CEA rising after surgery

[Sandy Jo]

I am a 57 yr.old woman who had surgery for stage 3 colon cancer in May 2003, immediately followed by 6 mos. of chemotherapy (5FU and Leucovorin). My CEA count was 22 before the surgery; it went down to high-normal during chemo, but started to slowly rise half-way through chemo and is now at 102.9. I've had several PET/CT scans, barium enemas, colonoscopies, and a bone scan, all with "unremarkable" results except for a large hiatal hernia. My doctors are taking a wait-and-see approach and will continue to schedule these tests. Could such an elevated CEA count be caused by conditions other than cancer, and are there other tests/scans I should be receiving?    Thank you.

[HEARTANGELS]

A related discussion, CEA RESULT IS WORRISOME was started.

[Kevin Pho, MD]

There has already been a pretty good discussion on this in the comments below.  

As you know, the CEA level is used as a prognostic indicator - it should return to baseline after resection.  However, the test is not perfect.  The sensitivity to detect relapse is between 58 to 89 percent and the specificity is between 75 to 98 percent.

The number you are interested in is the specificity - this means the probability of a positive test being recurrent cancer.  As you see, the studies only show this to be 75 to 98 percent, so there is always the chance that the elevation is not related to recurrance.

Anyways, as mentioned below, you have had a comprehensive workup already with every test completed.  I am not aware of further testing that could be done that would further evaluate for recurrence.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[tessa0825]

Is CEA at any level normal in adults? I thought CEA production stopped before birth? I didn't know we were supposed to have any in our blood as adults unless we smoked or had some abnormal reason for it to be there..I wish one of the Drs. would explain this better to us..

[TJV]

    Sandy Jo  Chemotherapy and radiation therapy can cause a  rise in CEA due to the death of tumor cells and release of CEA into the blood stream.

    Tessa  0825   CEA levels can rise in MANY benign conditions as the surgeon said above.    A CEA  level can rise due to a simple infection   Also a small percetantage of perfectly healthy people have unexplained elevated CEA levels.    That's why tumor marker tests are not a good screening device  --- it just causes anxiety and unnecessary tests.

  Very often, people worry unnecessarily because the test results are positive They may then go through a battery of expensive tests to discover they do not have cancer. Even then, the worry doesn't cease in the case of many people.

    And then there are the false negatives.  People who actually have cancer may get 'false negative' results. This might lead to doctors ignoring symptoms that would otherwise have alerted them to cancer.

   As for it's use in monitering cancer patients , that is a bit different , but still there's a major question with reliability and what the medical response should be to an elevated level . Would it make much difference in prognosis etc. ?

   Joe   It doesn't matter if values fluctuate, so long as the results are within normal limits.  






  

[surgeon]

CEA is a protein which exists in the blood of NORMAL people. The level can increase for various reasons. Cancer is on the list; so are other things. As I said above, it's not very precise as a test for cancer or for following someone who's had cancer. Many centers don't use it in the diagnosis, treatment, or followup for cancer for those reasons. When it's elevated it may or may not be significant, whatever the levels. So it's NOT a very good test. Outcomes of treatment haven't been shown to be affected by its use. I personally don't use it. Some doctors do. I don't know how to explain it any better than that. If it were a better test, there'd not be such questions about it or such variation in its use by doctors.

[curious joe]

My question is about CEA values. My father had colon cancer in 1998...one positive node out of 21 tested...chemo for 6 months. His pre-op CEA was 0.7 and subsequent CEA's have ranged from 0.7 to 1.0.  In May, he had 1.6...I know this is in the normal range, but I'm wondering if this fluctuation is significant? How can you have 0.8 one month and 1.6 at the next testing. This is a 100% increase. Should we be concerned? His oncologist didn't say anything to him, but I know that in the CA-125 test that their is some fluctuation in values and as long as it's in the normal range, there is no significance. Is this the same with CEA?

