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CEA - What's the Efficacy for Monitoring Colon Cancer

sailor_on_a_lee...
Posts: 51
Joined: Jun 2012

Hey ya'll,

My oncologist seems to put great stock in monitoring my CEA.  

The "normal range" for my particular lab is 0.0 to 6.1 ng/mL.  My first CEA measurement was on June 18, 2012, resulting in a value of 3.4.  Beginning on July 25, 2012 my CEA was measured every two weeks throughout my first 12-round cycle of chemotherapy.  After the conclusion of that chemo cycle on December 12, 2012, my oncologist has measured my CEA once a month.  At no time has the value exceeded the maximum "normal" of 6.1 referenced by my lab.  Over 14 separate tests the mean value return is 3.96 while the median is 4.1, both well below the maximum "normal" of 6.1 referenced by my lab. The highest single value was 4.6 and the lowest 3.4 neither of which is above the maximum referenced "normal" value. 

According to my oncologist, this is good and indicative that my cancer stable.  Then I read that CEA may or may not be indicative of anything or it may indicate the cancer is stable.   

Just wondering what other colon cancer patients have been told by their oncologists and looking for any article or other references that any of you can direct me to.

Thanks,

Rick

Sundanceh's picture
Sundanceh
Posts: 4283
Joined: Jun 2009

For rectal and liver mets, CEA was a firm indicator.

When it migrated to my lungs...CEA became a no-factor...I went down to the lowest in my life at 0.8, but had a huge 4x6cm tumor embedded in my chest cavity...

I've always used CA19-9 as another marker as reference...it's always been off the charts...value is 0-37.....I've been as high as the 600's....my lowest was 3 months ago at 73....three months later it sits at 102.

It seems to vary with the individual as to what the marker indicates. 

It's not a good idea to judge your progress by CEA though...as I alluded to above, that got me into big time trouble and cost me the last 3-years in another big fight and recovery.

It's the whole package really....bloodwork, CT and or PET...that gives everyone the best perspective that modern medicine has to offer us.  Between those the portrait of what we are looking at comes into clear focus. 

Your CEA might be valid for your case....mine was in certain areas...but not in others.

 

k1
Posts: 220
Joined: Dec 2009

And don't forget that there are weirdos like me whose recurrent cancer (liver mets) has only been diagnosed by mri, having not shown up on CT scan or PET scan and a CEA of less than 5.0. 

Special K

(i liked the nickname and am keeping it.  It is one of my favorite cereals and had some tonight)

LivinginNH's picture
LivinginNH
Posts: 1293
Joined: Apr 2010

 

Hi,

My Rick had a CEA of 0.1 that went to "high" of 3, even though he had colon, liver and peritoneal mets.  So, as Craig mentioned, CEA is not always a good indicator for proper diagnosis and continuing care.

Cyn

janderson1964's picture
janderson1964
Posts: 1577
Joined: Oct 2011

CEA is not an indicator for me. Mine has always been between .5 and 1.1 for the past 7+ years evan leading up to both of my recurrences. They still take my CEA because it could change.

Maxiecat's picture
Maxiecat
Posts: 524
Joined: Jul 2012

This is good to know...my last one was 0.9 at the end of the year last year.   I asked about it today and the are running the bloodworm now for me.   I just want to know what it is.   I think a better indicator of how we are doing is how we are feeling and scans.   I asked for a PET today...but this Drs office does not believe in PETS...I was told that they rely on CT Scans.   when I get to my appendix cancer specialist ... I'll have them do one then.  I am about 7 weeks out from my last chemo and I have had a liver MRI in February..... Confirmed nothing new growing in liver and that the Neurontin I was on was causing elevated liver panels.

