Carbohydrate antigen 19-9 — tumor marker: Past, present, and future

Abstract

Carbohydrate antigen 19-9 (CA 19-9) is a cell surface glycoprotein complex most commonly associated with pancreatic ductal adenocarcinoma (PDAC). Koprowski first described it in 1979 using a mouse monoclonal antibody in a colorectal carcinoma cell line. Historically, it is one of the most commonly used tumor markers for diagnosing, managing, and prognosticating PDAC. Additionally, elevated CA 19-9 levels are used as an indication for surgery in suspected benign pancreatic conditions. Another common application of CA 19-9 in the biliary tract includes its use as an adjunct in diagnosing cholangiocarcinoma. However, its clinical value is not limited to the hepatopancreatobiliary system. The reality is that the advancing literature has broadened the clinical value of CA 19-9. The potential value of CA 19-9 in patients' workup extends its reach to gastrointestinal cancers – such as colorectal and oesophageal cancer – and further beyond the gastrointestinal tract - including urological, gynecological, pulmonary, and thyroid pathologies. Apart from its role in investigations, CA 19-9 presents a potential therapeutic target in PDAC and acute pancreatitis. In a bid to consolidate its broad utility, we appraised and reviewed the biomarker’s current utility and limitations in investigations and management, while discussing the potential applications for CA 19-9 in the works for the future.

Keywords: Carbohydrate antigen 19-9 antigen, Pancreatic diseases, Liver diseases, Biliary tract diseases, Gastrointestinal diseases, Pancreatic neoplasms

Core Tip: Carbohydrate antigen 19-9 (CA 19-9) is the “go-to” tumor marker when one discusses the diagnosis, prognosis, and recurrence of pancreatic ductal adenocarcinoma. However, its utility in screening special population groups and determining management for pancreatic ductal adenocarcinoma is more obscure, with many interpretations of its utility in the literature. Additionally, CA 19-9 is useful beyond pancreatic pathologies, with current studies pointing towards its potential use in gastrointestinal, urological, pulmonary, uterine, ovarian, thyroid, and salivary gland diseases. We provide an in-depth analysis of the current practices of CA 19-9 and its potential applications in the future.