Carbohydrate antigen 19-9 (CA 19-9) is a modified Lewis(a) blood group antigen. CA 19-9 may be elevated in patients with gastrointestinal malignancies such as cholangiocarcinoma, pancreatic cancer, or colon cancer. Benign conditions such as cirrhosis, cholestasis, and pancreatitis also result in elevated serum CA 19-9 concentrations but in these cases values usually are below 1000 U/mL. Individuals that are Lewis negative (5%-7% of the population) do not express CA 19-9 due to the lack of the enzyme fucosyltransferase needed for CA 19-9 production. In these individuals, a low or undetectable serum CA 19-9 concentration is not informative regarding cancer recurrence. Reference Value: 35 U/mL