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CEA level

Kduggan
Posts: 5
Joined: Jan 2018

Hi, 

my husband just had his sigmoid colon removed on Monday.  His initial CEA level was .5 with the tumor that they removed.  They also removed the lymph nodes around the area and the Dr. Said he didn’t see anything , however, the test do not come back until Friday . Can anyone share any knowledge on the probability that this tumor could have MET into liver. The oncologist says there are two areas in the liver that could be cyst. But he wants to do biopsy. With .5 CEA are his chances night that it has moved to liver. Thanks. (probably a stupid question) thanks for your time. 

Worried Wife 

beaumontdave's picture
beaumontdave
Posts: 1078
Joined: Aug 2013

My sigmoid section was removed with 2 of 17 nodes showing involvement. My CEA was 11 before, 4 after, but rising over the next 2 years or so. They took 3 mets from my liver, and the CEA went to 5-6, and rose again to 44 over 2+ years. They took one met from my liver, and the CEA has been 2-3 ever since, 3 years and counting. CEA numbers are individual things, different for everybody, and for some useless. Their use, for those who can rely on them, is to check for reccurrance, based on a steady numerical increase. Needle biopsys are more definitive, but one of mine came up negative, and the oncologist still wanted the cyst/lesion out. Even if your hubby has liver mets, they can stop it there, as they did for me, so take heart, you find out where he's at fairly soon. Welcome to the board............................................Dave

Kduggan
Posts: 5
Joined: Jan 2018

Congratulations on your 3 years ! Thank you for your response. 

JanJan63's picture
JanJan63
Posts: 2482
Joined: Sep 2014

Hello and welcome. In my case my CEA was never over 1 while I had the tumour in my colon. My understanding is that anything under 10 is in the normal range and a smoker can have it as high as the low teens and it's still normal. Now that I have mets in my lung it's gone up. As Dave said, it varies for everyone. For some it's fairly accurate and for others it means very little. 

Jan

Annabelle41415's picture
Annabelle41415
Posts: 6554
Joined: Feb 2009

The CEA levels sometimes aren't very accurate in determing everyone's diagnosis - it sure didn't mine.  You will probably have to wait for further testing to determine if the spots are cancer or not.  There are a lot of doctors that don't even do the CEA level testing because it doesn't always prove accurate.  Wait for the biopsy.  There are so many things in our body that are normal and don't show up because we've never had a scan before - but it's just normal things.  The spots don't necessarily mean anything.  Wishing your husband well.

Kim

Phil64's picture
Phil64
Posts: 835
Joined: Apr 2012

In my case CEA was highly corelated with cancer activit. Normal CEA is <=3 (<=5 for smokers). My oncologist tested CEA weekly. i was also told that more concerning than a specific number is if the level rises. If there are two consecutive rises then it may be time to scan and look for mets.

My oncologist also shared with me that he had one patient with a stable CEA around 50. And in her case they never found any cancer mets. 

Additionally, I have had false reads. In one case the result was 8. My oncologist immediately had me retested the next day and the result was normal. Go figure?

In answer to your specific question - a CEA of 0.5 is within normal and not concerning. 

tanstaafl's picture
tanstaafl
Posts: 1292
Joined: Oct 2010

....His initial CEA level was .5 with the tumor that they removed. 

Sounds like CEA is not currently a marker for him. 

We've had more action with CA19-9 and later AFP, than CEA in recent years.  Many patients and forum members with CRC but without much CEA show with CA19-9 in the 20-35 range or higher before chemo and/or surgery.   Because heavy chemo distorts CA19-9 and usually insurer interference, a lot of US oncologists can't be bothered at all even though it is standard in some countries.  CA19-9 is less reliable for initial detection because of overlap with benign diseases and inflammation.  Also drs often use the pancreatic cancer detection range, over 37 (brands 34- 40).  If you already have a CRC diagnosis,  literature based interpretations change and CA19-9 results in the 0-2, 19-30s, and over 37 ranges take on important new meanings or possible serial uses during eras with less distortion, like before or long after heavy chemo or radiation. 

Other common blood work that may give partial cancer information for prior CRC dx include ALP, LDH, GGTP, WBC, MCV, neutrophils:lymphocytes(NLR), platelets:lymphocytes(PLR).  When used in combination, undistorted blood data is a powerful tool.  We're willing to pay for it ourselves.

If you get the data, you have something to talk about.  It's been helpful for us months and years later.  

zx10guy
Posts: 266
Joined: Dec 2013

I would want a PET ordered first before considering doing a needle biopsy.  There has been discussions about "seeding" resulting from doing a biopsy as there can be cancer cells on the outside of the needle.  As the doctor withdraws the needle the cancer cells are spread along the path of the needle.

