Further testing is needed. Arnaud JP, Koehl C, Adloff M: Carcinoembryonic antigen (CEA) in diagnosis and prognosis of colorectal carcinoma. So CEA trending back down. mso-padding-alt:0in 5.4pt 0in 5.4pt; The content on this site is for informational purposes only. You mention a PET and a CT scan. For instance, mine runs above a 15 constantly and every Dr has said that indicative of SOMETHING. JAMA 270:987-988, 1993. August 20th, I had a CT Thorax with Contrast and CT Abdomen and Pelvis w IV Contrast and it has shown nothing. [60,62], Randomized Studies of Intensive Surveillance vs Minimal or Moderate Surveillance in Resected Colorectal Cancer Patients. [23-25] The highest sensitivities reported (89% and 91%) were associated with studies implementing frequent CEA monitoring (4 to 8 weeks) with a low abnormal cutoff of 2.5 to 3 ng/mL. Br J Cancer 78:1346-1349, 1998. My oncologist tested my CEA right away and it was a normal 1.8. The elevated level will not indicate where and how is the cancer, but it will indicate that there is one to search for. Nordlinger B, Guiguet M, Vaillant JC, et al: Surgical resection of colorectal carcinoma metastases to the liver. [69] It is unlikely that CEA surveillance for more than 5 years would result in added benefits, as the risk of recurrence beyond that time point is considered minimal. Higher than normal CEAlevel alone cannot diagnose a new cancer. Sakamoto T, Tsubota N, Iwanaga K, et al: Pulmonary resection for metastases from colorectal cancer. Pharmacol Res 49:383-396, 2004. My lung Dr says i need to talk to my oncologist about looking for cancer in my body cuz as far as she knows,  she sees no other reason for the numbers to be that high, and I still can't get insurance to pay for pet scan. Back in March, my oncologist didn't initially order a CT scan for that checkup. The patient had subsequent spontaneous normalization of CEA and remains free of disease recurrence. Herrera MA, Chu TM, Holyoke ED, et al: CEA monitoring of palliative treatment for colorectal carcinoma. It sounds as though you are doing all you can to live a healthy life and have a keen eye on your wellbeing. BMJ 324(7341):813, 2002. Cancer 42(3 suppl):1439-1447, 1978. [57-62] These randomized studies involved various intervals of follow-up in the intensive and control arms. Chevinsky AH: CEA in tumors of other than colorectal origin. I do hope those posts did not offend anybody. Fortner JG, Silva JS, Cox E, et al: Multivariate analysis of a personal series of 247 patients with liver metastases from colorectal cancer. I have been given two option, wait 3-6 months and test again to see the trend, or do with no delay a gastro- and colono-scopy to search for the presence of something wrong. Serum CEA was < 2.5 ng/mL in more than 87% and < 5 ng/mL in more than 95% of 1,020 subjects attending primary prevention clinics. I may ask my oncologist to see if this is a good idea for me to have done. 30. 70. [33] Another study suggested a similar prognostic value for patients with stage IV disease. [20] The sensitivity of CEA in detecting recurrence was 58%, with a median lead time of 6 months. Br J Surg 84:666-669, 1997. Zink S, Kayser G, Gabius H, et al: Survival, disease-free interval, and associated tumor features in patients with colon/rectal carcinomas and their resected intra-pulmonary metastases. Given the possibility of false-positivity of CEA levels during the surveillance of patients with resected colorectal primary or resected metastatic disease, it is prudent to confirm an ongoing rise in CEA prior to the initiation of an extensive disease recurrence work-up. Non-malignant conditions which may have elevated CEA include: From: http://patient.info/doctor/carcinoembryonic-antigen-ceahttp://patient.info/doctor/carcinoembryonic-antigen-cea, =====================================================, From: http://www.questdiagnostics.com/testcenter/testguide.action?dc=TH_CEA. 2. Child PW, Yan TD, Perera DS, et al: Surveillance-detected hepatic metastases from colorectal cancer had a survival advantage in seven-year follow-up. 46. [60,62] Both studies showed an increase in curative resections in their intensive screening arms, but only one translated into an improvement in survival. what needs to be done because doctor doesn't really understand other than keep monitoring CEA level but I'm afraid we are just missing certain cancer detection. Dis Colon Rectum 41:1116-1126, 1998. World J Surg 8:279-286, 1984. I've also seen literature which says benign causes of elevated CEA above 10ng are rare but it does say it can happen. Dis Colon Rectum 37:875-881, 1994. 