Pre- and post-operative CEA levels

SandiaBuddy

I have noticed quite a few postings about CEA levels and thought some might be interested in this summary of a JAMA article on the topic:

 

"In this cohort analysis of 1027 patients, the 3-year rate of recurrence-free survival (RFS) in patients with elevated preoperative CEA that normalized after surgery was similar to the RFS rate in patients with normal preoperative CEA. Patients with elevated postoperative CEA had significantly lower RFS than patients with normal postoperative CEA."

https://jamanetwork.com/journals/jamaoncology/article-abstract/2666759?redirect=true

Tunadog

Thanks

Interesting read.

ron50

My onc

Did not consider CEA to be of any value to me as an indicator of cancer or of recurrence. I was 2.8 at dx and after surgery it has basically stayed at <0.5 for 20 years. Ron.

NewHere

Another Study

Dealt with post-op trends of CEA once chemo started.  There was something about the CEA pattern during chemo.  Basically CEA rises during chemo and there is a relationship between how it rises and falls and prognosis.  Do not quite remember the details, but it was acceleration/linear.  I just remember at the time of reading it, my CEA pattern was not a good one.  Turns out it was right.  (Within a couple of weeks of surgery, my CEA was down to normal.  Once chemo started it went up in the not happy pattern.)

In a weird twist of everything, my CEA is now the lowest has been, even though it is back in lymph nodes and lungs.  (Cannot biopsy lymph nodes.  Lungs have multiple spots.  But in the past my CEA went up when the last lung mets grew.)

Annabelle41415

CEA

This was not a factor for me as mine was always below the normal range.  I'm talking the lowest it could be.  So it's not a good indicator for some people.  A lot of doctors don't even take the test as it is so unreliable. 

Kim

abita

I think I am a bit confused.

I think I am a bit confused. My doctor said not everyone gets markers, but when they do, lowering indicatesyhe chemo is working. 

Annabelle41415

abita said:

I think I am a bit confused.

I think I am a bit confused. My doctor said not everyone gets markers, but when they do, lowering indicatesyhe chemo is working. 

Markers

Not everyone's cancer responds to markers, mine didn't.  Mine was normal the whole time going through treatment.  If you are a good indcator that has high markers starting out and then going through treatment it goes down than that is wonderful.  It means the treatment is working.  If your marker never changes or is normal when starting out then the marker is not a good indicator for you.  Some doctors won't even test because it's not always realiable in everyone.  Hopes that helps a little in the explanation.

Kim

tanstaafl

makes me cynical

Sounds like another belt tightening justification to me, music to insurers and government payers.  This might be then used for guidance to zombie doctors that follow their insurers etc to deliver minimal care. Too bad for new patients.  I'm still steamed about what data was missed for us at diagnosis, pre-op, post-op and the first year, despite repeated inquiries.  Basically I had to dig them out myself and painfully work around some of missing data.

The problem with CEA usage is that the current protocols don't take enough data to be as useful as an informed patient would chose, and that well read, well informed doctors could use. Biomarker prolems are often compounded during radiation, RFA, Folfox and Folfiri treatments by increased distortion of the markers as chemo/treatment progresses and slow recovery after chemo finishes.   These papers that seek such conclusions on one point data are a serious misuse of technology, compounded by many assumptions and presumptions.

CEA is made to look bad by poor sampling, inadequate blood work, poor analysis and iatrogenic problems.  Multiple biomarkers sh- or could be checked and tracked for advanced CRC (3s and 4s) starting from, and especially on the first day of diagnosis.  All these problems should be fixable for most patients (we did), but don't hold your breath.  This is another reason why aggressive, informed patients can have advantages.

tanstaafl

abita said:

I think I am a bit confused.

I think I am a bit confused. My doctor said not everyone gets markers, but when they do, lowering indicatesyhe chemo is working. 

markers

CEA is the best single marker across the CRC stages for initial detection.  Other markers have lower yields of patients but are very important for patients that do have them.  Advanced CRC patients are more likely to have one or more markers, and should persist to find 2 (or only one) markers or at least periodically recheck for them (e.g. annually). There are many times and ways to best use cancer markers, not just 1-2 ways that CEA is typically used in very limited ways.  Thorough data sets will rapidly show which markers matter most, at present.  Markers do change (e.g. from near 0 to elevated). During intense treatment,  highly distorted markers might be checked less often.  Basically current clinical practices don't know how to provide first class, personalized care and aren't particularly bothered to find out - one size fits all. 

There are number of serum cancer markers that apply to different CRC patients down to about 1%:  CEA, CA19-9/CA242, AFP, CA72-4, CA15-3, CA125, with varying degrees of complexity.

Some other common blood panels that often carry cancer or treatment effectiveness information are  ALP, LDH, MCV, GGTP, WBC (and differentials) but can reflect other conditions too. 

Some  common blood panels that can help more accurately identify stable conditions for comparison, identify distortion, or perhaps aid minor adjustments include  hsCRP, ESR, HgbA1C, TSH.

If you don't collect the data, it is lost and limits your future options.  Even if your dr doesn't know WTF to do with it today, later drs with better knowledge may.  Also you have better information to compare on the boards.  We spend about an extra $600-$1000 a year on "extra" blood tests, after some hard shopping, with a number of life saving advantages and incidents, sometimes per year.   It also helps cut other costs, illness, pain and suffering substantially, albeit we use a much more personalized drug treatment with natural chemistries too (less noisy data).   Even in the early 1980s a CRC patient could get a "Chem25" test (varies by lab, does not include the cancer markers) and do better than most people here today.