the Link Between Fecal Occult Blood and Elevated CEA Levels

Fecal occult blood and its correlation with CEA levels?

Hello doctor, my father, a long-time smoker, had a blood test yesterday that showed a CEA level of 9.4.
The doctor advised him to quickly schedule a colonoscopy, but we have to wait two weeks for the results.
In July, he had a fecal occult blood test done by a different doctor, who said there were no issues, so he wasn't referred for a colonoscopy at that time.
Could you please tell me what the likelihood of colon cancer is if the fecal occult blood test was normal but the CEA level is elevated at 9.4? Is it possible that there could be a problem developing within six months? Thank you for your response.
🙏🏻

Niming, 50~59 year old female. Ask Date: 2022/12/30

Dr. Chen Shidian reply Gastroenterology and Hepatology

It's a matter of perspective, and there is no definitive answer (there should be no colorectal cancer, but polyps cannot be ruled out).
If concerned, a colonoscopy should be performed, but lung cancer is also a possibility; the important thing is to quit smoking.

Reply Date: 2022/12/30

More Info

Elevated levels of Carcinoembryonic Antigen (CEA) can be a significant concern, especially in the context of colorectal health. CEA is a glycoprotein involved in cell adhesion, and its levels can be elevated in various conditions, including malignancies, particularly colorectal cancer. However, it is essential to understand that CEA is not a definitive marker for cancer; rather, it serves as a tool for monitoring disease progression or recurrence in patients with a known history of cancer.

In your father's case, a CEA level of 9.4 ng/ml is indeed above the normal range, which is typically considered to be less than 4.6 ng/ml. However, it is crucial to note that elevated CEA levels can occur for reasons other than cancer, including smoking, inflammatory bowel disease, pancreatitis, and even benign tumors. Given your father's history as a smoker, this could also contribute to the elevated CEA levels.

The fact that your father had a normal fecal occult blood test (FOBT) in July is a positive sign, as it suggests that there were no detectable blood traces in the stool at that time. FOBT is a screening tool used to detect hidden blood in the stool, which can be an early sign of colorectal cancer. However, it is important to understand that a normal FOBT does not completely rule out the possibility of cancer, especially if there are other risk factors or symptoms present.

The relationship between elevated CEA levels and fecal occult blood tests is complex. While a normal FOBT may suggest a lower likelihood of significant colorectal pathology, elevated CEA levels can still indicate underlying issues that may not be detected through stool tests alone. This is why your father's physician has recommended a colonoscopy. A colonoscopy is a more definitive diagnostic tool that allows for direct visualization of the colon and rectum, enabling the physician to identify any abnormalities, such as polyps or tumors, and to take biopsies if necessary.

Regarding the risk of colorectal cancer, it is difficult to provide a specific probability based solely on the elevated CEA level and a normal FOBT. The risk can be influenced by various factors, including family history, personal medical history, lifestyle factors (such as smoking), and the presence of any symptoms (such as changes in bowel habits, weight loss, or abdominal pain). Given your father's elevated CEA level, it is prudent to proceed with the colonoscopy as recommended by his physician. This will provide a clearer picture of his colorectal health and help determine if any further action is necessary.

In summary, while an elevated CEA level can be concerning, it is not a definitive indicator of cancer, especially in the presence of a normal FOBT. The best course of action is to follow through with the colonoscopy to investigate further. Early detection and intervention are crucial in managing colorectal health, and your father's healthcare team will be able to provide the most appropriate guidance based on the results of the colonoscopy and any additional tests that may be warranted.

Similar Q&A

Understanding High CEA Levels: Causes, Concerns, and Next Steps

Hello Dr. Chen: I received my physical examination report, and my CEA level is 55.5, which is very high. I subsequently underwent a colonoscopy, gastroscopy, chest X-ray, and CT scan, all of which came back normal. I also had my blood drawn again, but the levels are still very hi...

Dr. Chen Bozhang reply Family Medicine
Hello: In response to your question. An elevated CEA (Carcinoembryonic Antigen) level is commonly seen in patients with colorectal cancer, pancreatic cancer, gastric cancer, and breast cancer. Additionally, conditions such as hepatitis, liver cirrhosis, and inflammatory bowel dis...

Understanding Elevated CEA Levels: Next Steps in Surgical Evaluation

In April 2002, during a routine check-up, the CEA level was 10.5. In May, a colorectal examination was performed, and a 1 cm polyp was removed. Subsequently, for the next two months, two CEA tests were conducted, both showing a level of 4.35, which is still above the normal range...

Dr. Huang Yuanhui reply Surgery
Answer: Surgery Dr. Huang Yuan-Hui stated that since our hospital already has a colorectal surgery specialty, this question is specifically addressed by Dr. Hou Yong-Ji from the colorectal surgery department. Thank you. Colorectal Surgery Dr. Hou Yong-Ji: 1. Carcinoembryonic anti...

Understanding Elevated CEA Levels: Causes, Risks, and Treatment Options

I previously went to Taipei Hospital for a comprehensive health check-up, and the report indicated that my CEA level is 6.25 ng/ml (<4.6). This is already above the standard value. What kind of pathological changes could this indicate, and how can I prevent and treat it? Dr. C...

Dr. Chen Shidian reply Gastroenterology and Hepatology
Hello, users: Elevated CEA levels may indicate gastrointestinal or thoracic issues, but they could also be caused by smoking. Please consult an internist for further evaluation and monitoring of changes. Wishing you good health!

Understanding Elevated CEA Levels and Low AST: Key Concerns and Next Steps

Hello, doctor. I have no history of smoking, but I recently received a report indicating that two indices from my company health check last month were abnormal: carcinoembryonic antigen (CEA) was elevated at 5.6 ng/ml, and liver function test SGOT (AST) was low at 12 U/L. PSA and...

Dr. Chen Shidian reply Gastroenterology and Hepatology
A low AST level is likely due to low muscle mass rather than a disease. The interpretation of a high CEA level can vary among physicians; it is advisable to consult an oncologist. Strategy 1 is to undergo a comprehensive examination at your own expense, while Strategy 2 is to mon...