Why CEA Levels Rise After Colon Cancer Surgery and Chemotherapy

Q: Why CEA Levels Rise After Colon Cancer Surgery and Chemotherapy

Hello： 1. <br>An increase in CEA levels does not necessarily indicate a clear recurrence of cancer. <br>2. <br>I also recommend continuing with 5-FU chemotherapy, as it is the most effective drug for colorectal cancer and is the standard treatment; furthermore, examinations have

Why does CEA remain elevated after colon cancer resection and chemotherapy?

Dear Doctor,
My mother was diagnosed with a colon tumor at the end of January this year, with an initial CEA level of 114.
After the Lunar New Year, she underwent a resection surgery one week later, and her CEA level before the surgery was 190.
Following the surgery, the doctor determined it to be stage III colon cancer.
Three weeks post-surgery, her CEA level was 75, and chemotherapy was initiated one month after the surgery, using 5-FU, administered weekly for a total of six cycles.
As of today, she has completed two cycles.

However, the chemotherapy has not shown significant benefits for my mother.
Over the past three months of chemotherapy, her CEA levels were tested three times.
The first test showed a decrease from 75 to 67 after surgery, but then it rose again to 99, and this week it has further increased to 108.
These rising numbers have caused great concern for our family, leading us to question the efficacy of the chemotherapy drugs and whether the cancer cells are spreading.

The attending physician arranged for an abdominal ultrasound, chest X-ray, and CT scan, all of which indicated no tumors or cancer cells present (after the CEA level rose to 99).
Therefore, there is no evidence of cancer spread, and as a result, no alternative medications can be considered.
However, after my mother has endured the unpleasant side effects of chemotherapy, her CEA levels continue to rise, leading to feelings of disappointment—does chemotherapy really work?
We initially considered paying out of pocket for a PET scan, but the attending physician advised against it, stating that the test is too sensitive and there are not many qualified doctors in the country to interpret the results, which could lead to misdiagnosis.
Yet, with my mother's CEA levels continuously increasing, we are left wondering what could be causing this.
Are there no other options available to help us?
I sincerely request your guidance to illuminate our path, so we can encourage my mother to persist and maintain her courage in the fight against this illness.
Sincerely,
Jasper
E-MAIL ADDRESS: [email protected]

Jasper, 30~39 year old female. Ask Date: 2005/07/01

Dr. Chen Sirong reply Oncology

Hello: 1.
An increase in CEA levels does not necessarily indicate a clear recurrence of cancer.
2.
I also recommend continuing with 5-FU chemotherapy, as it is the most effective drug for colorectal cancer and is the standard treatment; furthermore, examinations have not shown any recurrence.
3.
Personally, I suggest undergoing a PET scan, as it is self-paid and you do not need to consider the original physician's opinion.
You can go to a hospital that offers combined PET and CT scans, such as Shin Kong Hospital.
If there are any issues detected in the PET scan, a CT scan can be performed immediately, allowing for a single payment for dual examination, which also reduces the chance of misdiagnosis with the assistance of the CT scan.
Sincerely, Dr.
Chen Sih-Rong, Oncology.

Reply Date: 2005/07/01

More Info

Understanding the rise in Carcinoembryonic Antigen (CEA) levels after colon cancer surgery and chemotherapy can be quite complex and concerning for patients and their families. CEA is a protein that can be found in higher levels in individuals with certain types of cancers, including colon cancer. However, it is important to note that CEA is not exclusively a cancer marker; it can also be elevated in benign conditions and in smokers.

In your mother's case, her initial CEA levels were significantly high at 114, which indicated the presence of a tumor. After surgery, her CEA levels dropped to 75, which is a positive sign, suggesting that the tumor was successfully removed. However, the subsequent rise in CEA levels to 99 and then to 108 after two cycles of chemotherapy is understandably alarming.

There are several reasons why CEA levels might rise even after surgery and chemotherapy:
1. Tumor Marker Variability: CEA levels can fluctuate for various reasons, including physiological changes in the body, inflammation, or even the effects of chemotherapy itself. It is not uncommon for CEA levels to rise temporarily during treatment, and this does not always indicate cancer progression.

2. Chemotherapy Response: The effectiveness of chemotherapy can vary from patient to patient. While 5-FU (Fluorouracil) is a standard treatment for colon cancer, it may not work for everyone. The rise in CEA levels does not necessarily mean that the cancer is spreading; it could also mean that the cancer cells are responding differently to the treatment.

3. Residual Disease: In some cases, there may be residual cancer cells that are not detectable through imaging studies but can still produce CEA. This could explain why CEA levels are rising despite no visible tumors on scans.

4. Non-Cancerous Causes: Elevated CEA levels can also be due to non-cancerous conditions such as liver disease, inflammatory bowel disease, or smoking. It is essential to consider these factors when interpreting CEA levels.

Given that imaging studies (ultrasound, chest X-ray, and CT scan) have not shown any evidence of cancer recurrence or metastasis, it is crucial to continue monitoring CEA levels and to maintain open communication with your mother's healthcare team. They may suggest additional tests or adjustments to her treatment plan based on her overall health and response to therapy.

Regarding the suggestion of a PET scan, while it can provide more sensitive imaging for detecting cancer, it is essential to weigh the benefits against the potential for false positives and the availability of experienced radiologists to interpret the results. If you and your family feel strongly about pursuing this option, discussing it further with her oncologist may provide clarity and reassurance.

In conclusion, while rising CEA levels can be distressing, they do not always correlate with cancer progression. Continuous monitoring, supportive care, and open dialogue with healthcare providers are vital in navigating this challenging journey. Encourage your mother to stay positive and resilient, as many patients experience fluctuations in tumor markers during treatment. It is essential to focus on her overall well-being and the support of her medical team.

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