Elevated CEA and AST

My CEA has risen in 6 month intervals over the last 18 months from 2.7 to 3.2 to 4.3 .  I have tested negative for blood in stool and colonoscopy in October '07 was clean.  In December '07 I had AST of 35 in contrast to AST of 27 in Oct '06.  I am not experiencing any symptoms.  I do not drink more than 1 glass of wine a month and my weight with food modification and exercise has gone from 230 in 2006 to 160 in Jan 2008.( I weighed 156 in Jan 2007) An abdomen CT in 1/07  found a cyst on my liver which was said to pose no problem.

After endoscopy I was treated on 2 separate ocassions (2003 & 2005) for a peptic ulcer. I was told there was no infection. I had an endoscopy to confirm healing after 2nd ulcer in 2006.  But since I had the recurrence without taking any NAIDS since the 1st ulcer, is it possible I may have generated a 3rd ulcer ?  I have read that peptic ulers can cause elevated CEA, so would it make sense to do another endoscopy to see if there is a ulcer  ?  Also what suggestions do you have for investigating the elevated CEA  an dliver enzyme ?

[MissB1982]

Sorry for the Elevated CEA and AST post.  I thought I was sending my question to the MD instead of the community forum.

[Fernando Roque, MD]

Hi.  The CEA is not very useful as a screening procedure for testing the presence of cancer, particularly colorectal cancer, because it is too non-specific.  Various conditions can cause a rise in CEA - even smoking and infection in the gastrointestinal tract can result in elevated levels, but non-cancerous causes of CEA elevation usually do not exceed 10 ng/ml.  The proper use of CEA is to monitor cancer recurrence of a biopsy confirmed malignancy or to detect tumor response to chemotherapy (CEA levels go down when the tumor is shrinking as a result of treatment).  CEA is also not used to diagnose peptic ulcers.

Your AST levels are also too mildly elevated to indicate any ongoing disease process. Even mild dehydration at the time the blood sample for AST was taken can raise the levels slightly. You have been adequately examined by your doctor, and since the findings are negative, I don't think there is any further need to work you up any further.

[jagott]

My husband had stage 3 colon cancer about 2 1/2 years ago, aged 43. He had successful surgery and he did great on chemo except the Oxaliplatin caused some neurapathy in feet but tolerable. His CEA levels were great 1.9, 1.8 then 1.7 in Oct. Just last week they went up to 5.1 (he is a non-smoker) A CT scan revealed several spots on the liver. Oncologist wants to put him on Folfiri with Avastin. He said surgery not needed. We just got the diagnosis over the phone yesterday. Seems like this CEA level is low considering, I'm hoping that is a good thing. Does anyone have anything to share? I'm wondering how a determination is made for re-section versus just chemo. Thank you!

[jagott]

Just an update: I just read an interesting article in the Journal of Clinical Oncology about an older man who had Oxalyplatin toxicity 'masquerading as recurrent colon cancer'. It has a lot of medical jargons so I'm not sure if I understood it properly. Here is the link:
Oxaliplatin Toxicity Masquerading As Recurrent Colon Cancer
http://jco.ascopubs.org/cgi/content/full/22/15/3202-a

Can a doctor tell me what this means and if this might be a possibility for my husband?
Thank you!

[Fernando Roque, MD]

Hi.  While a CEA level of 5.1 in a person without colon cancer may not be significant, in a  patient with an established diagnosis of colon cancer, any CEA level more than 5 should prompt the doctor to investigate for disease recurrence or progression.  True enough, in your husband's case, recurrence was discovered in the form of liver metastases.  I've read that JCO article you mentioned, and I guess you're wondering if those spots in the liver and the increased CEA that your husband has could be attributed to Oxaliplatin toxicity.  The answer is no.  In that article, Oxaliplatin toxicity manifested as ascites (fluid accumulation in the abdominal cavity) and portal hypertension (increase in blood pressure in the portal vein - a vein supplying blood to the liver, due to obstruction of the flow in the liver).  These two conditions could not account for the spots in the liver seen on CT, or the elevation in CEA from 1.7 to 5.1.  The decision whether to resect liver metastases or just perform chemotherapy without resection depends on several factors such as size and location of metastatic lesions, the number of lesions, and the fitness of the patient's body for surgery (it's possible that the liver metastases are resectable, but the patient is too weak to withstand the operation).

[jagott]

Thank you ever so kindly for your explanation. This is very helpful. I'm trying to remain positive. My husband is 45, otherwise healthy, 6'2" 174 lbs (gained weight on his original chemo!) He did super on his Folfox although there was never any sign on cancer after the surgery, all Dr's were amazed! I'm hoping that a CEA of 5.1 is a hopeful sign that the spots are not as bad as they could be if CEA was 12 or higher, based on other articles I've read. We'll know more on Thurs.

Thank You.

[jagott]

Here is an update: My husband was diagnosed with a colon cancer recurrance in 1/08 but appears to be responding to Folfiri. His CEA dropped from 5.1 to 3.1 (after 2 treatments) then to 2.4 (after 2 additional treatments with Avastin added in to Folfiri)  but then slightly elevated to 3.8..... (after an additional treatment but missed a week due to vacation) my doctor says +2/-2 of CEA is not that big of a deal. Dr. Roque: Do you have any thoughts on this or is it just too soon to really know? My husband had a CT scan yesterday (Oncologist said he would schedule half way thru treatment)  waiting on results.........many thanks!!

