A 50-year-old woman with known primary sclerosing cholangitis (PSC) develops progressive jaundice and a dominant stricture on MRCP. Which tumour marker elevation is most specific for cholangiocarcinoma superimposed on PSC?
- A Combined CA 19-9 >129 U/mL and CEA >5.2 ng/mL ✓
- B CA 19-9 alone
- C CEA alone
- D AFP elevation
Correct answer: A. Combined CA 19-9 >129 U/mL and CEA >5.2 ng/mL
Explanation
In PSC, CA 19-9 alone has poor specificity (elevated in benign biliary disease), but the combined criterion of CA 19-9 >129 U/mL plus CEA >5.2 ng/mL achieves specificity of about 86% and sensitivity of 66% for detecting cholangiocarcinoma. AFP is a marker for hepatocellular carcinoma, not cholangiocarcinoma. The combined biomarker panel is the standard approach in PSC surveillance.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.