Alex

Maxiecat's picture
Maxiecat
Posts: 524
Joined: Jul 2012

Update...CEA is on the rise... Went for X-rays today on my back...been having a lot of pain in my lower back.   I heard from the nurse that the dr is concerned and wants to see me soon

jen2012
Posts: 1196
Joined: Aug 2012

I'm sorry Maxiecat.   Please let us know what the doctor says.  Will keep you in my prayers.

hippiechicks's picture
hippiechicks
Posts: 314
Joined: Sep 2012

Keeping you in my thoughts .... sorry you have to be going through this!

PatchAdams
Posts: 272
Joined: Nov 2011

So concerned about you! 

Varmint5's picture
Varmint5
Posts: 371
Joined: Feb 2012

My daughter's CEA was 6,827 at its highest. Now it is 17. CEA has been a good indicator for her. I hope it will always be, but have to be aware it might not - which I now know because of Craig and others. Her original oncologist told us he uses it as an indicator for whether the chemo is working, but that the CEA does not correlate with the amount of cancer present. I'd let him keep checking it if I were you, but insist on the other tests as well (scans).

Sandy

Trubrit's picture
Trubrit
Posts: 1423
Joined: Jan 2013

Before I started chemo my CEA was 13, high I guess. I had a CT/PET scan which showed no evidence of disease. 

This past chemo session, I actually asked my Oncologist if he intended to check my CEA, as I had noticed it is not on my regular blood work standing order. He told me that he is not concerned with my CEA, and will only do it after all of my treatment is over. 

I figure if he's not concerned, then I won't waste my time worry abuot it. 

I do know that all of our Oncologist seem to follow different paths. 

sailor_on_a_lee...
Posts: 51
Joined: Jun 2012

Thank you for all your comments.  They provide additional and valuable insight into treatment and monitoring. 

This reflects the insanity of cancer treatment and monitoring.  After all these years, one would think a "standard protocal" for each particular type of cancer followed by all oncologists would have emerged.   

Instead, each oncologist is conducting experiments of one on each patient.  I recognize each of us and each cancer are/is different.  Still after all these years some similarities should have emerged that lend themselves to standardization. 

Or, are they just "practicing" medicine?

 

sailor_on_a_lee...
Posts: 51
Joined: Jun 2012

Thank you for all your comments.  They provide additional and valuable insight into treatment and monitoring. 

This reflects the insanity of cancer treatment and monitoring.  After all these years, one would think a "standard protocal" for each particular type of cancer followed by all oncologists would have emerged.   

Instead, each oncologist is conducting experiments of one on each patient.  I recognize each of us and each cancer are/is different.  Still after all these years some similarities should have emerged that lend themselves to standardization. 

Or, are they just "practicing" medicine?

 

Trubrit's picture
Trubrit
Posts: 1423
Joined: Jan 2013

I have suffered constipation with each chemo session. My Oncologist told me No, no, no, to laxatives, as did my surgeon and GI Dr.  One week I did not get to see my Ocologist but was seen by another Oncologist in the same practice. When I told him about the regular bouts of constipation he just said 'Take a laxative every day, regardless of whether I was consipated or not'. 

Go figure!

pete43lost_at_sea's picture
pete43lost_at_sea
Posts: 3915
Joined: Nov 2010

my cea with rectal and liver mets was like craigs a good indicator. cea peaked 1770 now 4.1. my ca199 top 60 now 18. both of these are normal and clear pet. what does that mean, alot and nothing. measuring ctc's and protien markers maybe informative, thats probably beyond where you are at, just now. if your interested read defeat cancer it free on amazon kindle, its a good place to start, it explain rgcc molecular testing in chapter 3 i think. we are so different, our tumours different, then the tumours are different day to day. either growing or dieing with or without chemo. so many variables, i would trust your doctors judgement the reality is you have a metastatic illness, or at least the potential, we all got ctc's and their in lies a whole other discussion. welcome to the forum. hugs, pete

ps if your doctor is practicing its good, we all need individual treatment thats highly personalised, our tumours as unique as we are different. any standards based approaches seem to me to offer less than optimal outcomes.

hippiechicks's picture
hippiechicks
Posts: 314
Joined: Sep 2012

My CEA was never higher than 1.0 and that was during my last month of chemo...at its lowest reading at .6, I had a recurrence with a large tumor, so I do not hold much stock in that test at all.

thxmiker's picture
thxmiker
Posts: 1216
Joined: Oct 2010

There are many protein markers and our Oncs need to use several instead of ONE!   My CEA was 1125 because they were more worried about monitoring my H5IAA. I kept complaining, and it was not until my body shut down during vacation, that the correct tests were done. 

