CA 19-9 persistent elevation before cancer diagnosis and bone metastases| JOURNAL OF GERONTOLOGY AND GERIATRICS

Abstract

Background. CA 19-9 is an antigen expressed by several epithelial cells and currently used for the diagnosis
and follow-up of gastrointestinal cancers. Even if a serum level > 1000 UI/ml has a specificity for pancreatic
cancer of 99.8% its elevation is also reported in benign diseases. The pancreatic ductal adenocarcinoma is
tipically aggressive and therefore shorter follow-up are expected to be found before diagnosis.
Case presentation. A 75-years-old female referred to us for evaluation of high level of serum CA 19-9 (558 UI/
ml) observed for the first time one year before when she had also been undergone colonoscopy that have
excluded neoplasms.
At the adimission she complained fatigue, weight loss, hyporexia, nausea, low-grade fever and intermittent
self-limiting skin lesions of the lower limbs. Serum CA 19-9 level was > 1000 UI/ml.
Her past medical history was significant for chronic HCV hepatitis, essential hypertension and hysterectomy
for leiomyofibroma of the uterus thirty years before.
We did not found any neoplasm and scheduled a close follow-up with colonoscopy, CT and PET for one additional
year. At the end of December 2015 we observed the appearance of small painful nodules in the subcutaneous
periumbilical region and a CT showed a pancreatic tail malignancy and bone metastases. Periumbilical
biopsy was performed and the diagnosis of pancreatic ductal adenocarcinoma was proven.
Conclusion. A long time observation of a persistent and progressive CA 19-9 increase should never exclude
the malignant origin. The trend, more than the duration of this finding may guide clinical decision.
Abbreviations
Carbohydrate Antigen 19-9 – CA 19-9
Computerized Tomography – CT
F-18-fluorodeoxyglucose positron emission tomography – 18F-FDG PET
Carcinoembryonic Antigen – CEA
Cancer antigen 125 – CA 125