Question 95

Question:

A 71-year-old female with no significant past medical history presents to your office complaining that her friends have noticed a slight yellowing of her skin over the past month. She denies any abdominal pain, but reports a recent 15-lb weight loss as well as persistent “itching all over.” On physical exam, you palpate a large, round cystic mass in right upper quadrant which you think may be her gallbladder. Which of the following serum markers is likely to be abnormally elevated given the most likely diagnosis?

Correct Answer: C.  CA-19-9

Painless jaundice is the classic presentation of pancreatic cancer. A mass at the head of the pancreas blocks the common bile duct causing an obstructive jaundice. Bile salts accumulate in the dermis causing marked pruritis. The gallbladder may become distended and palpable on physical exam (Courvoisier’s sign). The weight loss is additional sign of malignancy.
CA-19-9 is the tumor marker most closely associated with pancreatic cancer.
CA-125 is associated with ovarian cancer.
CEA is associated with colon cancer and other GI malignancies.
AFP is associated with hepatocellular carcinoma as well as yolk sac carcinoma (a type of testicular nonseminoma).
Beta HCG is associated with choriocarcinoma (another type of testicular nonseminoma).