A case of middle aged man presented with c/o pain abdomen, loss of appetite and weight loss. Patient underwent CT abd which revealed ? Multiple liver mets. FNAC from the liver revealed poorly diffrentiated ca. His s. cea value WNL, Ca 19.9 > 3700, how ever on CECT no pancreatic abnormality. Pls comment on how to proceed in this case


The serum CA 19-9 concentration increases to the greatest extent in patients with pancreatic cancer or cholangiocarcinoma. CA 19-9 resembles carcinoembryonic antigen in colorectal carcinoma and various different gastrointestinal adenocarcinomas

Studies have compared endoscopic ultrasound (EUS) with helical computed tomography (CT), multidetector row CT (MDR-CT), magnetic resonance imaging (MRI), and angiography for initial diagnosis and/or staging of pancreatic cancer. However, direct comparison of the data can be difficult because of differences in inclusion criteria and reference standards. The imaging modalities chosen to stage patients with pancreatic cancer should take into account the studies' accuracy as well as local expertise.

When CA 19-9 levels were greater than 1000 U/mL, the PPV and specificity approached 100% and were correlated with unresectable tumors. So EUS is needed

CA 19 9 is usually increased in hpb malignancy. However it is also increased in colon, stomach and mucinous ca ovary. In colon its associated with poor prognosis. I would do a upper GI scopy with or without EUS, lower GI scopy and biliary tree assessment. As someone has suggested, a pet CT may help in this situation. If all above are normal, we have to treat it as adenoca of unknown primary. A biopsy instead of an fnac with ihc will be of more benefit

The antigen was found by immunoperoxidase staining in 40–80% of carcinomas from the gallbladder, stomach, pancreas, and colon

Dr jain I would suggest a whole body Pet CT scan first up. Followed by pal chemo Is the pt jaundiced? N the right kidney is grossly hydronephrotic. Why?

So upper GI endoscopy , colonoscopy and pet ct also needed

CT abdomen reports a solid cystic mass in right kidney.. possible renal primary with liver metastasis.. PET CT scan.. Urologist opinion..

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