My CEA went to 2.0!  Yeah, accept I had pains, and during a colonoscopy that they found a tumor. During surgery several more.  My CEA is still 2.1, and I am doing FOLFIRI and waiting to have HIPEC surgery at the end of April. 

 

So, We all need to take our health care in our own interests and find a Oncologist that does the same.  It is sad that many more are not true Professionals, and just in practice.  

Can any one here imagine whats a client would tell them if we told them we just kind of pracctice at our profession!!!  I'll do you accounting, I just practice it.  I'll fix your car, I kind of practice working with wrenches. nuck nuck nuck.

 

Best Always, mike

 

belindahill's picture
belindahill
Posts: 142
Joined: Jan 2011

Hello, your post is very interesting, my husbands cea has always been around 4 to 5 . Even when his colon cancer had spread to liver lung peritumium. His oncologist has said my husbands cea level is not a good bench mawhitish his cancer. He has bloods done every 3 weeks and  Ct about every 3 months. He was dx Aug 2010. Take care and lots of luck.

belindahill's picture
belindahill
Posts: 142
Joined: Jan 2011

Hello, your post is very interesting, my husbands cea has always been around 4 to 5 . Even when his colon cancer had spread to liver lung peritumium. His oncologist has said my husbands cea level is not a good bench mawhitish his cancer. He has bloods done every 3 weeks and  Ct about every 3 months. He was dx Aug 2010. Take care and lots of luck.

smokeyjoe
Posts: 1428
Joined: Feb 2011

When I first saw my oncologist my CEA was low  1.4  ....went down to .8 and remained there while I was on folfiri.....it was so low he said he didn't think CEA was a marker for me .... went on for months and he never brought up my CEA during my appointments,  I would only find out by asking for a copy of my bloodwork while I was getting chemo.  ...   I just wanted to see because I was curious as it's talked about a lot on this forum...... I went on a chemo. break and after 10 months off chemo.  my CEA jumped to 3 .....  I started to freak about this at a doctors appt.  ....  he didn't understand my concern as it was still  "in the normal range".    Well,  next one was higher up to 5 ..... I had gone back on chemo. ......  it's now up to 11  and my oncologist the last appointment  for the first time in two years brought up that CEA marker is rising and it may be time to switch chemo.  ......  so he's gone from saying he didn't think it was a marker for me  to  him paying attention to the fact that CEA has gone up  and my scans have shown some progression....... 

sailor_on_a_lee...
Posts: 51
Joined: Jun 2012

After makinkg my initial post I did some more research regarding "Cancer Markers" for CRC.  According to the American Society of Clinical Oncology's (ASCO) Guideline on Tumor Markers for Gastrointestinal Cancers which can be found at http://www.cancer.net/publications-and-resources/what-know-ascos-guidelines/what-know-ascos-guideline-tumor-markers-gastrointestinal-cancers/recommendations.  The entire ASCO Guideline for tumor markers can be found at http://www.cancer.net/publications-and-resources/what-know-ascos-guidelines/what-know-ascos-guideline-tumor-markers-gastrointestinal-cancers

Apparently, according to ASCO the CEA is the "best" available tumor marker for monitoring CRC.  I would like any feedback you all might have regarding these recommendations especially in light of the other tests some of you have been getting done on a regular basis. 

