CEA

CEA is a funny thing. The whole time I was dealing with the colon cancer initially it never went above 2. Now that I have mets its gone above 100. Six weeks of chemo brought it down to 7. I had it checked again the other day and will get the result next week. For many people it's just not that indicative of what's really going on and anything under ten is great. I've read that a smoker can have it as high as 13 without any signs of cancer. I've also been told that it can increase after some treatments for a while. I can't remember why that is but the explanation was reasonable.

Jan 

With as much focus there is on CEA, to me it's surprising that the general medical community really doesn't know much about it.  Yes, the science is clear about what CEA is and why it's tracked.  There has been numerous studies on establishing what the "norms" are in regards to CEA.  But for the now over 5 years I've been in this mess, for every medical publication stating one thing about CEA, there is another that contradicts it.

So here is what we know.  Various tissues in your body produce CEA.  It's normal.  Your liver metablizes CEA out of your blood.  There are two serum tests which are used to measure CEA.  The older Bayer/Siemens and the new Roche test.  The Bayer/Siemens has the established norms of for non smokers and <5 for smokers.  The Roche test raises these limits.  Depending on your lab, normal for a non smoker can be around 4.7 and less.  For smokers, it can be around 5.6 and less.  CEA metabolism takes time and thats why oncologists typically don't run multiple CEA tests within a short time of each other.  The only time an immediate follow up CEA is done is to rule out a lab error.  Which can happen.  Well differentiated tumor cells are known to express more CEA than poorly differentiated.  So this part gets into the paradox of a few statements made by the medical community.  Those with high pre operative CEA have a poorer prognosis than those with normal CEA levels.  But this contradicts the statement about well differentiated tumors producing more CEA as having a well differentiated tumor is also a postive prognosticator.  Tumor cells can also change over time where if CEA was not a good indicator for you will all of a sudden be a good indicator.

I wrote up my last year's experience with my CEA here.  If you search for it, you'll find it.  It seems I'm one of those that does not follow the established trends for CEA.  To preface this, since being tracked for CEA, I've always been on the higher side with CEA; just outside the established normal range for non smokers.  I did have a high pre op CEA at 13.9 which came down after surgery and continued to go down during chemo with one reading having a 1 point jump which came back down again.  So for what ever reason, my CEA decided to jump from 5.2 to 15.6 in a matter of 3 months.  It has stayed in the range of around 14 to 15 on average through out last year.  I've had every test you can imagine done and we still haven't found anything.  Since posting my experience, I've found some others have come forward with higher than normal CEAs and nothing was found.  If I recall correctly, one individual's CEA has been around 10 with no cancer found.  I also found a medical publication about a woman in Taiwan who's CEA jumped into the hundreds and eventually came down to her final normal in the 60's.  They tracked her for 5 years and never found any cancer.

My oncologist through out this craziness with my CEA has held steadfast that he doesn't think there is anything going on.  He has said about 1 in 4 of his patients have exhibited high CEA but with no cancer.  A friend who sees another oncologist for rectal cancer has heard her oncologist say that he also has patients which have had CEAs as high as 20 with no cancer.  My oncologist ordered a new serum test along with CEA called AFP.  I didn't know he did this.  The AFP test came back as normal.  And the outcome of that CEA test was a reading of 14.3 which is down from the previous reading ordered by my GI doctor 6 days prior at 20.2.  My oncologist said if there was cancer going on we wouldn't see these wild swings.  My oncologist also said CEA for him is more to see if there is any possibility of metastatic spread.  When he said that, it actually makes a lot of sense.  You see people who had normal CEA when first diagnosed (excluding those already stage 4) to have their CEA spike up and find metastatic spread/recurrence.

I'm starting to settle in on CEA being just a tool but not one that should have any significant weight.  Ultimately, the final say are what scans show or through direct visual observation...ie colonoscopy.  I wonder if there is any effort to come up with a better test as CEA to me is iffy at best.

abita said:

Do you know if the levels

Do you know if the levels going down during chemo mean the lesions on liver are shrinking by the chemo

My oncologist was really happy with the CEA results and a CT scan showed the tumours had shrunk somewhat. I don't know anything about liver mets so I can't respond to that, mine are in my one lung.

Jan