Should My 82-Year-Old Father with High CEA Levels Undergo a Colonoscopy?

The fecal test for CEA is 97.12; is a colonoscopy necessary?

My father is 82 years old and has prostate cancer with bone metastasis.
He is currently undergoing hormone therapy.
Recently, he had a stool test, and the CEA level was 97.12.
The gastroenterologist recommended a colonoscopy, but my father has experienced significant physical decline since starting hormone therapy earlier this year and is concerned about his ability to tolerate the procedure.
Given his current condition, what would be the implications of proceeding with or forgoing the colonoscopy in terms of treatment planning? Would there be a significant difference?

Leinard, 50~59 year old female. Ask Date: 2016/06/13

Dr. Chen Qifeng reply Gastroenterology and Hepatology

1.
The stool test should primarily focus on the results of occult blood, not CEA.

2.
In theory, a colonoscopy should be performed, but it may not be appropriate in all cases.

Reply Date: 2016/06/13

More Info

When considering whether your 82-year-old father should undergo a colonoscopy given his elevated CEA levels (97.12) and current health status, several factors must be taken into account. CEA, or Carcinoembryonic Antigen, is a tumor marker that can be elevated in various cancers, including colorectal cancer. In your father's case, the significantly high CEA level raises concerns about potential malignancy, particularly in the context of his existing prostate cancer and its metastasis.

The Importance of Colonoscopy
A colonoscopy is a critical diagnostic tool that allows for direct visualization of the colon and rectum. It can help identify polyps, tumors, and other abnormalities that may not be detectable through non-invasive tests. Given your father's high CEA levels, a colonoscopy could provide valuable information regarding the presence of colorectal cancer or other gastrointestinal issues.
However, the decision to proceed with the colonoscopy must consider your father's overall health, particularly his physical condition after starting hormone therapy for prostate cancer. Hormonal treatments can lead to fatigue and a decline in physical strength, which may affect his ability to tolerate the procedure and the sedation typically used during a colonoscopy.

Weighing Risks and Benefits
1. Risks of Colonoscopy: For elderly patients, especially those with compromised health, the risks associated with colonoscopy include complications from sedation, potential perforation of the colon, and post-procedural recovery challenges. Given your father's age and current treatment for prostate cancer, these risks may be heightened.

2. Benefits of Colonoscopy: If the colonoscopy reveals abnormalities, it could lead to early detection and treatment of colorectal cancer, which is crucial for improving outcomes. Early intervention can significantly impact survival rates and quality of life.

Treatment Implications
If the colonoscopy is performed and reveals cancer or significant polyps, the treatment plan may change dramatically. Options could include surgical intervention, chemotherapy, or other therapies tailored to his specific condition. Conversely, if the colonoscopy does not reveal any significant issues, it may provide peace of mind and allow for a focus on managing his existing prostate cancer.

Conclusion
Ultimately, the decision to proceed with a colonoscopy should involve a thorough discussion with your father's healthcare team, including his oncologist and gastroenterologist. They can provide insights into the risks versus benefits based on his current health status and treatment goals.
If your father is deemed too frail for the procedure, alternative approaches, such as imaging studies or close monitoring of his CEA levels, may be considered. It is essential to prioritize his comfort and quality of life while making informed decisions about his healthcare.
In summary, while a colonoscopy could provide critical information regarding his health, the decision must be carefully weighed against his ability to tolerate the procedure and the potential impact on his overall treatment plan.

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