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Rising CEA Level

Posts: 100
Joined: Mar 2004

I know that this topic has been discussed multiple times but I have a question. Up until now, my dad's cea level has matched what was on the PET scan. If the level went up, we found 1 or 2 spots in his liver. In February, my dad had radiofrequency ablation to remove a spot, we were successful. His CEA was 2.8. In March it went to 4.1 and 5.2 in April. However, his latest scan is clear and only shows the healing of the Radiofrequency ablation. The doctor says other things could cause the number to rise or this is a false negative PET. This is so confusing because up until now, cea has matched the PET scan. We have never had a false negative. Has anyone experienced this or know of someone who has?

johnom's picture
Posts: 86
Joined: Jul 2004

Dear j,
Maybe the problem is with the CEA, not the PET scan. I think many people believe it's inaccurate a lot of the time, and confusing all of the time. I have never had a CEA over l.l...ever. I don't understand the concept of a false PET scan. Either they see something or they don't. If it's false, why not run another one? don't you love the specificity cancer treatment seems to lack? It sounds like he is fighting hard and well so far. Good luck to both of you.

nanuk's picture
Posts: 1362
Joined: Dec 2003

02:50 PM EDT
From what I understand, the normal level of CEA should not exceed 2.5 but that 5 is acceptable. Anything over 10 is highly suspect for malignancy. It seems to be a precarious test in terms of giving accurate diagnosis and that is why it is used in conjunction with other tests...ie CT and Pet scans.It can also be affected by other factors. But it does give a base line figure to monitor possible changes.
I know how scary it is though...my husband has to have one at the end of this month. His last one was 3.1 and a CT scan showed "nodules" on the liver. However, the Pet scan showed no malignancy and the oncology surgeon was not surprised as he felt that his CEA levels would have been higher had there been a recurrence or mets.

nanuk's picture
Posts: 1362
Joined: Dec 2003

01:26 AM EDT What does CEA mean? [reply]

It's been 6 months since my last Chemo treatment and I had a blood test in April to monitor my liver. Is that what CEA is? My oncologist never explained anything in detail. What should CEA levels be? Thanks again for the info. To Sponge Bob---if you read this message, I guess my technical problem fixed itself. Arlene

03:04 AM EDT Re: What does CEA mean? [reply]

this is a question asked frequently on this and other forums, and I don't feel qualified to answer your question; I do know that it is one test that can indicate tumor activity, but not in all patients.. I used the phrase "CEA tests" in the Search feature on this site, and received 188 hits..you might want to browse those posts for some CEA information. I'm sure you will also get
an abundance of answers from our more educated semi-colons.. Bud

09:35 AM EDT Re: What does CEA mean? [reply]

Arlene - Tough question, and even tougher when your oncologist doesn't explain things.
CEA is one of a number of tumor markers and stands for CarcinoEmbryonic Antigen. The basic concept behind tumor markers is that by measuring them you can add a piece to the puzzle in the monitoring of specific cancers. Probably the most well known tumor marker testing is the PSA test in men for Prostate cancer. Different markers are associated with different types of cancer, so if you did a search on just tumor markers you would see all sorts of cryptic letters and numbers (CEA, CA19-9, CA125......)
There has been considerable discussion in various medical journals about the use of CEA and it's role in predicting future tumor growth/decrease. I think the best site to gather some basic information from a number of medical journal resources is www.thedoctorsdoctor.com. Use the search function and type in CEA. You will get a number of abstracts that discuss the the entire scope of research on CEA.
What should a CEA level be? - I get tumor markers every month, and the lab that does my tests (could vary if yours uses a different test, or QC thresholds are set at different levels) indicates the 100% of non-smokers and 100% of smokers expected CEA values are 0-10.0. At the 98% level those numbers drop to 0-2.5.
Now for the art(interpretation) behind the science. As I indicated I have tumor markers run every month, and have had for 3 years. My CEA has come down from a high of 25 to it's current 14.1, and once had a low of 9.8. Clearly my results are outside the expected range in terms of best case and 100%, but they show a continous downward trend.
As I have worked through these things with my surgical oncologist and oncologist we have determined that the trend line is more important than any given individual result. I have had a couple of physicians tell me that a +/- 20% bounce in individual tests is within the variablility of the test. My surgical oncologist (I see a particular specialist every 3 months due to a very rare form of appendicidal/colon cancer) takes 3 factors into account in determining my condition - CT scans, Physical exam and patient functioning, and finally Tumor Marker results. He has never discussed the actual weighting of those 3 factors, but tumor marker results seem to carry the lightest weight. Not to say that they are not important, but because of variability in the test and the potential for something as simple as a cold to impact the results, individual results have never caused him to react. Again the trendline of the results seem to have more importance for him. As a statistician I have to agree.
None of what I have said should be used to cut across the relationship with your own physician. Take it as advice from some one who has been dealing with these things for over 3 years. Do your research with the power of the internet as Nanuk suggests, and then use your learnings to initiate/drive the conversation on your next appointment with your oncologist.
Good Luck