Rick

 

 

 

Tumor Marker

Screening

Staging/Treatment

Planning

Testing for the Spread of Cancer After Surgery

Finding out how the Treatment is Working

CEA

No

Only to assist in treatment planning or staging; not to make decisions about adjuvant therapy (additional treatment after surgery)

Yes, every three months, for at least three years after diagnosis, for patients with stage II or III cancer

Yes, every one to three months during treatment, for patients with metastatic cancer

CA 19-9

No

No

No

No

DNA ploidy

N/A

No

N/A

N/A

p53

No

No

No

No

ras (KRAS)

No

No

No

No

TS, DPD, TP

No

No

No

No

MSI

N/A

No

N/A

No

18q-LOH/DCC

N/A

No

N/A

No

tanstaafl's picture
tanstaafl
Posts: 960
Joined: Oct 2010

We've watched CEA, CA19-9 and CA 72-4 as series with the broadest combined coverage.  Two out of three is particularly meaningful.  Before and after surgery may give a good indication of sensitivity and range, but nothing guaranteed since each cancer nodule can have its own evolution.   For us, CEA and CA19-9 have been sensitive to tumor growth and have the most data.  CA19-9 is noisey, disturbed by inflammation, and other "benign diseases". We track ESR for some normalization of CA19-9 from inflammation, all totaled basically an expensive pain in the ---, but any percentages and bits can improve one's odds.  

An initial dragnet of biomarkers, before first surgery, might allow odd but important fish that occasionally turn up, like CA-129.  

When the chips were down CA19-9 seemed to provide critical information in terms of confirming CEA rise (for my wife, it can vary for each patient), and showing pronounced response to a change of chemotherapy before CEA did.   

MCV may be a useful tool for 5FU based treatments but is not a confirmed standard test either.  Basically MCV starts low before 5FU based treatment including Xeloda. The higher and longer the rise, the more likely a favorable outcome.  When MCV drops back down, that particular chemo formula is likely no longer working.  Some papers assign threshholds of response, with 103 and above being most favorable. For my wife, MCV seems to be favorably responsive with some immunotherapy adjuncts.      

LDH is something we watch for met activity and chemo response, too. Along with SGOT, SGPT, ALP, GGTP.

ESR itself is a measure of inflammation, and helps measure how we are doing on controlling that.

We watch RBC and WBC to guage tolerable chemo severity, primarily for a tolerable amount of leucovorin.   

Basically, the more involved you are and resolved to take knowledgable concrete steps, the more you can do with expanded monitoring.   

 

 

taraHK
Posts: 1961
Joined: Aug 2003

It's an interesting question. It seems that CEA is a reliable marker for some of us, and not for others.

I was one of those for whom CEA was not a reliable marker -- not elevated when I was diagnosed with Stage III rectal cancer, and not elevated when I had lung metastases (3 separate times). But my oncologist kept taking it -- and, after skipping merrily along in NED-land for a few months -- suddenly my CEA was elevated -- for the first time ever. Sure enough, had some tests and I had bone mets. My oncologist reckons my cancer mutated (in fact, probably has several times) - but who knows. 

I guess if cost is not an issue, I'd say keep getting CEA tested. It may not be a very reliable marker for CRC, but it's one of the few we have if not the only. 

Tara

luvinlife2
Posts: 172
Joined: Jul 2012

My CEA has actually been a very good indicator of how my cancer is behaving.  I have been in active treatment for over 4 years and have my CEA tested every 3 weeks.  Interestingly enough, my ALP numbers also fall and rise in accordance with my CEA so my onc relies on this test and we follow up with a CT scan if the numbers trend upwards.

AnnLouise's picture
AnnLouise
Posts: 276
Joined: Mar 2013

My CEA number has always been a good indication in the progression or regression of my cancer. Always happy to see the numbers go down and the minute the number goes up my doctor orders a scan and there is progression somewhere. My number is the highest it has been for a long time and I am starting radiation next week for a lung tumor. So my number should go down....it is 24 now and was 1 last summer after my liver resection. Anyway to answer your question, my onc thinks it is a good indicator for me. Your numbers sound good to me.....~ Ann

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