{"id":6523,"date":"2023-09-08T06:30:00","date_gmt":"2023-09-08T09:30:00","guid":{"rendered":"https:\/\/gastropedia.pub\/pt\/?p=6523"},"modified":"2023-10-15T15:03:18","modified_gmt":"2023-10-15T18:03:18","slug":"elevacao-do-marcador-ca-19-9","status":"publish","type":"post","link":"https:\/\/gastropedia.pub\/pt\/gastroenterologia\/pancreas\/elevacao-do-marcador-ca-19-9\/","title":{"rendered":"Eleva\u00e7\u00e3o do marcador CA 19-9"},"content":{"rendered":"
\"image_pdf\"<\/a>\"image_print\"<\/a><\/div>\n

O ca 19-9 \u00e9 conhecido por ser um marcador tumoral de neoplasias bilio-pancre\u00e1ticas e, dentre os marcadores, apresenta uma acur\u00e1cia aceit\u00e1vel. Em estudos pr\u00e9vios, a sensibilidade para essas neoplasias variou entre 79-95% e a especificidade entre 82-91%. Entretanto, ele \u00e9 considerado como ferramenta diagn\u00f3stica apenas em pacientes que apresentem quadro cl\u00ednico de dor abdominal, perda de peso ou icter\u00edcia.<\/strong> Em pessoas assintom\u00e1ticas, o valor preditivo positivo da solicita\u00e7\u00e3o do marcador como screening para neoplasia bilio-pancre\u00e1ticas \u00e9 de apenas 0,9%, mostrando que \u00e9 n\u00e3o \u00e9 um teste v\u00e1lido para screening populacional. <\/p>\n\n\n\n

\u00c9 importante ressaltar que essa glicoprote\u00edna \u00e9 produzida pelas c\u00e9lulas ductais do p\u00e2ncreas e vias biliares, e c\u00e9lulas epiteliais do est\u00f4mago, c\u00f3lon, endom\u00e9trio e gl\u00e2ndulas salivares. Por esse motivo, o aumento nos n\u00edveis s\u00e9ricos deve ser observado com cautela, pois n\u00e3o necessariamente significa malignidade. <\/p>\n\n\n\n

Al\u00e9m disso, cerca de 6% da popula\u00e7\u00e3o caucasiana (e cerca de 22% entre n\u00e3o caucasianos) n\u00e3o \u00e9 capaz de produzir o Ca 19-9, e isso est\u00e1 relacionado a varia\u00e7\u00f5es no tipo sangu\u00edneo do Sistema Lewis (pessoas com gen\u00f3tipo negativo para os ant\u00edgenos de Lewis n\u00e3o produzem essa glicoprote\u00edna).<\/p>\n\n\n\n

<\/p>\n\n\n\n

Se quiser ler sobre aumento de amilase e lipase no sangue clique nesse link<\/summary>\n

Aumento de enzimas pancre\u00e1ticas no sangue – como investigar ou conduzir?<\/a><\/p>\n<\/details>\n\n\n\n

<\/div>\n\n\n\n

Quais as causas para aumento do ca 19-9?<\/strong><\/h2>\n\n\n\n

Al\u00e9m da neoplasia pancre\u00e1tica e neoplasia de vias biliares, existem outras doen\u00e7as neopl\u00e1sicas que podem cursar com aumento de ca 19-9, como listados na Tabela 1.<\/p>\n\n\n

\n
\"\"
Tabela 1 – Neoplasias extra-pancre\u00e1ticas que podem elevar ca19-9<\/figcaption><\/figure>\n<\/div>\n\n\n

Al\u00e9m de doen\u00e7as neopl\u00e1sicas, existem condi\u00e7\u00f5es benignas que evoluem com aumento do marcador, e est\u00e3o listadas na Tabela 2. Destaco, dentre elas, quaisquer processos inflamat\u00f3rios ou infecciosos do p\u00e2ncreas e vias biliares.<\/p>\n\n\n

\n
\"\"

Tabela 2 – Doen\u00e7as n\u00e3o neopl\u00e1sicas que podem cursar com aumento de ca19-9
<\/figcaption><\/figure>\n<\/div>\n\n\n

