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Summary Six hundred and sixty-three patients were followed with serial serum CEA measurements in addition to routine clinical surveillance after radical resection of colorectal carcinoma. Of 626 available for analysis, 366 (58.4%) remained clinically free of recurrence and had a normal CEA (<20ngml-1) throughout and 89 (14.2%) had a temporary non-progressive rise in CEA with no evidence of secondary disease. Of 171 patients who developed proven or suggestive recurrence, 114 had a preceding rise in the serum CEA and in further 21 the CEA rose simultaneously with recurrence. In 36 patients secondary disease was detected while the CEA was still within normal limits. CEA was more effective as an early index of distant metastasis, thus in 76% of those patients with a preceding rise in CEA, the secondary disease was disseminated, whereas only 20% had localised recurrence. The pattern of rise in CEA was of no practical value in distinguishing localised from distant recurrence.

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SUMMARY Of 663 patients treated with radical surgery for colorectal cancer, 52 showed a progressive rise in serum carcinoembryonic antigen (CEA) with no other evidence of recurrent disease and were randomised in a prospective study of chemotherapy. Twenty six patients in the treatment group received 5FU and methyl CCNU from the time of randomisation and the remaining 26 controls were given further therapy only if there were clinical indications. All patients were followed for five years or until their death and all but one (control) developed clinical evidence of recurrence. Overall there was no significant difference between the two groups with respect to disease free interval and survival. Whereas the rise in CEA in controls was generally progressive, marked inflections on the CEA curves were seen in the majority of patients receiving early treatment. Eight of 26 treated patients showed a fall in CEA of greater than 20% two months after starting therapy. These patients had a median disease free interval of 90 weeks and a median survival of 107 weeks, these figures being longer than those of treated patients who did not show a fall in CEA and control patients. The serum CEA therefore appeared to give important prognostic information in patients receiving cytotoxic treatment. Early therapy was generally well tolerated.

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