CEA Levels

Mine commonly ran around 5.0 while I remained cancer-free.  There are many factors other than cancer that can cause fluctuations in your CEA; general inflammation for one.

But I've NEVER had a CEA below 1.0.    It's not how low can you go, it's a matter of staying within normal limits (WNL).  Don't let these numbers frighten you - at this level, they are meaningless, even if they trend up.

Take a deep breath - you're okay!  (Btw, my recent surgery was the day after yours.  No follow-ups for me until May - 8 months post-op.  And we don't worry about CEA.)

Alice

When my CEA went from .5 to .6 I about freaked out.   Its what happens when you have been diagnosed with Cancer; especially when it has been a recent diagnosis, like yours.   

Truth is of course, that your CEA, like your weight, can fluctuate for no reason at all. How frustrating it is when you get on the scales after eating healthy and find you've gone up 5 tenths of a pound.  Its the same with CEA. It goes up a little, then a little more (and when we're talking little, .5  .7  it is little) it is still frightening to us, but it is normal. 

If you're a non-smoker, they consider your CEA normal until its above 3.0  I've heard of some Oncologistst say 5.0.  And for some people, CEA isn't even a good indicator. Also, other things going on in the body can influence the CEA results.   And one more thing, from my understanding, there are two ways to test your CEA blood results, and one always test a little higher. When I changed to a different lab fro my blood work, my CEA went from .5 to 1.6 (yes, I freaked out); but then I was told that my blood had been tested at a different lab, which tests come out higher. I've been fluctuating around 1.0 - 1.7 ever since. 

So welcome to the forum.  You are just being a normal Cancer patient, with all the anxiety that comes with the diagnosis. And we here on the forum are happy to let  you know that you can chill. All should be well.  But, with everything, we always advise you to talk to your Oncologist if your worries persest. 

TRU

I finally got down to a 1.8 after the last surgery, then it went to 2, then 2.2, then 2.6, it just kept bumping up. The Onc wasn't worried, but then it's not his test score, so I was, like you, nervous until the Dec. test, when it finally bumped down to 2 again. Merry Christmas! Now I'm not so worried, at least until June. We all ride that roller coaster one way or another, but your numbers seem great to me, so try to relax...................................Dave

I had 11 out of 20 or 21 nodes with cancer.  CEA at surgery was around 8.  Dropped to 3.7 after sugery.  Increased during chemo (which happens) to around 8.  Dropped to 3.7.  Hung there for a couple of tests.  Jumped a bit over 5, met to lung started growing (was there at beginning), surgery, back down to 3.7 for 6 month (two tests).  Just bumped to 4.  Making me a bit nervous, but will see next blood test.  On the scale they use, 5 is considered "High"

I was diagnosed with Stage 4 colon cancer which had metastized to my liver on October 2016. I received my first chemo therapy treatment on Oct 25th 2016 of 5-FU and oxyplatin with pump to take home with 46 hrs of 5-FU in it. It was called FOL-FOX. On 12/20/2016 erbitux was added as targeted therapy drug for liver tumors. At onset i had Cea level of >4000 ng/ml. today April 17,2017 my cea is 14.8. my liver functions are normal with no stomach pain and no cell activitie and tumors have shrunk as per petscan on Feb. 4th 2017. I continued with FOL-FOX and erbitux until April 5th 2017 when oxilplatin was stopped. On april 19th 2017, 5-FU was stopped, and just got erbitux. as long as 4/29/2017 petscan is good,blood levels remain good, and liver functions remain normal, and tumors are shrinking the plan is erbitux every 2 weeks as maintenance as long as necessary. I just starting to comprehend all this and dont understand all of it but as long as blood levels are good and liver functions are normal. This is my first contribution to CSN, of many i hope and prayer and just wanted to relate a part of my fight against this terrible killer. I wish all the best and pray for all.

CEA has been a constant bane to me since my initial diagnosis in 2012.  Preoperative CEA was 13.9.  The lowest it dropped to was 3.11 when the clinic I went to used a lab that did the Siemans/Bayer assay test that had 0-3 as normal for non smokers and up to 5 for smokers.  Before I switched clinics, the lab at this clinic changed assay methods and went with the Roche test.  This changed the scale for what was considered normal.  Depending on the lab, the new normal CEA level is anywhere from 4 to 5.  Since then my blood work has been done with the Roche test which I only had one CEA test come in just below the normal limit.  All my other blood work has come in between 5 to 6.  This has been going on for the past 2 years.

