Rising CEA Levels During Chemotherapy for Colon Cancer

Q: Rising CEA Levels During Chemotherapy for Colon Cancer

Tony Chen / 57 years old / Male Hello, medical condition： 1. Diagnosed with recurrent metastatic colorectal cancer in the lymph nodes near the aorta, measuring 17mm in diameter. 2. CEA levels have been consistently rising. The Canadian physician recommends cont

Elevated CEA levels in recurrent colorectal cancer?

Hello Dr.
Chen, I am from Taoyuan and currently in Canada.
In May 2019, I was diagnosed with cancer located between the ascending colon and the transverse colon, which was classified as stage III.
After an emergency surgery for resection and chemotherapy, I remained stable for a year and a half.
However, I was later diagnosed with a recurrence of colorectal cancer that had metastasized to the lymph nodes near the aorta, measuring 17mm in diameter.
On February 10 of this year, my doctor arranged for chemotherapy and targeted therapy every two weeks, along with blood tests every two weeks.
I have completed three treatments so far, and I am scheduled for my fourth chemotherapy session tomorrow, March 25.
Currently, my blood tests show normal levels for red and white blood cells, as well as liver and kidney function, and I have experienced minimal side effects from chemotherapy (only slight hair loss and mild chest tightness for the first three days).
However, my CEA levels have been steadily rising: from an initial 8.5 to 9.3, then 13.7, 18.7, and now 22.0, increasing by about 4 to 5 every two weeks.
I asked my doctor if the chemotherapy might be ineffective, and he mentioned that it could be, but advised me to continue with the treatment and reassess after a CT scan on April 19.
Is April 19 too far away? During this time, I will have two more chemotherapy and targeted therapy sessions.
If the doctor suspects that the treatment may be ineffective, why continue with two more sessions? Is it possible that the cancer cells are still growing during this period? Could this delay my condition? Does the continuous rise in CEA levels during chemotherapy and targeted therapy indicate that the cancer cells are not being controlled? Thank you for your guidance.

Tony Chen, 50~59 year old female. Ask Date: 2021/03/25

Dr. Chen Sirong reply Oncology

Tony Chen / 57 years old / Male
Hello, medical condition: 1.
Diagnosed with recurrent metastatic colorectal cancer in the lymph nodes near the aorta, measuring 17mm in diameter.
2.
CEA levels have been consistently rising.
The Canadian physician recommends continuing chemotherapy and reassessing after a CT scan on April 19.

Questions:
1.
Is April 19 too long to wait?
A: Actually, even in medical centers in Taiwan, scheduling a CT scan can take several weeks to a month.
It is normal for the oncology department to conduct follow-up examinations after a treatment cycle of about three months to evaluate the effectiveness of the therapy.

2.
Since the physician has indicated that the treatment may be ineffective, why continue with chemotherapy and targeted therapy for two more cycles? During this time, are the cancer cells still growing? Could this delay the progression of the disease?
A: After completing a treatment cycle (the duration of which you may need to ask your physician), it is standard to continue the medication until the cycle is finished before reassessing the situation.
From my experience, not using the medication could lead to a faster increase in tumor markers.

3.
Does a continuous rise in CEA levels during chemotherapy and targeted therapy indicate that the cancer cells are not being controlled?
A: Typically, yes! I recommend a PET scan or a CT scan of the chest, abdomen, and pelvis.
In some cases, the lymph node near the aorta may shrink, but new lesions could appear in other areas.

Wishing you good health,
Taoyuan Hospital
Chen Si-Rong

Reply Date: 2021/03/25

More Info

Understanding the rising levels of Carcinoembryonic Antigen (CEA) during chemotherapy for colon cancer can be a complex issue, especially for patients and their families who are navigating the challenges of cancer treatment. CEA is a tumor marker that is often used to monitor the treatment response in patients with certain types of cancer, including colon cancer. However, it is important to understand that CEA levels can fluctuate for various reasons, and an increase does not always indicate that the cancer is progressing.

Firstly, it is crucial to recognize that CEA is not a definitive marker for cancer presence or progression. While elevated CEA levels can suggest the presence of cancer, they can also be influenced by other factors such as smoking, inflammation, and even certain benign conditions. In your case, the gradual increase in CEA levels from 8.5 to 22.0 during chemotherapy may raise concerns, but it does not automatically mean that the treatment is ineffective or that the cancer is growing.

Chemotherapy, particularly in cases of advanced cancer, can take time to show its effects. It is not uncommon for CEA levels to rise initially during treatment, especially if the body is responding to the chemotherapy. The rise in CEA could be due to the release of tumor antigens into the bloodstream as cancer cells die off or change in response to treatment. This phenomenon is sometimes referred to as a "tumor flare," where the initial response to treatment may cause temporary increases in tumor markers before they eventually decrease.

Your oncologist's decision to continue with chemotherapy and targeted therapy, despite the rising CEA levels, is likely based on the understanding that treatment efficacy cannot be determined solely by CEA levels. Imaging studies, such as CT scans, provide a more comprehensive view of how the cancer is responding to treatment. The upcoming CT scan on April 19 will be crucial in assessing whether the cancer has stabilized, shrunk, or progressed, and it will provide a clearer picture of the treatment's effectiveness.

Regarding your concern about the time until the CT scan, it is understandable to feel anxious about potential cancer growth during this waiting period. However, it is also important to remember that chemotherapy is designed to work over several cycles. The fact that your blood counts and liver and kidney functions are normal is a positive sign, indicating that your body is tolerating the treatment well.

In summary, while rising CEA levels can be concerning, they do not provide a complete picture of your cancer status. It is essential to continue monitoring through both blood tests and imaging studies. Your oncologist's approach to continue treatment while awaiting the CT results is a common practice in oncology, as it allows for a more thorough evaluation of the treatment's effectiveness. If you have ongoing concerns, do not hesitate to communicate with your healthcare team; they can provide reassurance and adjust your treatment plan as necessary based on the results of your upcoming scans and tests. Remember, cancer treatment is often a marathon, not a sprint, and patience is key in this journey.

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