25. Yet all tests thus far have been negative, and some of my Drs are concerned, yet don't know what else to do, while another Dr or two feels that an elevated cea is no reason for concern. It is impossible from these studies to quantitate the benefit obtained from CEA monitoring alone, compared to the other modalities used in follow-up. I did not check-up last year, maybe related or not (health issues are not the the only problems life offers you) but I show those results to another doctor in my home country. 68. Loewenstein MS, Zamcheck N: Carcinoembryonic antigen (CEA) levels in benign gastrointestinal disease states. A multi-institutional study of long-term survivors. All I can do is trust my oncologist as we can't treat something that we can't find. But it would scare me as well. [27], CEA monitoring is more sensitive in detecting any disease recurrence than liver function tests, ultrasound of the liver, chest x-ray, or colonoscopy. I am not a medical doctor, and I probably miss the subtility of the correlation, but as a scientist I find difficult to understand this equation... To me either the level of CEA is totally unrelevant in term of cancer diagnosis in a non-diagnosed and asymptomatic person, and in that case there is no point to put a threshold on what is supposed to be normal, and more especially on what is too high to be benign, either there is effectively a level of CEA beyond what benign conditions are rare, and in that case the CEA marker is relevant in term of diagnosis. [1,2] CEA was subsequently characterized as a glycosylated cell surface glycoprotein with a molecular weight of 180,000 daltons. Similar CEA surges can be seen with immunologic therapy. Clin Chem 37(10 pt 1):1736-1739, 1991. All rights reserved. Arch Surg 132:505-511 (incl discussion), 1997. [22], More than 70% of patients with advanced colorectal cancer have elevated CEA levels. Adson MA, van Heerden JA, Adson MH, et al: Resection of hepatic metastases from colorectal cancer. Br J Cancer 49:689-693, 1984. 29. Here, contrast-enhanced CT and ultrasound of the neck and abdomen are usual methods for staging as well as follow-up for patients who continue to have elevated serum levels for calcitonin or CEA. All yielding no cancer found. CEA may be more helpful in the monitoring of patients with minimal peritoneal disease when CT scans have shown limited sensitivity. Second opinion was sought which also yielded an all clear. [36-44,48-56] These numbers compare favorably to a 5-year survival of < 10% with combination chemotherapy. Go VL: Carcinoembryonic antigen: clinical application. Fong Y, Cohen AM, Fortner JG, et al: Liver resection for colorectal metastases. Kievit J, van de Velde CJ: Utility and cost of carcinoembryonic antigen monitoring in colon cancer follow-up evaluation. Zeng Z, Cohen AM, Urmacher C: Usefulness of carcinoembryonic antigen monitoring despite normal preoperative values in node-positive colon cancer patients. Any correlation from CEA decreasing and shrinkage in tumor? Elevated/polypoid lesions (0-I) are defined as having more than double the amount of mucosal thickness in a histological specimen, while flat lesions (0-II) are less than that [1]. [11-13] The sensitivity of CEA for early colon cancer patients is low and increases with an increasing stage of the disease. Figure 1 illustrates a surge in CEA during adjuvant bolus fluorouracil (5-FU) therapy in a patient with a resected rectal cancer. [4] CEA is detectable in the serum through a radiommunoassay technique first developed by Thomson et al in 1969. Tumor cells are monotonous with scant to … 9. You have probably already read how CEA isn't always the best detector of Cancer, and there are folks here who have had elevated numbers in spite of continued clear scans. (Ugh!) I'm in the waiting period right now. work24 hasn't posted on the forum since December 2015. Do not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Your present DOctor should completely understand  this decision. st1\:*{behavior:url(#ieooui) } [22] Solitary lung recurrence was detectable by CEA in only 15% of instances. All but one study showed any increased number of curative resections in patients undergoing intensive screening vs a control arm. A prognostic scoring system to improve case selection, based on 1568 patients. [70,71], Transient Increase in CEA With Vaccine Therapy. I will keep you in my prayers and hope that you find your answer, but what is going on with you currently? Reiter W, Stieber P, Reuter C, et al: Multivariate analysis of the prognostic value of CEA and CA 19-9 serum levels in colorectal cancer. 