Tamb\u00e9m devemos aconselhar o paciente que ir\u00e1 coletar o exame a suspender o uso de biotina (normalmente presente em suplementos para fortalecer cabelos e unhas) alguns dias antes da coleta, pois o uso da vitamina pode elevar os n\u00edveis do marcador.<\/p>\n\n\n\n

Para quem pedir o marcador Ca 19-9?<\/strong><\/h2>\n\n\n\n

No geral, o marcador deve ser solicitado:<\/p>\n\n\n\n

    \n
  • Em casos suspeitos para neoplasia bilio-pancre\u00e1tica (paciente com quadro cl\u00ednico sugestivo, como dor abdominal, icter\u00edcia e perda de peso inexplicada) – sempre associados ao exame de imagem indicado para o diagn\u00f3stico;<\/li>\n\n\n\n
  • No momento do diagn\u00f3stico da neoplasia pancre\u00e1tica – o valor inicial do ca 19-9 se correlaciona com o progn\u00f3stico da neoplasia e com as estrat\u00e9gias de tratamento para cada caso;<\/li>\n\n\n\n
  • No seguimento das neoplasias biliopancre\u00e1ticas, submetidas a algum tipo de tratamento (neoadjuvante, cir\u00fargico ou adjuvante)<\/li>\n\n\n\n
  • No seguimento das neoplasias c\u00edsticas mucinosas (cistoadenoma mucinoso e IPMN) – alguns estudos tem reportado o aumento do ca 19-9 s\u00e9rico com risco de progress\u00e3o dos cistos mucinosos. <\/li>\n<\/ul>\n\n\n\n

    Fora desses contextos, a solicita\u00e7\u00e3o do marcador pode trazer mais d\u00favidas do que esclarecimentos.<\/p>\n\n\n\n

    Refer\u00eancias<\/strong><\/h2>\n\n\n\n
      \n
    1. Meira-J\u00fanior, JD et al. ELEVATED CA 19-9 IN AN ASYMPTOMATIC PATIENT: WHAT DOES IT MEAN? ABCD Arq Bras Cir Dig 2022;35:e1687 https:\/\/doi.org\/10.1590\/0102-672020220002e1687<\/li>\n\n\n\n
    2. Pavai, S et al. The Clinical Significance of Elevated Levels of Serum CA 19\u00b79. Med J Malaysia Vol 58 No 5 December 2003<\/li>\n\n\n\n
    3. Kim, S et al. Carbohydrate antigen 19-9 elevation without evidence of malignant or pancreatobiliary diseases. Scientific Reports, 2020, 10:8820  https:\/\/doi.org\/10.1038\/s41598-020-65720-8<\/li>\n\n\n\n
    4. Scar\u00e0, S et al. CA 19-9: Biochemical and Clinical Aspects. Advances in Cancer Biomarkers, Advances in Experimental Medicine and Biology 867, DOI 10.1007\/978-94-017-7215-0_15.<\/li>\n<\/ol>\n\n\n\n

      Como citar este artigo<\/h2>\n\n\n\n

      Marzinotto M. Eleva\u00e7\u00e3o do marcador CA 19-9 Gastropedia 2023, vol 2. Dispon\u00edvel em: https:\/\/gastropedia.pub\/pt\/gastroenterologia\/pancreas\/elevacao-do-marcador-ca-19-9<\/p>\n\n\n\n

      <\/p>\n","protected":false},"excerpt":{"rendered":"

      O ca 19-9 \u00e9 conhecido por ser um marcador tumoral de neoplasias bilio-pancre\u00e1ticas e, dentre os marcadores, apresenta uma acur\u00e1cia aceit\u00e1vel. Em estudos pr\u00e9vios, a sensibilidade para essas neoplasias variou…<\/p>\n","protected":false},"author":3341,"featured_media":7381,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[18,23],"tags":[],"ano":[137],"tipo":[121],"volume":[44],"class_list":["post-6523","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-gastroenterologia","category-pancreas","ano-137","tipo-assuntos-gerais","volume-volume-ii"],"yoast_head":"\nEleva\u00e7\u00e3o do marcador CA 19-9 - Gastropedia<\/title>\n<meta name=\"description\" content=\"O ca 19-9 \u00e9 um marcador tumoral de neoplasias biliopancre\u00e1ticas. 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