09:50 AM EDT Re: What does CEA mean? [reply]

CEA stands for carcinoembryonic antigen and it is a type of protein released by many bowel and rectal cancers. It therefore rises in level in teh blood when these cancers are tehre and goes down as they are treated. You can then use them to montior any recurrence.
The downsides are that the test is not very specific in that a lot of other things can make your CEA go up such as other tumours. Also some bowel cancers don't release the protein so if your CEA didn't go up initially at diagnosis it is unlikely to go up if teh tumour returns. ALso in some cases there needs to be alot of tumour bulk to make the CEA go upsubstantially which may leave it too late for treatment.
Therefore not all docs recommend monitoring it although tehre is little harm in having it done every 3-6 months as long as you interpret the results in the light of its limitations. You liver function test is a separate test they do which is likely to be for monitoring any recurrence of the tumour in your liver (one of teh favourite places for bowel cancer to spread to).
There is a website with more info on CEA at www.ehendrick.org/healthy/000258.htm
Hope this is helpful,

02:37 PM EDT Re: What does CEA mean? [reply]

WOW! That's one of the great things about the CSN - seems like the semi-colons know as much as the experts sometimes. I would just add a couple of comments to agent's (Bob's) response:
1. CEA tests are among the most suspect of all diagnostics due to the wide swing in results. I spoke with a Dr. friend of mine recently who told me how he drew two CEAs from the same patient on the same day and sent each to a different lab - and got back two different results.
2. Some people (myself included) don't ping on a CEA test (my numbers have always been around 1.0)
3. So many people get very worked-up when their CEA is "elevated" - like Bob said, it's not so much the actual number as it is the number taken in combnation with all other facors.
Glad your techno problem got fixed. Stay well!
- SpongeBob

nanuk's picture
Posts: 1362
Joined: Dec 2003

11:42 PM EDT
Well, I would say that it makes sense that the liver enzymes could be elevated because of chemo. If you think about it, the liver filters out toxins and chemo drugs are very highly toxic. So if the liver is on "overdrive" trying to purge those toxins from his system, the enzymes could be elevated as a result of that........As for the CEA, it is not so high. If it is under 10 I would not be too overly concerned about it, when I had a recurrence mine was up to 40! The only thing that I can say is try not to worry until you have something to worry about. I know, easier said than done, but just focus on the fact that he is getting rid of the port and the iliostomy!! Yea! You have to trust your doctors. I would like to think that they would tell you if you really had something to worry about. May 22 was only a little over 1 month ago. I think residual chemo can stay in your system for quite a while.
Who was your doctor at MD? Just wondering,

Posts: 13
Joined: May 2005

There are alot of good responses here WRT to CEA levels that I would agree with from my experience. Please remember that everyone is different and that Chemo can be a reason why it can be elevated as has been mentioned in this thread. I had similar concerns over the past few months when I was reading posts of "my cea is only .5" or something really low. If you are a male your cea is normally higher from what I researched and as mentioned there are repeatability issues with testing. If you are a smoker it will be higher but if are a smoker ... well enough said... I know what you are going through WRT cea numbers. Before chemo (after rectal surgery) my cea was 2.8. Three months after chemo was done it climbed to 3.8 and they found two new nodules on the liver and my liver counts were too high as well, anyway without doing anything other than waiting 6 weeks my cea fell to 2.5 and the liver spots were were determined to be cysts caused by the chemo and my liver test dropped in numbers. I was NED at this point! Some people can have CR cancer and not have elevated cea counts, but high cea counts can be a warning sign of disease, especiallaly if they continue to increase over several tests. There is no magic number for "oh crap, it's too high" but from what I have gathered a reading of 10 or higher is probably the threshold of major concern. Again, this is my opinion and I am NOT a health care provider, just someone who has sweat this issue over and over again. Good luck to you and don't panic over a short trend.

Posts: 5
Joined: Aug 2019

I had colon cancer a year ago. My doctor removed all of the cancer and has been monitoring my CEA. My CEA went from 3 to 42 to 179 in a few months. Nothing showed up on my PET Scan. Could Crohns cause a false reading with these numbers? I was diagnosed with Crohns the same time I was diagnosed with cancer a couple of years ago. Please give me your opinion

Trubrit's picture
Posts: 5417
Joined: Jan 2013

Because this thread is 14 years old, may I suggest you start your very own thread. That way, others will be more likely to respond

Here is the link to the Colorectal Cancer home page  https://csn.cancer.org/forum/128


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