Review Question - QID 107186

This unfortunate patient presents with signs and symptoms of a pancreatic mass, likely a pancreatic adenocarcinoma. CA19-9 is a tumor marker commonly elevated in pancreatic adenocarcinoma.

Pancreatic cancer is a morbid diagnosis, carrying the highest mortality rate of all major cancers. It has a 1-year survival of 25% and 5-year survival of 5%. Due to the indolent nature of its growth, pancreatic cancer often does not cause symptoms until advanced disease. Symptoms include abdominal pain, weight loss > 10 lbs (4.5 kg), jaundice, back pain, vomiting, indigestion, pruritus, and new onset diabetes mellitus. Patients with symptoms concerning for pancreatic cancer should have imaging with abdominal CT or MRI.

De La Cruz et al. discuss the diagnosis and management of pancreatic adenocarcinoma. They conclude that pancreatic protocol abdominal CT scan is considered the standard for diagnosing and staging pancreatic adenocarcinoma.

Cwik et al. discuss the role of CA19-9 and CA125 in the diagnosis of pancreatic adenocarcinoma. They conclude that CA19-9 had a positive predictive value of 94% and a negative predictive value of 89%. Though very useful, CA19-9 should be interpreted in reference to pancreatic imaging such as CT, ultrasound, or MRI.

Figure A shows an axial CT image with contrast. Cross lines in top left quadrant of the image surround a macrocystic adenocarcinoma of the pancreatic head.

Incorrect Answers:
Answer 1: Renal cell carcinoma can lead to secondary polycythemia, which could present with elevated hemoglobin and hematocrit.
Answer 3: Choriocarcinoma, as well as tumors of embryonic derivatives, can present with elevated B-HCG.
Answer 4: Hepatocellular carcinoma can cause elevated alpha fetoprotein.
Answer 5: Prostate adenocarcinoma and benign prostatic hyperplasia can lead to a rise in prostate specific antigen (PSA).