That said.  I had a biopsy done on two lessions picked up on a CT when I was first diagnosed.  It was unclear whether they were mets or hemangiomas.  A PET was ordered which showed now hyper metabolic activity in those areas.  A biopsy was done during my colon resection procedure to be more definitive.

Kduggan
Posts: 5
Joined: Jan 2018

They are wanting to do the biopsy and then the PET scan if needed.  I will ask about reversing it. What exactly is hyper metabolic activity in your case ? 

zx10guy
Posts: 266
Joined: Dec 2013

Tunadog has given a good summary of a PET scan.  I would add cancer cells are hypermetabolic which means the metabolism of these cells are supercharged compared to normal cells.  As such cancer cells will draw more of the radioactive glucose used in the PET scan test.  All of your cells are drawing from the same radioactive glucose.  What the PET scan is doing is measuring the differential between your normal cells and the cancerous ones.  This is why you are told to go on a specific diet before going in for the scan along with cutting out any strenuous physical activities.  SUV readings of 3 and below are considered normal.  Readings in the 3 to 5 range are in that grey area while anything above is pretty indicative of cancer activity.

When I had my PET done at initial diagnose to check on those liver lesions, my primary tumor lit right up with a reading of I think 6.4 SUV.

Kduggan
Posts: 5
Joined: Jan 2018

Thank you for explaining.  

Tunadog's picture
Tunadog
Posts: 235
Joined: Mar 2017

Hyper Metabolic refers to lighted areas in your PET/CT scan where sugar from the radioactive isotope injucted is absorbed. The cancer attracts the sugar of the radioactive isotope. The hyper metabolic reading is reported in a SUV (Sugar Uptake Value) number. 

The Value is relative my last scan an area in my sacral area was 11-15. The suspect growth the in my Thyroid is reading 3.6.

The higher the number the higher probability level of cancer activity.

Good Luck

Worriedchild
Posts: 56
Joined: Dec 2017

 i need a help if your thyroid show suv of 3.6 did doc sah some

suspicion ? My fathers adrenal

is 4.1 suv and bulky but nuclear physician mentioned it as beningn iam worried for him

Tunadog's picture
Tunadog
Posts: 235
Joined: Mar 2017

I had a Fine Needle Biopsy which came back inconclusive. I then had another FNB which was sent for gene testing and came back 40% suspicious. We decided to watch it as it has not grown since it was first noticed two years ago.

 I will investigate it further, since Thyroid cancer is slow moving. My rectal cancer is my greatest concern.

Kduggan
Posts: 5
Joined: Jan 2018

Has anyone gone the herbal , nutritional route , to try and kill the cancer cells.  I’m reading a lot out there on herbs etc. Has anyone had any success. 

steveja
Posts: 41
Joined: Apr 2017

>>Has anyone gone the herbal , nutritional route , to try and kill the cancer cells.

Lotsa ppl do.   It's 99.9% voodoo - so please don't avoid conventional treatment.  Try something SAFE as a complement, not a replacement for conventional treatment.

 

OTOH I think there is a lot of psychological value in "doing something", rather than waiting passively for the next lab test as some surgeon chops off the bad bits.   I've taken Modified Citrus Pectin, but I have no illusion that it is  effective.

 >>I’m reading a lot out there on herbs etc. Has anyone had any success. 

The only thing we should measure as 'success' is a published report in a peer reviewed journal.    Everything else is anecdote and conjecture.

FWIW it appears that there are some modifable lifestyle issues (like more exercise) that do reduce all cause mortality of colon cancer survivors.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5658451/

JanJan63's picture
JanJan63
Posts: 2482
Joined: Sep 2014

I agree. I think natural supplements are fine in addition to conventional treatments but they do not take the place of it. 

Jan

nkeelty's picture
nkeelty
Posts: 18
Joined: Nov 2015

HI! I did try the miseltoe treatment for awhile but ran out of funds for it. Believe Big is an organization in Baltimore that has spear headed getting trails at John Hopkins started. I do believe they have started them or will in the near future. There are 2 types that were discussed and I could only afford the shots for 9 months. There is one regimn that is daily IV treatments but it is very spendy, like $10,000, and you have to go to Colorado. It did work for the women that started Believe big and she has been NED for quite awhile now. If you want to go herbal look into the Hopkins trails.

tanstaafl's picture
tanstaafl
Posts: 1292
Joined: Oct 2010

John23 seemed to get many years of some kind of cancer relief from a rather aggressive, fresh herbal TCM approach.   He left behind his herbal TCM list and perhaps some day someone will decypher its biochemical basis.  John did not comment much on his markers other than CEA wasn't much of a marker for him, a favorable survival factor.  Most all of us have been big on surgery.

