Carcinoembryonic Antigen (CEA) as a Prognostic and Monitoring Test in Clinically Complete Resection of Colorectal Carcinoma

Abstract

The prognostic and postoperative monitoring capabilities of the CEA assay were compared to pathological staging of the operative specimens, clinical followup including endoscopy, radiology and scanning techniques, as well as DNCB skin testing and laboratory enzyme determinations (alkaline phosphatase and transaminase). A total of 46 patients with curative resection for colorectal carcinoma were studied. This included 23 patients with recurrent tumors compared to 23 long-term survivors without signs of recurrence at the time of the study. Preoperative CEA determinations were a good prognostic tool comparable to pathological staging of the specimen. Post operative CEA monitoring was the earliest sign of recurrence in 14 of 23 patients and was positive at the time of recurrence determined by other methods in 20; it was negative in only three cases. The incidence of false positive results among the non recurrent group became a lesser problem when repeated elevated values were required before considering the patient as having a recurrence. From these data, it seems reasonable to propose the use of a second-look operation in patients with maintained elevation of circulating CEA and no clinical signs of tumor presence, if we are to treat recurrence at an early stage. Chemotherapy would be an alternative way to deal with this problem, since the absence of clinical signs in general correlate with small bulk of tumor which at this time may be more susceptible to chemotherapeutic agents.

Serum CEA testing in the post-operative surveillance of colorectal carcinoma

“…The rate of rise was shown that a CEA rise was the first indication of recurrence in the majority of patients developing secondary disease (Mach et al, 1974;Booth et al, 1974;Herrera et al, 1976). In the present study there was a proven or suggestive recurrence rate of 27.3% after a mean follow-up of 39.7 months.…”

“…Much of the initial enthusiasm for the test evaporated as it became apparent that serum CEA testing lacked specificity and sensitivity (Sugarbaker et al, 1976;Sorokin et al, 1974) and it has since been shown to be of minimal value in the primary diagnosis of gastrointestinal disease (Hine et al, 1978). However, in the post-operative surveillance of patients who have had radical resections of colorectal carcinomas, several studies have shown that a rise in the serum CEA precedes clinical recurrence in the majority of cases (Sorokin et al, 1974;Mach et al, 1974;Booth et al, 1974;Herrera et al, 1976;Wood et al, 1978). In some instances the lead-time has been up to 29 months (Sorokin et al, 1974).…”

New insights into the role of age and carcinoembryonic antigen in the prognosis of colorectal cancer

“…Since the CEA level seems to roughly reflect the tumour burden and/or diffusion (Wanebo et al, 1978), its preoperative evaluation might offer a crude estimate of neoplastic spread and, thus, of the probable difficulty of achieving successful radical resection. A drop in CEA levels after the resection is considered a favourable indicator of the completeness of the surgical excision (Herrera et al, 1976), although CEA concentration is generally regarded as more sensitive for hepatic and retroperitoneal metastases than for local recurrence or peritoneal and pulmonary metastases (Crawford et al, 2003). According to Kanellos et al (2006c), the measurement of the CEA level in the blood intraoperatively taken from the mesenteric vein offers some advantage, as both indicator of hepatic metastases and predictor of 5-year survival.…”

Preoperative Carcinoembryonic Antigen and Prognosis of Colorectal Cancer. An Independent Prognostic Factor Still Reliable

“…1,3,4,9,10 With this in mind, in our opinion, the carcinoembryonic antigen (CEA) maintains its position, as for over 30 years it has continued to be the most widely used marker 11 and whose validity, with regard to colorectal follow-up, has been sanctioned by leading organizations such as the American Society of Clinical Oncology (ASCO) 12 and the European Group on Tumor Markers. 13 Moreover, as Herrera 14 and Wanebo 15 had already reported by the end of the '70s, the preoperative determination of the CEA (p-CEA) seems to be related both to the staging of colorectal neoplasia and to the patient's prognosis. However, to date, none of this has been conclusively demonstrated and is still a matter of intense debate both in prestigious scientific journals 4,7,11,[16][17][18][19][20][21] as well as in different guidelines.…”