<s>[INST] Hi, My name is DHIRAJ SHETTY.I was diagnosed with adenocarcinoma of pancreas in july 2013.Since then I have undergone 9 sessions of chemotherapy.First 3 being gemcite + cisplatin Second set of 3 chemos being gemcite + oxyplatin + xeloda And the last 3 chemos of folferinox. I have handled my chemos very well. And over the period got my ct scans and blood tests done regularly. The tumor has remain stable through out and has not spread at all. But surprisingly my CA19.9 reports have suddenly shot up in the last reports. I feel confused, as the tumor has not spread but the CA19.9 levels are significantly elevated. Kindly advise and please let me know if it can be a case of NEUROENDOCRINE TUMOR (NET) [/INST] CA 19-9 levels are increased in pancreatic adenocarcinoma and not Nets. They may be elevated in a number of other conditions such as jaundice. But you don't have jaundice and the picture that you have mentioned, it definitely goes in favor of the cancer coming back. Sometimes, a small recurrence is not visible on a CT scan. Also, CT scan only scans a certain area of the body like the abdomen, while the disease can recur anywhere. It will be worthwhile to do a PET scan as that will show any small area of tumor recurrence anywhere in the whole body </s>