Elevated CEA and AST

[MissB1982]

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.