Is a CEA Level of 10,000 Possible? Cancer Marker Limits

Q: Is a CEA Level of 10,000 Possible? Cancer Marker Limits

Hello, Miss La Bao： <br>Question 1. <br>Is there a limit to the CEA index? <br>Carcinoembryonic antigen (CEA) is the most commonly used tumor marker for colorectal cancer. <br>However, CEA is not exclusive to colorectal cancer; it can also be elevated in breast cancer, gastric ca

Is it really possible for the CEA level to reach 10,000?

Hello Director Lai, I discovered a CEA level of 1085 during my health check in August this year, and subsequently, the clinic tested it again with a value of 1500.
Later, after transferring to another hospital, the results showed that the level had risen to 10,000, and I was diagnosed with terminal gastric cancer, which has metastasized to the fifth lumbar vertebra and involved 16 lymph nodes in the abdomen.
The attending physician believes that surgery cannot achieve clearance, and I am currently undergoing first-line drug treatment, with the level now reduced to around 8500.
I would like to ask if there is a limit to the CEA level, and whether there are other potential underlying conditions in this situation?

La Bao, 30~39 year old female. Ask Date: 2018/12/20

Dr. Lai Yicheng reply Oncology

Hello, Miss La Bao:
Question 1.
Is there a limit to the CEA index?
Carcinoembryonic antigen (CEA) is the most commonly used tumor marker for colorectal cancer.
However, CEA is not exclusive to colorectal cancer; it can also be elevated in breast cancer, gastric cancer, pancreatic cancer, lung cancer, ovarian cancer, and prostate cancer.
Additionally, CEA is not solely associated with malignancies; benign conditions such as diverticulitis, peptic ulcers, chronic bronchitis, liver abscesses, alcoholic liver cirrhosis, and elderly smokers can also result in elevated CEA levels.
CEA is not recommended for early cancer screening, as a normal CEA value does not equate to safety or normalcy.
Nearly half of patients with related cancers may have normal CEA levels (less than 5 ng/mL).
CEA is generally used for detecting recurrence after surgery; for patients with stage II or III colorectal cancer, blood tests for CEA are typically conducted every 3-6 months post-surgery, which can detect approximately 60% of colorectal cancer recurrences.
However, nearly 40% of recurrences may still present with normal CEA levels, indicating that CEA is not effective for screening recurrences.
Therefore, while CEA is a convenient marker, it is by no means an "ideal" index.

Sincerely,
Dr.
Lai, Department of Radiation Oncology, Changhua Hospital.
Thank you.

Reply Date: 2018/12/20

More Info

Carcinoembryonic antigen (CEA) is a tumor marker that is primarily associated with colorectal cancer but can also be elevated in various other malignancies, including gastric, pancreatic, lung, breast, and ovarian cancers. It is important to note that CEA is not specific to cancer; it can also be elevated in benign conditions such as chronic obstructive pulmonary disease (COPD), liver disease, inflammatory bowel disease, and even in smokers.
In your case, a CEA level of 10,000 is extraordinarily high and typically indicates a significant malignancy burden, particularly in the context of advanced cancer, such as stage IV gastric cancer with metastasis to the lumbar spine and lymph nodes. The fact that your CEA levels have decreased to around 8,500 following treatment is a positive sign, indicating that the treatment may be having some effect, although the levels remain alarmingly high.

To address your question about whether CEA levels have a limit: technically, there is no upper limit for CEA levels. The values can vary widely among individuals and can be influenced by the type and stage of cancer, as well as other non-cancerous conditions. In clinical practice, CEA levels are often used to monitor treatment response and detect recurrence rather than as a definitive diagnostic tool. A normal CEA level does not guarantee the absence of cancer, and conversely, a high CEA level does not confirm the presence of cancer.
Regarding your concern about potential underlying conditions that could cause elevated CEA levels, it is crucial to consider the broader clinical picture. While your current diagnosis of advanced gastric cancer is the most likely explanation for the elevated CEA, other factors could contribute to this elevation. For instance, if there are concurrent benign conditions, such as liver disease or chronic inflammation, they could also elevate CEA levels.
In summary, while a CEA level of 10,000 is indeed possible and indicative of advanced malignancy, it is essential to interpret this marker in conjunction with clinical findings, imaging studies, and other laboratory results. Continuous monitoring of CEA levels during treatment can provide valuable information regarding the effectiveness of therapy and the overall disease trajectory. If there are concerns about the accuracy of the CEA readings or the presence of other potential conditions, further diagnostic evaluations, such as imaging studies or biopsies, may be warranted to clarify the situation. Always consult with your healthcare provider to discuss your specific case and any additional tests that may be necessary.

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