Elevated CEA Levels After Colon Surgery and Chemotherapy

Q: Elevated CEA Levels After Colon Surgery and Chemotherapy

Hello： The CEA (Carcinoembryonic Antigen) level is indeed a tumor marker, but it is not specific and is not limited to colorectal cancer. <br>Elevated levels can occur in various cancers throughout the body, such as head and neck cancer, lung cancer, breast cancer, gastric cancer

Postoperative and chemotherapy monitoring of abnormal CEA levels?

Hello Doctor, my mother underwent a colectomy last November, and her CEA level was in the 70s at that time.
After the surgery, the level did not decrease.
Following the initiation of chemotherapy, the CEA level continued to rise, reaching 160 last month.
The attending physician has conducted X-rays, CT scans, and finally a PET scan, but no issues have been identified.
The doctor also performed a repeat colonoscopy, which showed some inflammation at the surgical site, but everything else appeared normal.
She has now completed her eighth round of chemotherapy, yet the CEA level has risen to 180.
Could this be due to drug resistance, or is there another issue? Given that both the PET scan and colonoscopy have been performed, why has the CEA level not decreased and instead increased? We are desperate for answers, as our family is at a loss about what to do.

Penny, 20~29 year old female. Ask Date: 2017/04/13

Dr. Chen Yunfang reply Oncology

Hello: The CEA (Carcinoembryonic Antigen) level is indeed a tumor marker, but it is not specific and is not limited to colorectal cancer.
Elevated levels can occur in various cancers throughout the body, such as head and neck cancer, lung cancer, breast cancer, gastric cancer, pancreatic cancer, cholangiocarcinoma, and gynecological cancers, among others.
In follow-up monitoring, CEA can be very useful; however, using it as a screening tool when there are no symptoms can often lead to confusion, as it may be unclear where to investigate further.

One should not overly rely on positron emission tomography (PET) scans, as they can have limitations and blind spots.
For gastrointestinal cancers, PET scans are not suitable for detection because these cancers may not show any significant uptake.
Based on your statement that the initial CEA level was in the 70s, I suspect that there may have already been metastasis at the outset, indicating stage IV, as it is uncommon for colorectal cancer at stage III or higher to have such elevated CEA levels.

However, it is worth considering whether there might be another type of cancer that has not yet been identified, such as gastric cancer, lung cancer, or breast cancer.
I recommend discussing staging and further diagnostic approaches thoroughly with your attending physician.
An increasing CEA level certainly suggests that there are more cancer cells present, but what does it signify in terms of underlying pathology? Where is it coming from? Thank you for your inquiry.

Reply Date: 2017/04/13

More Info

Elevated Carcinoembryonic Antigen (CEA) levels following colon surgery and chemotherapy can be a source of significant concern for patients and their families. In your mother's case, the persistent rise in CEA levels after surgery and multiple cycles of chemotherapy raises several important considerations.

First, it's essential to understand what CEA is. CEA is a protein that can be found in the blood, and its levels can be elevated in certain types of cancers, particularly colorectal cancer. However, it is not a definitive marker for cancer recurrence or progression. In fact, many patients with colorectal cancer may have normal CEA levels, and some non-cancerous conditions can also cause elevated CEA levels. Therefore, while CEA can be a useful tool for monitoring treatment response and disease progression, it should not be used in isolation to make clinical decisions.

In your mother's situation, the initial CEA level of 70 and subsequent rise to 180 after surgery and chemotherapy could suggest several possibilities:
1. Incomplete Resection or Residual Disease: If there are cancer cells remaining after surgery, they could continue to produce CEA. The inflammation noted at the surgical site could also contribute to elevated CEA levels, as inflammation can sometimes cause an increase in this marker.

2. Chemotherapy Resistance: The rise in CEA levels despite ongoing chemotherapy could indicate that the cancer is not responding to the current treatment regimen. This resistance can occur for various reasons, including genetic mutations in the cancer cells that make them less susceptible to the drugs being used.

3. Non-Cancerous Causes: As mentioned earlier, elevated CEA levels can also arise from non-cancerous conditions such as smoking, liver disease, or inflammatory bowel disease. It’s crucial to consider these factors when interpreting CEA levels.

4. Monitoring and Imaging: The fact that imaging studies (X-rays, CT scans, and PET scans) have not revealed any new tumors or metastases is a positive sign. It suggests that, at least at this point, there is no visible progression of the disease. However, it does not rule out microscopic disease that may not be detectable by imaging.

Given these complexities, it is crucial to maintain open communication with your mother's healthcare team. They may consider additional tests or a change in treatment strategy if the current chemotherapy is not effective. This could include switching to a different chemotherapy regimen, adding targeted therapies, or considering clinical trials if applicable.

In the meantime, it is essential to support your mother emotionally and physically during this challenging time. Encourage her to maintain a healthy diet, engage in light physical activity as tolerated, and seek support from counseling or support groups for cancer patients.

In summary, while elevated CEA levels can be concerning, they are not definitive on their own. Continuous monitoring, thorough evaluation by her medical team, and a comprehensive treatment plan are vital in managing her condition. It’s understandable that you and your family are feeling anxious, but staying informed and involved in her care can help you navigate this difficult journey together.

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