How would you approach a patient with pancreatic adenocarcinoma who completed 6 months of adjuvant chemotherapy without evidence of disease on imaging but an elevated CA 19-9?

In patients with an elevated CA 19-9 and no obvious evidence of visible disease on routine cross-sectional imaging, a thorough evaluation should first be done to exclude occult metastases. This may include bone scan and/or brain MRI, as indicated.

If after a complete evaluation, no visible disease i...

What is not mentioned in this question is whether the CA19-9 is rising. A persistent elevation of this tumor marker after either surgery or adjuvant chemotherapy by itself is a poor prognostic sign. However, if the CA 19-9 is rising without biliary obstruction or a source of inflammation, rest assur...

I agree that a rising CA 19-9 is a key clinical clue. I have sometimes utilized functional imaging with CT/PET in this type of situation as it seems more sensitive to detect peritoneal disease. Some institutions use MRI/PET, although that imaging modality is not widely available, and its use may pos...

I agree fully that a rising or elevated CA19-9, although worrisome and mandates close follow-up, should not prompt initiation of cytotoxics in the absence of visible disease in patients who have completed definitive and potentially curative treatment. The CA19-9 is an imperfect tumor marker, and it ...