37. Rena O, Casadio C, Viano F, et al: Pulmonary resection for metastases from colorectal cancer: Factors influencing prognosis. If that is my only option, I will not have surgery, and just take my chances with the treatment. Our body provides us with all we need for survival, when we ignore the signals of a problem, we suffer the consequences dearly. An increased CEA level may also be due to: From:  https://www.nlm.nih.gov/medlineplus/ency/article/003574.htm, ======================================================. Any info would be greatly appreciated and thank you in advance. Pancreatitis is inflammation of the pancreas. [28] A recent study suggests a cost of $25,289 for each surviving patient after surgery for CEA detected recurrence. I was diagnosed with rectal/anal cancer in Nov. 2015 at which time my CEA was 6.7...after surgery and chemo, it hovered between 1-3, never going above 3.9. Carcinoembryonic antigen (CEA) monitoring in patients with stage I-IV colorectal cancer has been, and remains, a controversial issue in oncology practice. Aftere completion of chemo, my CEA at its lowest was 3.11 and hovered in this area above 3. A surge in CEA in the first 2 to 4 months after chemotherapy initiation is not uncommon in patients treated with combination chemotherapy and, unless associated with an increase in radiographic tumor measurement, should not result in a change in chemotherapy. Now my onc said I don't need to see him until a year from now. There are things found which were not cancer but could be the cause of the CEA elevation because of the pyloric issues found. [65] This meta-analyis, again, showed a statistically significant survival benefit in patients screened intensely, compared with a less intense regimen.[65]. Hi! Oncodev Biol Med 1:191-198, 1980. [16] The poor reliability of this test in early colorectal cancer and the imperfect specificity in the normal population makes this test unsuitable for primary colorectal cancer screening. 72. 11. Chau I, Allen MJ, Cunningham D, et al: The value of routine serum carcino-embryonic antigen measurement and computed tomography in the surveillance of patients after adjuvant chemotherapy for colorectal cancer. Rosen M, Chan L, Beart RW Jr, et al: Follow-up of colorectal cancer: A meta-analysis. Rarely, most often, we play with words and ideas, but behind this, there is a remarkable scientific incoherence. This is a very scary path. I'm completely new to this board. Guidelines for CEA monitoring are provided, based on a detailed literature review and institutional experience. Ohlsson B, Breland U, Ekberg H, et al: Follow-up after curative surgery for colorectal carcinoma. Last year during a routine checkup, CEA spiked to 9.7 and then 11. i would love to see if there are cases like this from other people. I must say he doesn't seem too concerned and he keeps saying that the test is unreliable as a diagnostic tool, I thought that was only because there are many false negatives but he says that they don't know enough about CEA with no evidence of malignancy as research is around monitoring proven tumours after removal ie for recurrence. I have a hard time just believing things are the way they are without a solid logical and scientific explanation. I wish all you the best in your personal situation. The same patients underwent CEA testing every 3 months during the first year, every 6 months in the second year, and then annually. June 2017 - severe abdominal pain. Basically a lot of slight elevation once stuff, some up to 15 with two "+"; rare 2+% false positives with at least one over 15 and other "+", ASCO  http://meetinglibrary.asco.org/content/122986-143, Ncbi Abstract  http://www.ncbi.nlm.nih.gov/pubmed/24925201, Cea is part of every blood panel I'ved had for 8+ years, after the colectomy my numbers slowly rose like yours. 7. Cancer 42(3 suppl):1412-1418, 1978. Shuster J, Thomson DM, Fuks A, et al: Immunologic approaches to diagnosis of malignancy. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries I stopped worrying about my CEA levels. So...your homework is to treat this with the utmost importance  and schedule a consultation with a new Doctor. I understand that there are lots of false negative even with CEA below 5 but I did not come across anyone who had false positive with CEA above 10. I found myself sifting through old published articles to the wee hours of the morning not sleeping much. J Cancer Res Clin Oncol 129:719-726, 2003. I don't know what the issue is with getting that done. My CEA is now 25 but so far all tests clear, PAP test, FOB test, mammogram,ultrasound of thyroid and neck glands, abdo CT with contrast, bone scan (full body). Are things any better? im new to this board and I really hope you can help me. This means that in my case, I do have some form of tumor but simply can't find it. Most thyroid nodules are benign hyperplastic lesions, but 5-20% of thyroid nodules are true neoplasms. My annual checkup program is pretty detail and it just happens to include all cancer related markers like CEA, PSA, etc. [62] However, patients undergoing scheduled screening were more likely to undergo curative resection for local or distant recurrences than patients with minimal follow-up. These investigators sought to characterize thyroid function in patients hospitalized with COVID-19 infection. 