My limited insight is that people (e.g. trials, drs and naturopaths) don't do alternative/comlementary approaches very thoroughly and simply have no basis to expect overwhelming success "killing cancer" - magical thinking or other biases. 

In our limited experience, no single bullet theory was enough, it takes at least 4-5 critical components to stop the markers' march, where 5FU is one of those critical components.   It takes potent combinations to succeed; underdose anything critical, and markers begin to move ... in the wrong direction.  The right molecule in the right place, long and strong enough for the most benefit with the least damage is important. 

For our purposes, there are usually 2-3 possible dosage levels of each special component:  a remedial level to remove deficiency; a tonic level to improve immune, metabolic or organ function, or perhaps ameliorate chemo damage; and a cancer inhibition or cidal level that varies for site and genetics.  Often times, people will not even reach a component's first rung if someone does not carefully research the issues and measure for effects (e.g. blood levels of vitamin D).

So far we don't spend more than a few dollars a day for any component, and prefer common cents.

steveja
Posts: 41
Joined: Apr 2017

Hi - Kduggan.

CEA levels are very accurate, however they are not always very diagnostic.  If you read the journal papers you'll see that you really shouldn't gt too excited with CEA<10.  Below that level there are a lot of false positives.  OTOH I had the same operation on 8/2016 and my high CEA was 5.8 pre-surgery, and it's never gone below 4.1 (grrr).  There are a handful of types of colon cancer, and not all of them cause CEA to rise. The types that produce high CEA are marginally more treatable.    Since your husband didn't have high CEA before surgery, then CEA will never be a useful marker for his colon ancer.   IOW you onco will likely not order reguar CEA tests.

I agree with zx10guy - you want a PET scan to see if those are benign liver cysts (fairly common) vs metastases.  A PET scan can image the sort of metabolic activity this occurs in a tumor.

--

FWIW I found this site that describes some of the consequences of LAR surgery.   I thought it was pretty useful,

http://colonrectalsurg.wustl.edu/en/Patient-Care/Low-Anterior-Resection-Syndrome

I found the whole - mal-functioning bowel thing - a good opportunity to eat less and get my weight down.  The soluble fiber supplements helped, and I didn't try imodium.   At ~18 months out, I still can't reliably distinguish gas(flatulence) from the need to defacate, which wakes me at night.  I 'go' about twice as often as before.  I can eat anything, but have to watch the amounts of very high fiber foods (watermelon, cabbage).  Guess that's the new-normal.

Annabelle41415's picture
Annabelle41415
Posts: 6554
Joined: Feb 2009

Actually CEA tests aren't very accurate as mine wasn't.  I'm not sure of the article you posted as I've not read it but my CEA was never accurate to identify my rectal cancer.  I'm not sure if I'd really get my CEA tested anymore because it doesn't tell me anything and I'm the one paying for it because my insurance won't.  CEA isn't very reliable by any means.

Kim

Worriedchild
Posts: 56
Joined: Dec 2017

i feel everyday is a new struggle appointment tomorrow for dad

need prayers 

would anyone tell me how long did it take them to recover from Open colon resection and  when did they recover anemia 

my dad is 2months and 10 days post operation 

it was a open colon resection

steveja
Posts: 41
Joined: Apr 2017

FWIW

CA19-9 has even less support than CEA.  You might want to examine the neutrophil:lymphocyte ratio (the numbers are on a basic CBC blood test).   High ratios suggest a problem and poorer outcomes.

 

 

tanstaafl's picture
tanstaafl
Posts: 1292
Joined: Oct 2010

CEA is the best marker overall for stages 1-4, at initial diagnosis with a single reading.  However some CRC cancer patients with a nice low CEA have high CA199 values that can be important.

CEA is the best marker overall for a series of blood tests at detecting recurrence, however some patients with low, flat CEA levels have high, responsive CA199.

CA199 is best used with skill and timing. CA19-9 is a marker affected by several conditions (inflammation, biliary diseases, other cancers, diabetes, thyroid problems,  treatments like RT, RFA or heavy cyclical chemo)  or changes in conditions, that overlap the common CA199 range for CRC, 19 - 37.  Nevertheless, careful use of CA199 can provide valuable information for advanced CRC patients (stages 3 and 4), and patients with KRAS and BRAF mutant cancer (even stage 2s). Especially with supporting panels like hsCRP, ESR, HgbA1C, thyroid for interference data.

