Pancreatic Cancer Diagnosis: The Role of Abdominal CT and CA 19-9 in Obstructive Jaundice Evaluation

The diagnosis of pancreatic cancer remains a significant challenge in clinical practice due to its nonspecific clinical presentation and late detection. The combination of abdominal CT and the tumor marker CA 19-9 has become an essential tool to enhance diagnostic accuracy and guide clinical management.

Diving Deeper into Diagnosis

Abdominal CT is a crucial imaging technique for identifying pancreatic masses and assessing their extent. However, it is important to note that certain benign conditions can mimic malignant ones on imaging. For instance, pancreatic tuberculosis may present with features similar to pancreatic cancer, including elevated levels of CA 19-9 and hypodense masses in the head of the pancreas.

The CA 19-9 marker is widely used in the diagnosis of biliopancreatic malignancies, although its elevation is not exclusive to malignant conditions. Studies have shown that persistently elevated levels of CA 19-9 can be found in benign diseases, as observed in patients with pulmonary fibrosis or non-ulcer dyspepsia, without evidence of malignancy [1].

In the context of obstructive jaundice, abdominal CT can reveal dilation of the common bile duct, suggesting the presence of an obstructive mass in the head of the pancreas. However, the differentiation between benign and malignant diseases of the duodenal papilla can be complicated, requiring a thorough evaluation of direct and indirect signs on CT, as well as tumor markers.

Conclusions

The combined use of abdominal CT and CA 19-9 is fundamental in the diagnosis of pancreatic cancer, but it must be interpreted with caution due to the possibility of false-positive results in benign conditions. An endoscopic biopsy may be necessary to confirm the diagnosis in uncertain cases. Accurate identification of imaging characteristics and correlation with CA 19-9 levels are essential to avoid misdiagnosis and guide appropriate treatment.

References

• [1] Persistent elevation of serum CA 19-9 with no evidence of malignant disease
• Isolated pancreatic tuberculosis with elevated CA 19-9 levels masquerading as a malignancy: A rare case report and literature review
• Research and analysis on computed tomography signs and clinical characteristics of chronic duodenal papilla mucositis and duodenal papillary carcinoma

Created 6/1/2025