13. [76], To illustrate the limitations of CEA in monitoring colon cancer response to chemotherapy, we show CT scans of a patient with progressive colorectal metastatic disease in association with a drop in CEA (Figure 3). Saying that, work24 hadn't actually been diagnosed, and their not re-posting may be a very good sign that all was well. J Exp Med 122:467-481, 1965. So I wouldn't freak out about CEA levels when they are normal or close to normal range. The GI specialist told me that elevated level of CEA alone does not prove the presence of a cancer, so no panic, however after telling me that other factors including smoking and begnin conditions may increase the level of CEA, he still confirmed that this level is abnormal, a bit too high to be explained by my smoking habits. Did you ever find out the reason for your high CEA? Should i be worried about this CEA level? Particular updates pertain to whether imaging studies, health-related quality-of-life (HRQOL) measures, tumor markers, and bronchoscopy improve outcomes after curative-intent therapy. First surgeon told me I'd had the tumor for years, but my CEA level was so low, I really don't think so. Wang WS, Lin JK, Lin TC, et al: Carcinoembryonic antigen in monitoring of response to systemic chemotherapy in patients with metastatic colorectal cancer. I may ask to see if I can have another CEA done. [31] In contrast, a resectability rate of only 3% was found in patients diagnosed with recurrent disease based on symptoms. Renehan AG, Egger M, Saunders MP, et al: Impact on survival of intensive follow up after curative resection for colorectal cancer: Systematic review and meta-analysis of randomised trials. My CEA this time was 10 .... panic stations! 6. I was wondering if work24 ever found out any more as I am naturally quite worried. Arch Surg 119:647-651, 1984. CT with contrast yielded nothing. Wanebo HJ, Rao B, Pinsky CM, et al: Preoperative carcinoembryonic antigen level as a prognostic indicator in colorectal cancer. My oncologist and oncology surgeon said that the CEA is not a good test when it comes to colorectal cancer. Hughes KS, Rosenstein RB, Songhorabodi S, et al: Resection of the liver for colorectal carcinoma metastases. [34,35], CEA has also been investigated as a prognostic factor in patients undergoing resection of hepatic metastases of colorectal origin. Even with the saying that circulates around various cancer support forums about cancer not playing by the rules and anything can happen. to zx10guy my story is similar in that my oncologist also said no to a re-test of the CEA. mso-style-noshow:yes; 45. In those particular settings, we recommend repeat testing at least 2 weeks after the initial elevation to confirm an ongoing rise before the initiation of expensive and extensive work-up. 20. 55. i have no symptoms related to cancer and my diagnostic examine like PET was full body scan. I think it would be ridiculous to do again a gastro- and coloscopy, after only two years. Adam R, Avisar E, Ariche A, et al: Five-year survival following hepatic resection after neoadjuvant therapy for nonresectable colorectal. Prior to finding out the CEA number, he had graduated me to 6 months follow ups. Eur J Cardiothorac Surg 21:906-912, 2002. Table 2 summarizes the current CEA screening guidelines recommended by the American Society of Clinical Oncology (ASCO), the European Society of Medical Oncology (ESMO), and the National Comprehensive Cancer Center Network (NCCN). J Thorac Cardiovasc Surg 124:1007-1013, 2002. CEA can be unpredictable. Ann Intern Med 104:66-73, 1986. [28-30] Sensitivity was shown to be comparable to computed tomography (CT) scan, but the combination was more effective in detecting recurrences than either modality alone. 3. J Clin Oncol 2:462-465, 1984. Again, my oncologist was quick to point out he's seen other patients of his which exhibited this CEA behavior. The only other tests I would maybe look into is a CT scan with contrast or maybe Cologuard which is probably more reliable than CEA for early CRC detection. 