Elevated CEA Levels: Next Steps in Surgical Evaluation

Q: Elevated CEA Levels: Next Steps in Surgical Evaluation

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. <

CEA (Carcino

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.
What further medical evaluation or treatment should be pursued? Thank you.

Lin, 50~59 year old female. Ask Date: 2002/07/26

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 antigen (CEA) is a protein synthesized by the liver, and it has been observed to be elevated in some colorectal cancer patients.
However, approximately 1/3 to 1/2 of colorectal cancer patients do not have elevated CEA levels; therefore, CEA is not currently recognized as a screening tool for colorectal cancer.
2.
The CEA values may vary according to the reference standards of each laboratory, so it is important to understand the reference values for proper interpretation.
3.
If CEA levels are elevated and the colonoscopy results are normal, additional tumor markers (such as CA-19-9, AFP, etc.) and abdominal ultrasound should be performed to rule out malignancies in other organs.

Reply Date: 2002/07/26

More Info

Elevated levels of Carcinoembryonic Antigen (CEA) can be concerning, especially when they persist after the removal of a polyp, as in your case. CEA is a glycoprotein involved in cell adhesion and is often used as a tumor marker in various cancers, particularly colorectal cancer. While a CEA level of 10.5 is significantly elevated, the subsequent decrease to 4.35 is a positive sign, indicating that the body may be responding to the surgical intervention. However, since this level is still above the normal range, further evaluation is warranted.

Understanding CEA Levels
1. What CEA Levels Indicate: CEA levels can be elevated in various conditions, not just cancer. Elevated levels can occur in smokers, individuals with inflammatory bowel disease, and those with other benign conditions. However, in the context of a history of polyps and elevated CEA, it is essential to consider the possibility of malignancy.

2. Post-Polypectomy Monitoring: After the removal of a polyp, especially if it was adenomatous (a type that can become cancerous), monitoring CEA levels is crucial. The fact that your CEA levels have decreased is encouraging, but the persistence above normal levels suggests that further investigation is necessary.

Next Steps in Evaluation
1. Consultation with a Specialist: Given your elevated CEA levels, it is advisable to consult with a gastroenterologist or an oncologist who specializes in colorectal cancer. They can provide a comprehensive evaluation of your situation.

2. Colonoscopy: A follow-up colonoscopy may be warranted to ensure that there are no residual polyps or new lesions in the colon. This procedure allows for direct visualization and biopsy of any suspicious areas.

3. Imaging Studies: Depending on the clinical evaluation, your doctor may recommend imaging studies such as a CT scan or MRI to assess for any signs of metastasis or other abnormalities in the abdomen and pelvis.

4. Additional Blood Tests: Besides CEA, other tumor markers or blood tests may be performed to provide a more comprehensive picture of your health status. This could include tests for other markers associated with colorectal cancer or liver function tests.

5. Regular Monitoring: If no malignancy is found, regular monitoring of CEA levels may be recommended. This could involve periodic blood tests and follow-up colonoscopies to ensure that any new polyps or changes are detected early.

Conclusion
In summary, while your CEA levels have decreased, the fact that they remain elevated necessitates further investigation. Engaging with a healthcare provider who can guide you through the necessary diagnostic steps is crucial. Early detection and intervention are key in managing potential colorectal cancer, especially given your history of polyps and elevated CEA levels. Regular screenings and vigilance in monitoring your health will be essential in ensuring the best possible outcomes.

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