الفهرس 
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Abstract
Background: The early diagnosis of pancreaticobiliary malignancies have been one of the difficult challenges for clinical practitioners, because its symptoms may not appear until the cancer is advanced and surgical removal becomes impossible. Both Serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9) are produced by epithelia of the pancreas, stomach, colon, liver, and biliary. Small tumors produce detectable levels of the CEA or CA19-9 antigen only in the body fluids such as bile, and this was suggested as a useful tool in the patient with otherwise occult liver metastasis or with primary tumors. Carcinoembryonic antigen (CEA) and carbohydrate antigen (CA19-9) are tumor markers for the diagnosis of gastrointestinal cancers. However, their serum levels have been found elevated in some benign diseases, such as pancreatitis, cholangitis, hepatitis and cirrhosis, as well. Their use in the differential diagnosis is not well defined.
Aim of the work: Our aim was to determine the role of both serum and biliary tumor markers CA19-9 and CEA levels in the differentiation of benign and malignant pancreaticobiliary diseases.
Method: 28 cases with pancreaticobiliary diseases, in addition to 7 calcular obstructive jaundice were studied. The studied groups were divided into 3 groups (malignant group, benign group and control one) and all of them were subjected to full medical history & examinations. And also had routine Lab., viral markers, tumor markers in bile and serum (Ca 19-9 and CEA), radiological investigations (abdominal ultrasound, CT & MRCP), ERCP & brush cytology (for some cases), and pathological examination of the lesion in some selected cases. Informed consents were obtained from each subject before blood samples were collected and pathological specimens were taken.
Results: Elevation of serum CEA & CA 19-9 in different benign and malignant pancreaticobiliary diseases (At a cutoff value 26.72 ng/ml, the sensitivity and the specificity of serum CEA were 92.9% and 85.7% respectively in diagnosis pancreaticobiliary tumors & at a cutoff 290.005 U/ml, sensitivity and specificity of serum CA19-9 levels were 85.7% and 71.4%, respectively for diagnosis of biliary malignancies). Elevation of biliary levels CEA & CA 19-9 in different benign and malignant pancreaticobiliary diseases (At a cutoff value 3.99 ng/ml, the sensitivity and the specificity of biliary CEA were 64.3% and 50% respectively, while At a cutoff value 215.965U/ml, the sensitivity and the specificity of biliary CA 19-9 were 71.4% and 42.9% respectively in diagnosis pancreaticobiliary tumors). Correlation between serum CEA and CA 19-9 with serum bilirubin and alkaline phosphatase in obstructive jaundice irrespective its pathology.
Conclusions: Measurement of both serum CEA & CA 19-9 with recent radiological methods may help in early detection of pancreatic cancer and cholangiocarcinoma, diagnosis, prognosis, and treatment and/ or follow up. Measurement of both biliary CEA & CA 19-9 of no clinical value.