[tessa0825]

I wonder if they (tumor markers) are more useful when results are considered with other tests results? My PCP did a CEA about 2.5 years ago (I didn't even know he had done one) after my white cell count had been very high for months. Both results together were reasons why I was sent to an oncologist/hematologist and to a GI Specialist. My PCP thought because of the CEA results that I had colon cancer and if not then he thought I might have leukemia but I DIDNOT. That was one of those days when you leave the Docs office feeling much worse than when you arrived. HE said the numbers (on the CEA) were consistent with colon cancer. Regardless, it turned out I had some major conditions that required surgery and treatment and if not for those 2 results starting things I don't know how long it would have went undetected. Do you have symptoms that they are trying to find a cause for?

[TJV]

   You be a source of discomfort between me and my surgeon. ?  No,  he made his bed of thorns all on his own.

  I can see no justification for these tests  . The only logical conclusion i can come to was that these tests were ordered  for his own amusement.  And i told him so.  I also told him i wouldn't let him operate on my pencil.   Putting blind trust in  in a surgeon especially, is tough enough , he broke that trust by not informing me of his intentions.

[tessa0825]

I don't know about you but for me it seems like when you have had cancer once, your Drs. use more precautions than they did prior to a cancer diagnosis. I had cancer in 95 and followed with my oncologist until he retired in 2000 and then I went back to my PCP for every thing. He noticed the WCC going up in late 2000 and when he did a CEA months later that was also elevated then he began looking for the reasons. I have since been diagnosed with dysplasia in my esophagus and diffuse scleroderma. I'm not sure if those were the reasons for the elevated CEA or not. I do know the scleroderma is the reasons for the high WCC..Tests like CEAs make me very nervous..If my Drs. still check it, they don't say and I don't ask.

[Sandy Jo]

I have had no symptoms to cause my doctor to keep looking -- just that pesky, ever-rising CEA count. I will admit that my doctor could have ordered some of these tests just to placate my fears!

[JackieG]

I sure am glad you are on this site.  You add a tremendous amount of value.

A general "thanks" from the regular visitors here.

regards,
Chicken Soup

[surgeon]

Well, I hate to second guess another surgeon -- especially from such a distance -- or to be a source of discomfort between you and your surgeon. Very few things in medicine are carved in stone; reasonable people sometimes disagree, based on certain past experiences, etc.

[TJV]

   I saw a surgeon last week in regards to abdominal problems, tearing sensations, , pressure, bruising, long standing discoloration etc  , stemming from a weight lifting accident.

   In addition to the tests i would expect him to order , he ordered  6 different tumor marker tests including the CEA .  Had i been aware of this before the blood was drawn, i never would of agreed to it.   I think this was way out of line and i did fax him telling him so.

[TJV]

Cigarette smoking will cause the CEA to elevate--- pancreatitis, hepatitis, , lung infection, inflammatory bowel disease, biliary obstruction.

   Surgeon  do you think there is any benefit to order these tumor marker tests in people who haven't been diagnosed with cancer?  A lot of doctors do order them routinely.

[surgeon]

I think the only tumor marker that has a role in screening, in people without symptoms or specific risk factors, is PSA for prostate cancer. Even that has come under recent scrutiny, however. Specifically with regard to CEA, I think there's no evidence at all that it has use as a screening tool, and some evidence for the opposite, in that it's inaccurate enough to lead to lots of testing which can have its own problems. It is used in some centers as a way to monitor response to treatment, as in the current questioner's situation. But, as I said above, it's less than perfect in that regard. The concept of tumor markers is a good one; meaning, there's reason to keep searching for better markers and it remains a subject of lots of study. There's reason to believe much better markers will emerge; ones that will accurately indicated the presense or absense of tumor.

[surgeon]

It remains controversial the extent to which monitoring CEA is useful in colon cancer patients, for two reasons. First, the test is not as accurate as would be ideal: it can be elevated for reasons other than cancer, including colon inflammation, etc. Second, there's not convincing evidence that when recurrance is detected by CEA rather than by other tests, there's a difference in response to treatment. In other words, it's not clear that finding it "sooner" by CEA leads to better results from treatment than when it's found because of symptoms, or other tests. You've had pretty much all the testing one would do at this point, except possibly exploratory surgery. Given the normal testing, and the fact that you're not having specific symptoms to suggest a problem (I'm inferring that) the periodic screening approach makes sense.