76. mso-pagination:widow-orphan; I'm dying to know during this wait time, what to expect, and what the trend is. To out a further twist to my story, I did the CEA level checking again after 1 week and results shows that it decreased from 14 to 12 now. 39. [21,31] In a surveillance study of 530 patients with resected stage II/III colon cancer, patients underwent a CT scan of the chest, abdomen, and pelvis at baseline, 12 months, and 24 months after initiation of adjuvant chemotherapy. However, given the high sensitivity and specificity of CEA compared to other modalities of screening, it is likely that the benefit noted is in large part attributable to CEA monitoring. As you said so eloquently Any pain in the stomack or intestines, any diarrheas or constipation, become suddenly suspicious and worrisome, while I would have even not consider it before. 31. So he was the one that ordered the PET; which showed nothing. This worries me because my doctor is telling me there isn't much to do other than regular blood work to monitor the CEA level - which can be too late if there really is tumor growing. [16] The sensitivity for stage III and IV disease at similar CEA levels was 74% and 83%, respectively. [14] In another study of 319 surgical patients, CEA was elevated in only 26% of resectable patients and in 72% of patients with unresectable or metastatic disease.[15]. God bless you all! It's alarming to me that despite the increased in CEA, nothing was detected for so long. But wil  pET scan and CT scan I don't know how they could tell if there is a cancer. The degree in CEA rise is important in estimating the likelihood of false-positivity: Elevations of more than 15 ng/mL are unlikely to reflect anything but disease recurrence. Ann Surg 228:59-63, 1998. 8. Jamison RL, Donohue JH, Nagorney DM, et al: Hepatic resection for metastatic colorectal cancer results in cure for some patients. Recommendations vary from bimonthly monitoring to no monitoring in the surveillance setting (for stage I-III disease). Figure 2 depicts a transient increase in CEA during adjuvant CEA anti-idiotype vaccine treatment several months after resection of hepatic metastases. There is a slight fibrosis in lung but he says it is normal at my age and certainly not related to CEA. That being said, only certain cancers have CEA production so a person can have other cancers without have any CEA detection at all. My CEA is now 25 but so far all tests clear, PAP test, FOB test, mammogram,ultrasound of thyroid and neck glands, abdo CT with contrast, bone scan (full body). Respiratory diseases - eg, pleural inflammation, pneumonia. For almost 10 years it was just a formality, all results always came perfectly normal. 64. Your physician should schedule a full exam to determine what else you may be suffering from that has gone unnoticed. Because our Emory Reproductive Center nurses are the absolute best! I hope your stay is short, and that you find the CEA results an anomaly. World J Surg 19:59-71, 1995. I personally feel doctors and medical researchers still don't know how to use CEA. 34. Diagnosed with Stage 3B Colon Cancer in Dec. of 2012. All scans have been NED. Sargent D, Wieand S, Haller DG, et al: Disease-free survival (DFS) vs. overall survival (OS) as a primary endpoint for adjuvant colon cancer studies: Individual patient data from 12,915 patients on 15 randomized trials. Probably in a near future, combination of those markers and other non-invasive tests will be able to confirm or rule-out the presence of a cancer, that will be truely early detection, with better survival chances. On my side, I will keep searching what is the reason of this abnormal result, and I may find, or not. Herbeth B, Bagrel A: A study of factors influencing plasma CEA levels in an unselected population. These levels followed... 2.4, 3.2, 3.6, 2.5, 3.4, 3.6, 4.2, 5.0, 5.4, 5.6, 5.3, 6.9, 4.0. He felt no need to follow up with a PET. Sometime the chemical solution efficacy dropped due to expiry or over exposure to air. I wasn't convinced since I looked at the scan images and saw a hot spot measuring 6.7 SUV. A friend who went through rectal cancer said her oncologist has said the same thing. [31] Overall, 32% of recurrences were detected by CT scan and 29% by CEA. Cancer Invest 23:338-351, 2005. J Exp Med 121:439-462, 1965. These guidelines are an update of the evidence-based recommendations for follow-up and surveillance of patients after curative-intent therapy for lung cancer. This manuscript reviews the accuracy of CEA testing, its value as a prognostic indicator, and its role in surveillance and response assessment. It showed nothing. Tate H: Plasma CEA in the post-surgical monitoring of colorectal carcinoma. [36-41] Others have failed to confirm an association; however, those series included a small number of patients and were likely underpowered to adequately investigate CEA as a prognostic variable.