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Carcinoembryonic Antigen (CEA)

Carcinoembryonic Antigen (CEA)

Test Highlight

Carcinoembryonic Antigen (CEA)

  

Clinical Use

  • Monitor persistent, metastatic, or recurrent adenocarcinoma of the colon following curative surgery

Clinical Background

CEA is an oncofetal glycoprotein present in the gastrointestinal tract and body fluids of the embryo and fetus. This 180-kilodalton antigen is also present in certain adult gastrointestinal cells, including the mucosal cells of the colorectum, and small amounts are present in blood. Although its physiological role is not clear, CEA is a useful tumor marker. Blood levels are usually not increased in localized or primary disease, but are often elevated in patients with disseminated cancers and in some patients with non-malignant disease.

CEA is useful for detecting recurrence of colon cancer; increased levels may precede clinical evidence of recurrence by as much as 6 months. The sensitivity for detecting recurrence is 97% in patients whose CEA was elevated preoperatively, but only 66% in those with normal preoperative levels.

CEA is not recommended for screening because of low sensitivity and specificity, particularly in the early stages of neoplastic disease. The American Society of Clinical Oncology (ASCO) has recommended the use of CEA testing for staging/prognosis, detecting recurrence, monitoring therapy, and screening for hepatic metastases in patients with colon cancer.1 Postoperative CEA testing is recommended at 3 month intervals for at least 3 years in patients with stage II or III disease.1 CEA is the marker of choice to monitor systemic therapy in patients with metastatic cancer; testing is recommended every 1 to 3 months.1

Method

Immunochemiluminometric assay employing a purified polyclonal antibody and a mouse monoclonal antibody

Interpretive Information

Normal CEA concentrations (<2.5 ng/mL) are seen in about 97% of apparently healthy individuals. Elevations may be seen in 19% of heavy smokers and 7% of former smokers, individuals with inflammatory diseases of the gastrointestinal tract (eg, peptic ulcer, diverticulitis, etc), liver diseases including cirrhosis and chronic active hepatitis, advanced renal disease, and fibrocystic disease of the breast. Levels can also be increased in as many as 30% of patients with breast, lung, hepatocellular, and pancreatic carcinoma (Table). About 30% of patients with metastatic colon cancer have normal CEA levels.

Preoperative CEA levels >5 ng/mL suggest poor prognosis for patients with CRC.1

Table. Distribution of CEA

Subject Group

No. of

Subjects

% with CEA in Indicated Range

0-2.5

ng/mL

2.6-5.0

ng/mL

5.1-10.0

ng/mL

10.0-20.0

ng/mL

>20.0

ng/mL

Healthy Subjects

Non-smokers

225 98 2 0 0 0

Smokers

150 87 8 5 0 0

Malignant Disease

Colorectal

250 38 11 7 6 38

Lung

158 46 16 11 7 20

Breast

221 68 15 8 2 7

Gastric

35 60 17 9 6 9

Ovarian

35 83 11 3 3 0

Pancreatic

43 44 21 16 7 12

Liver

6 50 17 0 33 0

Lymphoproliferative

15 80 20 0 0 0

Othera

40 75 10 10 5 0

Non-Malignant Disease

Cirrhosis

53 42 13 32 13 0

Other benign liver

5 40 20 0 40 0

Ulcerative colitis

11 91 9 0 0 0

Benign polyps

23 65 22 13 0 0

Colon and intestinal

15 67 20 0 13 0

Gastrointestinal

21 76 14 0 5 5

Breast

53 96 0 2 0 2

Kidney and bladder

12 83 8 0 8 0

Lung

29 69 24 7 0 0

Otherb

117 86 8 4 1 0

Source: Bayer Corporation.

a Other cancerous diseases include bladder, prostate, esophagus, head and neck, sarcoma, and kidney cancer.
b Other non-malignant diseases include benign uterine, cervical and vaginal, benign ovary, and benign male genital as well as other benign conditions.

References

  1.  Locker GY, Hamilton S, Harris J, et al. ASCO 2006 update of recommendations for the use of tumor markers in gastrointestinal cancer. J Clin Oncol. 2006;24:5313-5327.
     

Content reviewed 12/2012

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