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What Does Elevated CA Level Indicate?

Posted on Wed, 17 Sep 2014

Question: Hello Doctor -

I have received my blood work results recently and I have few concerns.

CA 19-9 - 38 reference range:0-35 U/mL)
Amylase, Serum - 100 (reference range: 31-124 U/L)
Lipase, Serum - 43 (reference range: 0-59 U/L)

The CA 19-9 value is HIGH and Amylase value is HIGH Normal.

I am very worried about high value of CA 19-9 value .

Is it clinically significant? What I need to do next? Do I have tumor?

Thanks

XXXX

Answered by Dr. Dr. Klerida Shehu (2 hours later)

Brief Answer:
Causes to slightly elevated CA 19-9....

Detailed Answer:
Hi XXXXXXX

It is true that CA 19-9 value is slightly elevated. There are many causes to increased CA 19-9 level including inflammatory diseases such as:
- pancreatitis
- irritable bowel syndrome
- biliary problems

and other tumor/cancer problems.

Your amylase level is completely within normal range. Clinical evaluation by GI specialist together with further investigations are needed to exclude tumor or inflammatory issues.

All the best! Let me know if I can be of further help!
Dr.Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Klerida Shehu (22 minutes later)

Hello Dr.Klerida -

Thanks for your answer.

I had CT Scan without contrast for abdomen and Pelvis on July-14-2014.

The CT finding --> "The pancreas appear unremarkable on this noncontrast exam"

1) What imaging tests you think should be done to eliminate the possibility of tumor?

2) Ultrasound or MRI of abdomen are good for further evaluation v/s CT?

3) What other tests you suggest for further evaluation?

4) What are the chances of having a cancerous tumor when CA-19-9 value is minimally elevated?

Thanks for your time and advice.

Best Regards

XXXX

Answered by Dr. Dr. Klerida Shehu (21 hours later)

Brief Answer:
Reports of tests you did so far are needed...

Detailed Answer:
Hi back XXXXXXX

Thank you for following up.

First, I need to have the full reports of all your lab tests and scans you did in order to get them analyzed myself.

Next, find the following answers to your queries:

1. If pancreas was unremarkable in the Ct-scan report, and from the lab tests you are reporting, then, nothing worrisome regarding pancreas.

I need to have the full report to evaluate your: liver, cholecyst, bowels, etc.

Abdominal ultrasound is a basic test that would give the first signs if anything wrong is happening.

If these tests resulted normal, no need to proceed to other tests.

2. Each of them have their specifications. Ct-scan is advised if anything unusual is suspected on the ultrasound due to high radiation risk.

3. I need to evaluate what you have done so far, before going to next steps.

4. Ca 19-9 is noted at high levels in normal and healthy people. I should evaluate all your clinical presentation together with all the tests you did before determining the right cause to slightly increase of your Ca 19-9 level.

Looking forward to have the requested reports soon.

Dr.Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Klerida Shehu (28 hours later)

Hello Dr.Klerida -

Thanks for your expert advice and your time.

Per your suggestion, I will scan the CT scan report and will send you soon.
The Ca-19-9 test and Amylase/Lipase test results I have already sent you in my previous message.

BTW, I have seen Gastroenterologist this week and he has recommended EUS/Endoscopic Ultrasound test and Colonoscopy test.

Doctor insisted that I should be under sedation or under short anesthesia during the procedure. I do not want to get sedation or anesthesia during the procedure.
I'm okay with local anesthesia.

What is your opinion on this?

1) Can EUS/Endoscopic Ultrasound and Colonoscopy done without sedation or anesthesia? I have heard that in many Asian countries they do these procedures without sedation or anesthesia.

Thanks again for your time and help!

Best Regards

XXXX

Answered by Dr. Dr. Klerida Shehu (9 hours later)

Brief Answer:
Can be done...

Detailed Answer:
Hi back XXXXXXX

1) EUS and colonoscopy can be done without anesthesia, however, many factors should be considered after physically examined the patient.

As I cannot give a full physical examination to you, and if your doctor said you should run EUS under anesthesia, then, I agree with this opinion. Sedation will help your relax, you won't feel the discomfort, thus, it will be much more easier for the endoscopist to run EUS. Generally, this procedure does not hurt, but can give some discomfort.

Colonoscopy can be run without sedation; no problem if you do not want to use anesthesia.

Let me know the results!
Dr.Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Klerida Shehu (3 days later)

Hi Dr. Klerida -

Thanks for your response.

I had my EGD and EUS both done this morning. I did not get any sedation/anesthesia and It went well. It was tough and painful but I was able to tolerate it.

Doctor took biopsy and I'm waiting on the results.

Wondering, what kind of symptoms I should look for after the procedure to see that there are any complications (perforation, bleeding from biopsy, infection) developing?

Is there anything I need to be watchful about?

I greatly appreciate your time and expert advice.

Best Regards

XXXX

Answered by Dr. Dr. Klerida Shehu (4 hours later)

Brief Answer:
Following symptoms to get considered,,,,,

Detailed Answer:
Hi back XXXXXXX

Thank you for following up and keeping me updated on your actual health condition. I am extremely happy to know that the 2 procedures went fine without sedation. You are really a strong person.

Usually, these procedure will cause only pain that will be subsided in few days. The side effects usually occur during the procedure or 1 hour after the procedure.

In most severe cases, patients have reported:
- bleeding vomitius
- unbearable abdominal pain
- dark-red feces

All the best
Dr. Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Klerida Shehu (27 hours later)

Hello Dr. Klerida -

Thank you very much for your response.

I am still waiting for my reports for EUS and EGD.

BTW, I have my colonoscopy scheduled for next week.

I am thinking of doing it without sedation too.
In your opinion, which procedure is more painful or uncomfortable - EUS/EGD or colonoscopy?

If I can tolerate EUS/EGD without sedation, do you think I will be able to tolerate colonoscopy too? or colonoscopy is more uncomfortable?

Best Regards

XXXX

Answered by Dr. Dr. Klerida Shehu (5 hours later)

Brief Answer:
Hopefully you will tolerate colonoscopy perfectly.

Detailed Answer:
Hi back XXXXXXX

Colonoscopy is much easier than EUS/EGD and I think if you were able to tolerate EUS/EGD without sedation, you will be fine and will perfectly tolerate colonoscopy too.

Colonoscopy is not as uncomfortable than EUS/EGD.

All the best and good luck for the next procedure!
Dr.Klerida

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Klerida Shehu (44 hours later)

Hello Dr.Klerida -

Thank you very much for your time, help and expert advice!
I greatly appreciate it!

Best Regards

XXXX

Answered by Dr. Dr. Klerida Shehu (4 hours later)

Brief Answer:
Thank you to...

Detailed Answer:
Hi and thank you to!

It's a great pleasure for me to hear that my advice was somehow helpful to ease your concerns.

Wish you all the best!
Dr. Klerida

Note: For further follow up on digestive issues share your reports here and Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar