Diabetes is increasing all over the world along with the increase of obesity and associated diseases and is a well-known risk factor for pancreatic cancer. The incidence of pancreatic cancer is also increasing and has one of the lowest survival rates of all cancers.
CA 19-9 is a tumor-associated antigen which is elevated in pancreatic cancers, cancers of the upper gastrointestinal tract, ovarian cancer, hepatocellular cancer, colorectal cancer, inflammatory conditions of the hepatobiliary system, and in thyroid diseases.
CA 19-9 is used in the diagnosis of pancreatic cancer but is also a marker of pancreatic tissue damage which might be caused by diabetes. The association between diabetes, pancreatic cancer and elevated levels of Ca 19-9 has not been investigated until now.
A research article published in October 28 issue of the World Journal of Gastroenterology addresses this association. The research group led by Dr Oya Uygur-Bayramicli from Istanbul examined 76 type 2 diabetics and matched them with control subjects of the same age and gender in order to get reliable comparisons. Ca 19-9 levels were statistically significantly higher in the diabetic group but there was not any case of pancreatic cancer in that group, which was confirmed with the help of abdominal CT.
One conclusion reported by the researchers is that diabetes can be accepted as the last step of chronic pancreatitis with the new developing concepts of pathogenesis and that the elevation of Ca 19-9 is due to chronic pancreatitis and not to pancreatic cancer.
As a solution to the problem they suggest using higher cut-off values of Ca 19-9 in diabetic patients to differentiate benign and malignant pancreatic disease. Furthermore, subtle elevations of CA 19-9 in diabetics should be considered an indication of exocrine pancreatic dysfunction.
The study was performed in a large teaching hospital in Istanbul, Turkey, with a special interest in diabetes and gastrointestinal oncology and is therefore quite representative of the population.
Reference: Uygur-Bayramicli O, Dabak R, Orbay E, Dolapcioglu C, Sargin M, Kilicoglu G, Guleryuzlu Y, Mayadagli A.Type 2 diabetes mellitus and CA 19-9 levels. World J Gastroenterol 2007; 13(40): 5357-5359
Correspondence to: Assoc. Prof Dr Oya Uygur-Bayramicli, Department of Gastroenterology, Kartal State Hospital, Istanbul, Turkey. firstname.lastname@example.org
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World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection for providing a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. The WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.
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