The sera of 563 patients who underwent colonoscopy were assayed for glycolipid antigen CA 19-9 and CEA. These patients represented a broad spectrum of clinical diseases ranging from advanced metastatic cancer of the colon, pancreas, or stomach to those with negative colonoscopic examination. Sensitivity and specificity for CA 19-9 and CEA were calculated using the following clinical definitions. Malignant or pre-malignant disease was defined as colon, pancreatic or stomach carcinoma, stomach dysplasia, atypical adenomatous polyp, atypical villous adenoma, carcinoma in situ and carcinoma in an adenomatous polyp. When the normal group included patients with adenomatous polyp, hyperplastic adenoma, inflammatory disease and patients with no disease apparent, the sensitivity and specificity for CA 19-9 was 23% and 96%, and for CEA, 23% and 95%, respectively. When adenomatous polyp patients were placed in the malignant or pre-malignant disease group, the sensitivity and specificity for CA 19-9 was 8% and 96%, and for CEA, 11% and 95%, respectively. When comparing CA 19-9 and CEA in colorectal carcinoma, the percent positivity of the CEA assay was equal to, or better than, CA 19-9 in all Dukes' stages. In pancreatic carcinomas CA 19-9 showed better diagnostic performance than CEA.