Ca 19.9 Serum Biomarker and its reverence

Several serum markers for pancreatic cancer have been evaluated, the most useful of which is carbohydrate antigen 19-9 (also called cancer-associated antigen 19-9, CA 19-9).

CA 19-9 is a substance found in blood that is often high in people with pancreatic cancer. High levels can be caused by pancreatic cancer or other health problems. A CA 19-9 blood test is used to check how well cancer treatment is working. This test is not used to confirm (diagnose) pancreatic cancer.

Bilirubin is a chemical that gives bile its color. Bile
is uid made by the liver to help digest food. Bile ows out of the liver through small tubes called bile ducts. There may be too much bilirubin in the blood if a tumor is blocking a bile duct. Too much bilirubin causes a yellowing of the eyes and skin—a condition called jaundice. It also increases the level of CA 19-9 in the blood.

If you have jaundice and symptoms of cholangitis or fever, then your doctors will place a stent in the bile duct to unblock it. You will be given antibiotic drugs along with the stent. Your doctor may also place a stent if you are very itchy from jaundice or won’t have surgery within a week. If bilirubin levels return to normal before surgery, a CA 19-9 test can be done.

After completing adjuvant treatment, you will have follow-up tests. Follow-up tests are tests given after treatment to check how well treatment worked. These tests look for signs of cancer return (recurrence) or spread (metastasis) after treatment.
Follow-up tests are recommended every 3 to 6 months for 2 years, and then once every year. A medical history and physical exam can help to nd signs and symptoms of pancreatic cancer early. CA 19-9 is a substance found in blood and high levels can be caused by pancreatic cancer. Thus, a CA 19-9 blood test is recommended as part of follow- up testing. A CT scan is also recommended to look for early signs of cancer recurrence. more  

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Dr.Chandra: Interesting factor is that when the metallic Stent was being placed to my father on 26th Aug 2014, we did insist for biopsy at the stricture area by picking some lesion, but, the report said NON Malignant, but, the Gastro Surgeon did explain that always the first Cytology report is important. Hence, the initial stage, the growth and it judgement etc is all on case to case basis and the Critical Care method was an option, which we adopted as Chemo, Radiation or the impossible surgery for a 85 years patient needs a good education, awareness, emotional control and to be prepared as my father use to say" I have lived enough, so it is done and we need a reason for the death and it is certain, but, when it happens, is not known" The only good thing out of this treatment line is that, my father did not get any severe pains or such suffering, otherwise, as critical care to kill the pain, Morphine drugs and its lengthy treatment was not necessary, so, NO Painful death. ... if I can draw a poor ethical or Unethical practices of large hospital, is that: my father being a doctor, we had a price offer for the Stent with doctor discount for the same make and specifications, it was only Rs.30K, but, the hospital refused to use our procured Stent, instead, it procured from the same shop / agent and charged us Rs.47K + ERCP charges extra. So, no ethics being practiced neither by the doctors / large hospitals, but, only greed. However, my father, being follower of Pandit Deen Dayal Upadhyayaji, did not charge for poors (in 1960s till 90s) and helped in making an MLA to establish a Kannada school at seekal village in Karnataka as part of his freedom / post Independence action plan to build our Nation to ensure good education in Village and also health care, the Doctors / hospitals in Vadodara, did not even forego the greed. No problems, Mr. JP Nadda and Dr. Harshavardhan were informed about such loot in private sector, which is making Cancer care highly expensive in India, I hope, Doctors and the equipment supplier's must start thinking INDIA FIRST (I think e commerce platform must eliminate such middlemen loot in connivance with anti social actions of exploiting the emotional factors of the relatives of patients in a Democratic Nation for which we all pay taxes.) more  
Have send out a post for all pancreatic cancer patients. However you may discuss below with your doctor: Liposomal irinotecan for metastatic pancreatic cancer (Update in October 2015) Liposomal irinotecan is a nanoliposomal encapsulated preparation that allows irinotecan to remain in circulation for a longer duration compared with standard irinotecan, which increases drug uptake within tumor cells, and conversion of irinotecan to its active form, SN38. The international phase III NAPOLI-1 trial randomly assigned 417 patients with gemcitabine refractory locally advanced or metastatic pancreatic cancer to weekly administration of leucovorin-modulated fluorouracil (FU) (the control arm), liposomal irinotecan alone, or liposomal irinotecan plus FU and leucovorin every two weeks [45]. Median overall survival, the primary endpoint, was longer with combination therapy (median 6.1 versus 4.2 months), as was progression-free survival (3.1 versus 1.5 months with control). The most commonly reported grade 3 or worse adverse events with combination therapy were neutropenia, fatigue, diarrhea, and vomiting. Based upon these results, liposomal irinotecan was approved, in combination with FU and leucovorin, for patients with metastatic pancreatic cancer following prior administration of a gemcitabine-based regimen. more  
Dr. Chandna my mother has pancreatic cancer and it got diagnosed in April 2014 doctor is just going on and on with chemotherapies and after every two months with CT scan says it is increasing . mom has started complaining about stomach ache now and doctor has prescribed maftal spas for pain moreover he never asks us to get the pet scan done he just asked for CECT whole abdomen. Please suggest something. more  
Dr.Chandra: My father at 85 years had yellow eyes and we went for Bilrubin tests which was very high as 11 and the sonography showed a stone but the ERCP showed the CBD stricture (block) and was released by a plastic stent as the doctor who diagnosed did not have metallic stent. The cytology did mention malignant with adeano carcinoma. Due to blockage challenges of the plastic stent, we did change it for Boston scientific stent (26th Aug2014) in 3 weeks after the plastic stent insertion (3oth July2014). Though we got the CT scan done on 5th Aug 2014 did not reveal any Cancer, but, we changed the plastic stent due to cytology report. While discharging after metallic stent insertion, it was opined as cholengio carcinoma. My father used to get shivering and fever and a tablet with antibiotic used to reduce the fever. In Dec 2015, he was unable to swallow the soft food and he was fast losing the weight. A pulmonolgist did read (wrong read) the x ray wrongly and treated for TB (in 2nd week of Jan 2015), which was a metastatis, due to age there is no chemo nor surgery and moreover my father was a doctor, so he prepared us well to face whatever be the consequences and we took a well informed decision of no surgery and Chemo. The Cholengio carcinoma developed upto Pancreas and he had frequent chocking of throat and his voice volume was getting reduced and finally we lost him (which is very sad to lose a best friend of my life time i.e my Baba, on 24th June 2015 i.e 290 days after the Metallic Stent insertion. Am sharing this information for the people to understand the challenges in old age cancer diagnosis due to Jaundice and its growth despite being from Doctor's family. One has to be prepared to face the consequences with a good understanding of science and without being misled, but, sometimes, we do get carried away due to emotions and hence awareness is very necessary. The CA 19-9 was only 162, but, cytology report was the key decision maker for us as CT scan did not reveal any tumour etc as plastic Stent was already placed before CT scan. more  
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