Carcinoembryonic Antigen

Aka: Carcinoembryonic Antigen, CEA

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II. Indications

  1. Stage II or III (Duke B1-C1) Colon Cancer monitoring
  2. Do not use to screen for Colon Cancer or other cancer

III. Interpretation

  1. Normal
    1. Non-smokers: <2.5 mg/ml
    2. Smokers: <5 ng/ml
  2. Increased
    1. Benign disease unlikely if >10 ng/ml
    2. Distant metastasis most likely if >100 ng/ml

IV. Efficacy

  1. Not specific
    1. Seen in other adenocarcinoma (see below)
  2. Sensitivity varies by tumor stage and differentiation
    1. CEA not increased in poorly differentiated tumors
    2. Increased in <25% of Duke A or B stage Colon Cancer
    3. Increased in 50% with Duke C stage Colon Cancer
    4. Increased in 75% of Duke D stage Colon Cancer

V. Causes of increased CEA

  1. Benign causes
    1. Tobacco Abuse
    2. Peptic Ulcer Disease
    3. Inflammatory Bowel Disease
    4. Pancreatitis
    5. Hypothyroidism
    6. Cirrhosis
  2. Malignant causes
    1. Colon Cancer
    2. Breast Cancer
    3. Gastric Cancer
    4. Lung Cancer
    5. Pancreatic Cancer
    6. Bladder Cancer
    7. Cervical Cancer
    8. Melanoma
    9. Lymphoma

VI. Protocol for monitoring after Colorectal Cancer resection

  1. Repeat CEA level q2-3 months for 2 years

VII. References

  1. Bast (2001) J Clin Oncol 19:1865-78 [PubMed]
  2. Fletcher (1996) Ann Intern Med 104:66-73 [PubMed]
  3. Longo (2002) Surg Clin North Am 82(5):1091-108 [PubMed]

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