[Fernando Roque, MD]

Hi.  Your doctor is correct in saying that a fluctuation in CEA level in the +2/-2 range is not a big deal, provided that the CEA values are all less than 5. What is more important is to look at the trend in serial CEA determinations. Are the values persistently going up or going down?  In your husband's case, after going down for two consecutive determinations, the CEA went up on the next testing.  So, is this significant?  If the subsequent values show further elevations, it might mean disease progression even with the Folfiri treatment.  But a single elevation shouldn't be hastily interpreted as such.

[Summer8935]

My husband has just recently had his CEA increase for the first time.  In the last two months, it has gone from 2.9 to 12.5 yesterday.  He just recently received a ct-scan which showed some tumor changes, but his PET-scan was negative.  The cancer surgeon believes that it is scar tissue growing and changing shape, but the oncologist believes that it is progression of the disease.  The egos are conflicting, and it upsets me.  Both are from very reputable cancer centers.  They have both decided that a biopsy is needed.  We are scheduled for a biopsy next week.  The cancer doctor believes that the results will be back in about a week.  I am concerned about the drag in time.  It has been 4 weeks since he finished his last round of chemo.  What are your thoughts.  We are scared to death.  We have been fighting this for 2 years, with lots of complications from the initial surgery, and many surgerys since that time.

[Fernando Roque, MD]

Hi.  In light of the increased CEA value of 12.5, I would not blithely dismiss the tumor changes as "scar tissue" without having a biopsy done.  Your oncologist is right in saying that the elevated CEA value may represent disease progression, and warrants further investigation by means of a biopsy. I can understand your anxiety and concern over the whole situation.  However, waiting for another week until the biopsy results come out is not too long a delay to have an effect on your husband's treatment.  I do hope the results come out fine.  Best of luck.

[bjordan8]

I am 42 years old and during a routine yearly exam had a blood test.  The test came back with elevated alk phos and CEA (8.0).  I had a CT Scan, colonoskopy, endoscopy, digital mamm, and most recently a pelvic ultrasound.  I don't have the results from the ultrasound but all other test came out clean as a whistle.  I'm now being referred to a Oncology/Hemotology Dr.  Any thoughts on what could be causing the elevated CEA level.  P.s. Never had cancer (and hope I don't have it now!).

[titiortiz]

Hi, my Dad (70 yr old) was diagnosed with colon cancer (T2 N0 M0) in 05/2009. After surgery his CEA levels are still going up. Pre-surgery his level was 5.68..4 mths after surgery level went down to 4.67.... 3 mths after level went up to 7.7. At that time, PET scan was done and came back negative Colonoscopy was performed as well, showing no signs of recurrance. Couple weeks ago another CEA test was done and levels are still going up.(9.67)  MRI of the abdomen was done and this showed 1 cyst in liver of 4mm..Doctors say this is not metatstasis. Also, CT scan was done, and was fine.  He is healthy and active.
My Dad never received chemo. Any idea on why levels still going up??

[Huck69]

I am a 40 year old female that was diagnosed in Nov 2007 with stage III colon cancer after the birth of my daughter at age 37.  I had no symptoms, but it was discovered after the birth of my daughter gave me hemorrhoids and a colonoscopy was done.  The colonoscopy revealed a flat polyp and after surgery it was discovered it had gone through my colon and into 3-4 lymph nodes out of 37 taken.  I had colon resection surgery and followed by 12 rounds of fulfox chemo with Oxalyplatin and then also radiation with Xeloda pills.  In May of 2009, a 4 mm non calcified nodule was discovered in lung that turned out to be colon cancer that had spread there.  It was successfully resected in June of 2009.  My tumor markers remained .5 for about a year after my first colon resection surgery and have steadily risen to .7 and now 1.0 since my lung surgery.  In addition, another 3 mm non calcified nodule was discovered in Oct 2009 on my upper right lobe of my lung. I had another scan done this week (June 2010) and it has not changed or grown since it was first discovered on CAT scan done in October of 2009.  Could you tell me if you think that this has the possibility of changing and becoming another malignant tumor?  Or do you think it could be scar tissue from pneumonia found in my right lung following lung surgery last summer?  And if so, then why would my CEA levels continue to rise?  I was given antibiotics for the pneumonia (and felt great even when they discovered it) and it was completely cleared up 7 months ago.  So should I be concerned about the rising CEA levels? Or the reoccurrence of another non calcified nodule?

[Liska522]

My mom has surgery in October of 09 and they removed a part of her colon and rectum.  Could not preform colonoscopy because of the inflamed diverticuli. It was diverticulitis. No malignacies were found. Her CEA was a 47...they were sure they would find cancer. They did not. Amazing. She has had 2 PET scans to show nothing and three CT scans with and without contrast.She has also had a follow up colonoscopy and it was clear too...I am at a loss... Her CEA level continues to rise. It rises on an average of 10-18 points each time they check it. It is now at 153. It has gone from 47 to 93 to 114 to 120 to 140 and as of last week it i s 153. We have no answers as of yet...doctors here have no idea why it is so elevated. She is a non smoker and is 59.  Any one have any clue for our next step. We are thinking Mayo Clinic to get a consult to see why her levels continue to rise.

[xtinedian]

Hi, my father had resection last May 2011. He went on Chemotherapy for 6 sessions with 5FU and leucovorin. He had CEA june 2011 and the result is 3.1 then september 2011 2.1 and the latest was 3.9 taken just this month of February 2012. He also had whole abdomen ultrasound and it was normal. Is his latest CEA significant? Please help!