[42-44]. Thus, a definite impact on overall survival is unlikely to be detected unless a large randomized study addressing this issue is conducted. Goldstein MJ, Mitchell EP: Carcinoembryonic antigen in the staging and follow-up of patients with colorectal cancer. Dis Colon Rectum 48:744-748, 2005. He even knows I look at my own CT and PET scans along with getting the radiology reports well before he looks at them and reports back to me. Personally I think we are at a verge of early detection of cancer. N Engl J Med 299:448-451, 1978. Forgive me if this is the wrong way to ask but I am doing this on my phone and I can't read much due to screen size. Cancer 77:1254-1262, 1996. and my CEA jumped by 10 points. Testing methodology changed from the Siemens Bayer to Roche assay which increased my CEA results. [68] Patients with recurrent disease undergoing resection had a 5-year-survival rate of 27% vs only 6% in the nonresected cohort. Garcia M, Seigner C, Bastid C, et al: Carcinoembryonic antigen has a different molecular weight in normal colon and in cancer cells due to N-glycosylation differences. 75. My mum used to say 'What you don't know, won't hurt you', and with her sage advice, there is one test that I refuse to have (not Cancer related though). This MSKCC study was mentioned on the boards last year. I wish I never did this test and just keep monitoring usual check-up, but now I have this result on the table, I have no other choice than monitor it, and I am getting totally hypochondriac. [22], Other studies that have imposed strict CEA monitoring guidelines reported higher sensitivity rates. For example, in a study of 33 patients undergoing 5-FU-based chemotherapy, the positive-predictive value of CEA was 54% for a partial response, 77% for minor and partial responses combined, and 100% for progressive disease. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Colonoscopy was done and found a polyp in my appendix. I believe many doctor have this in mind, but failing in identifying the cause of the elevation (which is maybe impossible at this time cause too early), they prefer to reassure the patient, emphasing on the non-relevance of the marker. [28-30] Sensitivity was shown to be comparable to computed tomography (CT) scan, but the combination was more effective in detecting recurrences than either modality alone. Rocklin MS, Senagore AJ, Talbott TM: Role of carcinoembryonic antigen and liver function tests in the detection of recurrent colorectal carcinoma. A friend of mine said her oncologist also said the same thing where some of his patients have exhibited high CEA with no cancer. I came across the elevation of CEA due to error of testing. However, mortality in the 2 treatment groups was similar at 3 months (17% versus 20%) and 1 year (24% versus 28%). When that came back clear, he felt everything was fine. Patients with stage III disease had a median time to recurrence of 13 months if preoperative levels were > 5 ng/mL, and 28 months if < 5 mg/mL. 40. Int J Colorectal Dis 16:96-101, 2001. mso-style-parent:""; Financial Disclosure:The authors have no significant financial interest or other relationship with the manufacturers of any products or providers of any service mentioned in this article. In regards to other things causing elevated cea, I'm aware that smoking can cause it to go as high as 6, and emphysema/COPD related problems can cause it to go as high as 10-12 max (according to a couple of Drs) yet my level has remained even higher than that for almost 3 years now, and no one has a clue as to what could be wrong and my insurance won't pay for pet scan. Chest 119:1069-1072, 2001. Along with multiple organ systems that may be affected by COVID-19 is the thyroid gland. A Markov analysis. © 2021 MJH Life Sciences™ and Cancer Network. 10. Makela JT, Laitinen SO, Kairaluoma MI: Five-year follow-up after radical surgery for colorectal cancer. In the presence of nonmeasurable advanced disease requiring therapy (such as nonmeasurable carcinomatosis), a CEA rise on at least two occasions and at least 2 months apart almost always indicates progressive disease. Harrison LE, Guillem JG, Paty P, et al: Preoperative carcinoembryonic antigen predicts outcomes in node-negative colon cancer patients: A multivariate analysis of 572 patients.
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