Used in combination with high CEA, high CA199 predicts metstatic cancer and shorter OS if not successfully exterminated.  High CEA and high CA199 together is an especially important finding.  E.g. One member struggled with low CEA, high CA199 cancer for many years; when his CEA became active too, his conventional treatments were no longer effective and he was quickly gone. 

High pre-op CA199 increases the likehood of targeted cimetidine successfully stopping cancer recurrence in those patients  who would recur after 5FU based treatment.  Ultralow CA199  (under 2 units) predicts cimetidine is of no value to these CRC patients.   The Japanese data suggest that tissue staining with both CA199 and CSLEX1 (a particular CD15s antibody) is the best companion marker treatment today for those stage 2 and 3 patients who will recur and die without cimetidine in the post op period.  All too cheap and big medicine isn't interested in cheap.  This targeting even appeared to work well for us, dealing with stage 4b.

In our case, CA199, rising rapidly, was also the first responsive marker to an improved chemo treatment.  The greedy little metastatic mutants producing CA199 sucked up the chemo and died faster than the slower CEA bearing cells sitting there like inert lumps, relatively speaking.   CA199 bearing cells are more likely to imply uncontrolled, -able metastasis if not targeted effectively. 

Marker expressions change with time, as cancer cells struggle to survive too. Several off label tests, like the NLR that you mention, provide pieces of information.  It is worth tracking many treatment related panels, to us.

Most doctors are totally out of the loop on CA199 related CRC skills. However, as an added marker for high risk patients, especially the very first use, preferably before any heavy duty treatments, very high value pieces of information can be obtained.

Annabelle41415's picture
Annabelle41415
Posts: 6554
Joined: Feb 2009

As stated above my CEA level was always normal and my radiologist and oncologist told me this was the marker to look for so it wasn't a good indicator for me.  I'm wondering why they never suggested the other marker test knowing that the CEA marker was a waste of a test.  Hmmm, do doctors just not know this or are they to blind to even think about giving you another marker test because they are too much boxed in to a set standard.  Makes me angry that they have a test that could be more accurate.  Thanks for the info.

Kim

tanstaafl's picture
tanstaafl
Posts: 1292
Joined: Oct 2010

First they are stuck in a box by training.  They are taught nothing basic about it in US med schools and have nothing to develop from.  At least, I'm old enough to remember the discovery years of CA199 in the scientific news, and it was discovered from CRC.  I pointedly asked all oncologists (including Ivy, MDA alums) about extra CRC markers and got no useful information in 2010-2011.  Our internal medicine MD was actually slightly better at the principles of marker use and hunting. Life Extension Fdn had some useful info.

Second, is that CA199 is largely munged as a marker during std US treatments and much of the (half+)year that follows.  Heavy cyclical chemo rapidly degrades CA199 accuracy by cell damage and inflammatory rises each cycle . Ditto initial radiation tx for rectal cancer in the US (some countries avoid[ed] RT with better surgery and chemo techniques, at least for several decades).  Sometimes, even after a surgery, an infection will degrade accuracy.  So, during US oncologists' tenure, CA199 problems typically develop rapidly - as an iatrogenic result !  "dr's fault"

Third are economic and legal problems.  Insurers got a statute passed that enables them to easily save costs by dismissing "nonstandard medical practices" as prosecutable fraud rather than having to discuss the merits.  This is totally corrupt and bad science, but has been the situation for a while.  There are other legal intrusions to force some "standard" upon drs and patients too.

So why bother?  Because the life it saves could (have) be(en) yours. In many situations and cases it is the only useful marker, as a monitoring marker for KRAS/BRAF mutants, as a one time, prognostic companion marker for cimetidine, or  especially for many of the patients that have ultralow (poor) CEA.  It's information value is additive to CEA, not "competitive".

When is it useful?  Periods before treatment, and long after, are likely good.  Not all treatments disrupt CA199 - e.g. natural immune tx, continuous immunochemo, surgery.  Some treatments are likely to improve its stability - like anti-inflammatories, certain diets, and IV vitamin C.   The year on chemo following my wife's second surgery, her CA199 data were tighter than most std patients' CEA data, off chemo.

So what has CA199 done for us?  1. it early predicted the likely treatment utility of cimetidine, probably important for many stage 2-4a KRAS/BRAF mutants patients that would later suffer recurrences; 2.  it showed us chemo dosage response when CEA could not and most patients would have "lost" the chemo and helped make a succesful surgery, 4. as time goes by, CEA is a less valuable, less useful marker for my wife, still on long term chemo.  Well worth the money for our most expensive, cash paid marker, as much as I despise the 3.8x CEA price that we pay.

 

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