# Relationship of carbohydrate antigen 19-9 and Lewis antigens in pancreatic cancer

Source: https://onco.cc/key-papers/paper-tempero-ca19-9-lewis-antigens-cancer-res-1987/  
OnCo record `paper-tempero-ca19-9-lewis-antigens-cancer-res-1987` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The 1987 study showing that people who lack the Lewis blood group antigens cannot make the CA 19-9 tumour marker, so in about one patient in ten a normal blood test says nothing about the cancer.

## Summary

Tempero and colleagues studied 20 pancreatic cancer patients: Lewis a and b phenotype in saliva or on red cells, serum CA 19-9 by radioimmunoassay, and CA 19-9 and Lewis antigen expression in tumour tissue by immunoperoxidase. Patients who were Lewis a-negative b-negative failed to express CA 19-9 in tumour tissue and had normal or low serum levels (below 37 units per millilitre; P = 0.0011 versus Lewis-positive patients), whereas 88 percent of Lewis a-positive or b-positive patients had raised serum CA 19-9. The authors concluded that Lewis-negative patients cannot manufacture CA 19-9, and noted that Lewis a-positive patients unexpectedly expressed Lewis b antigen in tumour tissue.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: pancreatic-evidence
- Journal: Cancer Research
- Year: 1987
- Authors: Tempero MA, Uchida E, Takasaki H, et al.
- Findings: Lewis a-negative b-negative patients did not express CA 19-9 in tumour or serum (P = 0.0011).; 88 percent of Lewis-positive patients had serum CA 19-9 above 37 units per millilitre.
- What it means: The reason a normal CA 19-9 never rules pancreatic cancer out, why Lewis-negative patients need a different marker (CA 125, CEA or CA 19-9-independent panels), and a constraint on every blood-based detection idea on this page.
- Caveats: Twenty patients, 1987 assays.; No DOI is indexed; the PubMed record is the anchor.

## Sources

- PubMed: https://pubmed.ncbi.nlm.nih.gov/3308077/
- Europe PMC record: https://europepmc.org/article/MED/3308077

## Connected records

- key papers: [Lead-Time Trajectory of CA19-9 as an Anchor Marker for Pancreatic Cancer Early Detection](https://onco.cc/key-papers/paper-fahrmann-ca19-9-lead-time-gastroenterology-2021/)
- cancers: [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- terms: [CA 19-9](https://onco.cc/terms/ca19-9/), [Lewis-negative (Lewis antigen-negative, CA 19-9 non-secretor) status](https://onco.cc/terms/lewis-negative/), [Tumour markers (CEA, LDH, chromogranin, thyroglobulin)](https://onco.cc/terms/tumour-markers/)
- bottlenecks: [Biomarkers are not validated or standardised](https://onco.cc/bottlenecks/b-biomarker-validation/)
- journals: [Cancer Research](https://onco.cc/journals/cancer-research/)
- roadmaps: [Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question](https://onco.cc/roadmaps/pancreatic-roadmap/)
- ideas: [Run the ENDPAC score on every new diabetes diagnosis after 50 and scan the high scorers](https://onco.cc/ideas/idea-pdac-new-onset-diabetes-risk-score-pathway/)

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