Last year, during my normal checkup, CEA was run again and to my surprise....9.7.  A retest was ordered to make sure that number was real....came back at 11.  Ok.  So what's going on?  I had a CT with contrast done a few weeks prior to meeting up with my oncologist and having the CEA done.  That scan was clear.  My oncologist orders a PET.  That comes back clear.  So we're all scratching our heads wondering what is going on.  One last thing to do.  I was due for my 3 year colonoscopy.  Nothing was found during the colonoscopy and my GI doc was about to complete the exam.  He wanted to clean the cecum area of my colon to look before pulling the scope out.  That's when my colon shifted and a polyp popped out of my appendix.  He immediately said, that's not good.  Long story short about that is biopsies said high grade dysplasia.  Went back to my CRC surgeon and he did a right hemicolectomy to be sure nothing gets left behind.  Pathology comes back Stage 0 appendicial cancer.

I had 2 follow ups since the surgery.  CEA dropped back down to 5.4 and 5.2.  Everyone thinks, this was the cause of my CEA spike.  Fast forward to my recent check up just over a month ago.  Ask oncologist if I need to have a CT scan for this checkup.  He said no.  I go in and get CEA done.  Results come back at 15.6.  Here we go again.  Retest done to make sure no lab error.  16.7.  CT with contrast is now ordered.  Comes back clear.  I was already scheduled to have a small bowel capsule endoscopy.  GI doc tells me there were some things found but nothing that points to any cancer issues in my small bowel.  Talked to my CRC surgeon about what is going on.  He doesn't like what he's hearing and orders a PET/CT.  Had that done.  All clear too.  So what's left?  Colonoscopy.  Due to the elevated CEA nd my past history, GI doc agrees to move up the colonoscopy that was supposed to be during the summer; one year from when we found the appendicial cancer.  Again, nothing found.  So now I wait another couple of weeks to have my CEA retested.

If you want to talk about CEA panic, imagine having to deal with not a few tenths rise but several points of rise.  Depending on what the next reading says, my CRC surgeon is talking about doing exploratory surgery to see if there's something in my abdomen that isn't being picked up by scans.  My oncologist doesn't seem to worried and has said so.  He said I've always been on the high side with my CEA and this recent spike from the previous 3 months could be just my normal.  He said he's had patients which had CEAs as high as 20 end up not having any cancer recurrence.  I asked him how common is it.  He said in his practice he said about 1 in 4 of his patients being tracked with CEA will have high false positives.  He also said he's not convinced the CEA spike last year when the polyp with appendicial cancer was found was due to that cancer.  He said all along that polyps typically don't cause CEA elevation.  And the cancerous polyp I had was in situ with only the surface of the polyp having cancerous cells.  The rest was benign.

I guess we'll see if my oncologist is correct in two weeks.

steveja said:

Hey zx10guy

Hey zx10guy

Yeah - there are several  studies that show a pretty high false-positive rate for CEA in ppl like us who have had a resection.  OTOH the persistent high readings put us in the group with sibstantially increased odds of recurrence.   I'm not in a position to second guess your Docs or mine, but colon cancer often metastesizes to lung, liver, peritoneum, pancreas, ... where it can still elevate CEA.  Of course CEA can be elevated for entirely non-cancerous reasons.

I've had the same issue with Bayer vs Roche CEA measurements - I wish I had a good charcterization of the differences.

Cochrane reviews (highly respected meta-studies that are often used as guidelines) suggest a CEA of 10 as a trigger to start looking for recurrence.   20% of recurrences have no elevated CEA, and at CEA of 10, 68% of recurrences are identified with a positive, while 97% of negatives are true. 

 

http://www.cochrane.org/CD011134/COLOCA_detecting-recurrent-colorectal-cancer-testing-blood-carcino-embryonic-antigen-cea

How to live, always looking over your shoulder is the issue.

 

Frankly, I don't think doctors and medical scientists know everything around what CEA means to someone's prognosis.  In many documents, they state well differentiated tumor cells express a lot of CEA.  On the same train of thought, well differentiated tumors are felt to be a better prognostic indicator over poorly differentiated tumor cells which they say express less CEA.  But then they turn around and say high CEA numbers prior to surgery is a prognostic indicator of higher chances of recurrence and lower 5 year survivability rates.  Do you see the paradox in all of this?

I've been dealing with higher than normal CEA for now coming up on 4.5 years.  Other than the appendicial cancer caught last year considered a new primary, I was thinking when I past 3 years I could start seeing the light at the end of the tunnel.  Here I am with just about the same amount of activity as when I was first diagnosed.  The testing I mentioned in my first post in this topic was all done in a 2 week span.  In addition to the CEA coming up, I have an MRI Enterography coming up to add to the marathon testing check box.

steveja said:

They know a lot more about

They know a lot more about CEA and other markers than you might guess.  CEA levels can be elevated by several sorts of non-cancerous conditions, but note that colon cancer is not a single monoilithic thing - it includes several distinct types and perhaps uknown distinctions.  So your seemingly contradictory (but accurate) descriptions aren't contradictory at all.  Some forms of CRC are unlikely to be associated with elevated CEA, and also those same types have poor prognosis, however in others types of CRC, elevated CEA does correlate with poorer outcomes and suggests metastitisis to liver or lung (primarily, but others ...) .  There are loads of studies looking for better markers, but sadly for us that's still a 'future'.

