Lung Nodules: What Elevated CA153 and CEA Levels Mean

Q: Lung Nodules: What Elevated CA153 and CEA Levels Mean

Dear： Based on your description, it is most likely a recurrence and metastasis of breast cancer. <br>Although CA 15-3 can be elevated in other cancers, it is more specific to breast cancer. <br>Generally, the higher the tumor marker levels, the worse the prognosis. <br>The purpos

Pulmonary nodules?

Dear Dr.
Huang,
I would like to ask a few questions regarding my mother's condition.
Here is the situation: My mother was diagnosed with breast cancer 15 years ago and underwent a right mastectomy.
Since then, there has been no recurrence (the right axillary lymph nodes were also removed, leading to swelling in her left arm).
However, in recent years, she has started experiencing asthma, which has triggered allergic reactions, requiring frequent visits to the emergency department at Taipei Medical University.
Over the past decade, she has regularly undergone CA 15-3 and CEA monitoring, and as of her last blood test in February of this year, all values were normal.
However, in October of this year, her CA 15-3 was found to be over 100 (reference < 25), and CEA was also several times above the normal range.
Following her doctor's recommendation, a CT scan was performed, revealing a suspicious 1.5 cm x 0.5 cm white spot in her left lung, along with several smaller white spots distributed throughout the lung lobes.
Consequently, a PET/CT scan has been scheduled for this Thursday for further evaluation.
My mother mentioned that she had a PET scan three years ago, which showed no abnormalities.
I would like to ask the following questions:
1.
Besides malignant tumors, are there other causes that could lead to elevated CA 15-3 and CEA levels simultaneously?
2.
Does a higher index indicate a more severe condition?
3.
Can benign tumors cause elevated index levels?
4.
Is the statement "previously normal indices do not mean there are no tumors forming in the body; they just have not yet manifested in the values" correct?
5.
If it is lung cancer, can the indices suddenly spike this much within six months?
6.
Could the scattered small white spots be caused by other factors, such as inflammation triggered by asthma (the doctor mentioned that my mother currently has mild pleural effusion)?
I understand these questions are somewhat complex, and I appreciate your assistance in answering them.
Thank you.

Wo ai wo mama, 30~39 year old female. Ask Date: 2012/12/04

Dr. Huang Yiwen reply Pulmonology

Dear: Based on your description, it is most likely a recurrence and metastasis of breast cancer.
Although CA 15-3 can be elevated in other cancers, it is more specific to breast cancer.
Generally, the higher the tumor marker levels, the worse the prognosis.
The purpose of monitoring these indices is to alert us to changes; therefore, an increase indicates a new development that requires attention.
For lung cancer, CEA levels are typically elevated, but CA 15-3 is less likely to rise.
The complications of asthma are not as you described.
However, since your mother has already undergone a PET CT scan, we will have to wait for the results, which can vary in timing from person to person.
I hope this helps answer your questions, and I wish your mother well.
Huang Yi-Wen

Reply Date: 2012/12/04

More Info

Dear Patient,
Thank you for reaching out with your concerns regarding your mother's health, particularly in relation to her elevated CA 15-3 and CEA levels, as well as the recent findings from her CT scan. I understand that this is a worrying time for you and your family, and I will do my best to address your questions comprehensively.

1. Other Causes for Elevated CA 15-3 and CEA Levels: While elevated CA 15-3 and CEA levels are often associated with malignancies, particularly breast cancer and other adenocarcinomas, there are several non-malignant conditions that can also lead to increased levels. These include benign breast diseases, liver diseases, inflammatory conditions, and even certain infections. For instance, conditions such as pneumonia or chronic obstructive pulmonary disease (COPD) can cause inflammation that might elevate these markers. Therefore, while elevated levels warrant further investigation, they do not exclusively indicate cancer.

2. Correlation Between Elevated Levels and Disease Severity: Generally, higher levels of tumor markers like CA 15-3 and CEA can suggest a more advanced disease state, but this is not always the case. The interpretation of these markers must be done in conjunction with clinical findings, imaging studies, and the patient's overall health status. It is important to remember that tumor markers can fluctuate for various reasons, and a single elevated reading does not automatically correlate with disease progression.

3. Benign Tumors and Elevated Markers: Yes, benign tumors can sometimes cause elevated levels of tumor markers. For example, certain benign breast conditions can lead to increased CA 15-3 levels. However, the degree of elevation is typically lower than what is seen in malignant conditions. It is crucial to differentiate between benign and malignant processes through appropriate imaging and possibly biopsy if indicated.

4. Normal Levels Not Excluding Tumor Formation: Your statement is correct. Normal tumor marker levels do not guarantee the absence of cancer. Tumor markers can sometimes be within normal ranges even when a tumor is present, particularly in the early stages of cancer. This is why regular monitoring and comprehensive evaluations, including imaging studies, are essential for individuals with a history of cancer.

5. Rapid Increase in Tumor Markers: It is possible for lung cancer or other malignancies to cause a rapid increase in tumor markers within a short period. However, this can also occur due to other factors, such as inflammation or infection. The sudden spike in CA 15-3 and CEA levels should be evaluated in the context of your mother's overall health, symptoms, and imaging findings.

6. Small White Spots on the Lung: The small white spots observed on the CT scan could represent a variety of conditions. They may be benign, such as granulomas (often due to past infections), or they could indicate metastatic disease or primary lung cancer. The presence of mild pleural effusion (lung fluid) could also be related to inflammatory processes rather than malignancy. Further evaluation with PET/CT will help clarify the nature of these findings.

In conclusion, while elevated CA 15-3 and CEA levels are concerning, they are not definitive for cancer on their own. The upcoming PET/CT scan will provide more clarity regarding the lung nodules and help guide further management. It is essential to maintain open communication with your healthcare team, who can provide personalized insights based on the complete clinical picture.

Wishing your mother the best in her upcoming evaluations and a swift resolution to her health concerns.

Best regards.

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