I've reviewed the stats for my situation.  As a stageI, there is a ~10% chance of 5yr recurrence, but as a stageI whose CEA never returned to normal (<3), I've got a ~30% chance of recurrence.   'Recurrence' in this context generally means metastasis and then a ~30% chance of 5yr survival.  So given my age and other causes I'm looking at an almost 30% chance of not being here in 5-7 yrs.  Those are only odds, but they mean something.

I know that you and a lot of folks here have equal or worse odds & worse issues to face, but the picture isn't pretty even at my shallow end of this pool.   Maybe it's my personality, but I'd strongly prefer to know today - the waiting in ignorance is the harder part.   I need to find a way to deal with this issue.  And I DO appreciate the conversation.

I've never seen any studies or literature discussing post surgery/chemo outcomes with higher CEA baselines.  All the studies I've seen discuss pre surgery CEA levels.

As far as my statement about doctors and medical scientist not knowing the correlations between the grade of tumor cells and CEA, I still believe this.  Case in point, I mention my oncologist said in his practice 1 in 4 of his patients have exhibited high CEA levels (as high as 20) and not have any cancer as a result.  1 in 4 is pretty significant.  I have a friend who is dealing with rectal cancer.  She is seeing a different oncologist and the same topic came up about CEA rise and when one should worry.  She said he also has patients that have had CEA levels reach as high as 20-22 and not have cancer as a result.

I agree a better test needs to be developed.  Others have used other blood tests to supplement CEA such as CA19-9 or CA125.  So far none of my doctors have suggested using those other blood tests.  But as I said, we'll see if my oncologist is correct that he thinks the recent spike is probably nothing.  But one thing is for sure and I've seen a paper state this.  If your CEA is 30 or above, it's pretty much a certainty there is something going on.

zx10guy said:

I've never seen any studies

I've never seen any studies or literature discussing post surgery/chemo outcomes with higher CEA baselines.  All the studies I've seen discuss pre surgery CEA levels.

As far as my statement about doctors and medical scientist not knowing the correlations between the grade of tumor cells and CEA, I still believe this.  Case in point, I mention my oncologist said in his practice 1 in 4 of his patients have exhibited high CEA levels (as high as 20) and not have any cancer as a result.  1 in 4 is pretty significant.  I have a friend who is dealing with rectal cancer.  She is seeing a different oncologist and the same topic came up about CEA rise and when one should worry.  She said he also has patients that have had CEA levels reach as high as 20-22 and not have cancer as a result.

I agree a better test needs to be developed.  Others have used other blood tests to supplement CEA such as CA19-9 or CA125.  So far none of my doctors have suggested using those other blood tests.  But as I said, we'll see if my oncologist is correct that he thinks the recent spike is probably nothing.  But one thing is for sure and I've seen a paper state this.  If your CEA is 30 or above, it's pretty much a certainty there is something going on.

I just had my 1st year colonoscopy this morning, following a clean CT scan.  I've had Stage IIa with a resection of the ascending and part of transverse colon, all lymph nodes (22) were clean.  5 months later, I had a bowel blockage due to scar tissue and had more of the small bowel and transverse colon removed.  Pathology report was clean.  This was in November of 2016.  Had a CEA of 2.89 in Feb and then in May it was 4.8, but as I found out, a different lab with a different method, so even though I can't compare the two - I am  trying to deal with the stress.  First the oncologist said don't worry about it, then this morning I got a call from the nurse saying that I needed to have another CEA in 2 weeks.  The nurse doesn't know why the doc wants a new CEA.  First, I'm not sure that 3 weeks is enough time to wait between tests to see if there is a trend.  Second, I'm just getting over having a bacterial infection as a side effect of the 2nd surgery.  

My oncology surgeon, on the other hand, said that I'm one of those people who won't be able to use a CEA for diagnosis - it was 2 ish prior to surgery and 2 ish after surgery.  He prefers not to look at CEA at all for people like me, but the other oncologist is pushing for genetic tests, and suggested I do chemo even though it isn't protocol for my stage.

I know that it's good to stay on top of changes, but I wonder about the damage that having this type of stress does.  I'm planning to stop seeing the oncologist all together and stick with my onc surgeon, gastroenterologist and family doctor because I can't live my life with no answers.  

Best wishes for everyone else in this situation.  I know that I am in a good place as far as cancer goes and I feel very lucky to be here.