Carcinoembryonic antigen (CEA) levels and tumor histology in colon cancer (original) (raw)
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Background: Colorectal cancer is a major common public health problem throughout the world as well as developed countries like ours. Early diagnosis with precise preoperative staging bears great importance by providing more effective treatment and reduced mortality and morbidity in colorectal cancer cases. CEA and CA 19-9 are the most studied serum tumor markers that have been evaluated for the management of gastrointestinal cancers but their usefulness for diagnosis has been a challenging question.. The study prospectively enrolled 73 consecutive patients with a confirmed diagnosis of colorectal carcinoma by histopathology and 73 age and sex matched control subjects with no malignancy. The relationship of the tumor markers (CEA and CA 19-9) with perioperative disease staging (TNM), histological grading, sensitivity, specificity, PPV and NPV were analyzed using SPSS version 22. Result: Gender analysis revealed slightly male predominance (57.53%) over female (42.47%) though that was not statistically significant (p=0.128). Majority age distribution group was 13-30 then 31-40 years revealing tendency to occur malignancy at an earlier age in our patients. Majority of the tumors were located to rectum then sigmoid colon. Sensitivity of CEA and CA 19-9 were found 65.75% and 28.77% respectively. Specificity of CEA and CA 19-9 were 68.49% and 58.90% respectively. Positive predictive value of CEA and CA 19-9 were 67.61% and 41.18% respectively. Whereas negative predictive value of CEA and CA 19-9 were 66.67% and 45.26% respectively. Positive likelihood ratio of CEA and CA 19-9 were 2 and 0.7 which reveals CEA has some diagnostic value though not high but CA 19-9 has no diagnostic value. Negative likelihood ratio of CEA and CA 19-9 were 0.5 and 1.2 which also reveals same result as before. Serum concentrations of CEA were significantly higher in the patient group than in the control group (p = 0.001) but CA 19-9 was not significant (p = 0.086). Serum CEA was also significantly higher in advanced T stage. Serum concentrations of CEA and CA 19-9 were significantly elevated in the patients with spread to lymph nodes. Levels of both tumour markers were significantly elevated in the patients with distant metastasis. CEA and CA 19-9 levels are higher in well differentiated tumor than in those with poorly differentiated tumours. Conclusion: Preoperative levels of CEA and CA 19-9 do not have significant diagnostic value but may provide an estimate of lymph node invasion and distant metastasis in colorectal cancer patients.
Diseases of the Colon & Rectum, 1985
Serum levels of gastrointestinal cancer antigen (GICA) and carcinoembryonic antigen (CEA) were determined in 167 patients with colorectal carcinoma. Eighty-eight patients were studied preoperatively, and 79 postoperatively, before, at the time of, and after the diagnosis of relapse. The authors aimed to assess how often the GICA test failed, i.e., was false-negative in patients in whom the CEA test was true-positive and, more importantly, whether it could give diagnostic information in patients in whom the CEA test failed. Before surgery, serum GICA gave similar information to serum CEA in 56'percent of the patients: true-positive in 18 percent and false-negative in 38 percent; less information in 42 percent; and more information in only 2 percent. During the postoperative follow-up, serum GICA gave similar information to serum CEA in 55 percent of the patients: true-positive (i.e., rising persistendy from a postoperative nadir) in 27 percent and falsenegative in 28 percent; less information in 44 percent; and more informarion in only 1 percent. Therefore, this test in its present version, where both the catcher and the tracer antibody are the same, NS 19-9, is redundant.
Arquivos De Gastroenterologia, 2004
BACKGROUND: The problem of the relationship between blood carcinoembryonic antigen (CEA) levels and tissue CEA content in colorectal carcinoma, and the mechanisms for CEA release from tumor cells in tissue adjacent to the neoplasm is important to understanding the biology of colorectal carcinoma. It has not been adequately explained whether CEA in the peripheral blood is drained mainly by portal system blood or by the lymphatic system, or indeed by both systems. AIM: To study the behavior of CEA levels in peripheral blood (CEA-p) and venous effluent blood (CEA-d) among patients with colorectal tumors, who underwent curative operation. METHOD: A total of 28 patients were studied (12 male [42.9%] and 16 female [57.1%], mean age 66.1 years [range: 43 84]). Immediately after laparotomy, peripheral venous blood was extracted by antecubital venous puncture and venous effluent blood was collected from the main drainage vein of the lesions. Values of CEA-p, CEA-d and the gradient between CEA-d and CEA-p that were less than 5.0 ng/mL were considered normal. RESULTS: Eight (28.6%) patients were stage A in Duke's classification, nine (32.1%) stage B and 11 (39.3%) stage C. The neoplasm was located in the rectum of 14 patients (50.0%), in the transverse colon in five (17.9%), in the sigmoid in four (14.3%), in the cecum and/or ascending colon in three (10.7%), and in the descending colon in two (7.1%). The histopathological examination revealed well-differentiated adenocarcinoma in all the patients. Only one patient (3.6%), Duke's classification stage C, presented neoplasm with venous invasion. The gradient between the CEA-p and CEA-d levels were normal in 25 patients (88.3%) and high in three (10.7%). The mean value for CEA-p was 3.8 ± 4.1 ng/mL (0.1-21.1 ng/mL) and for the drained CEA (CEA-d) it was 4.5 ± 4.3 ng/mL (0.3-20.2 ng/mL), without significant difference between these values. There was a significant difference between the mean value for CEA-p and CEA-d levels greater than 5 ng/mL. CONCLUSION: The CEA-p and CEA-d levels in the colorectal carcinoma patients were not shown to be different. The results from this study suggest that, in colorectal neoplasm without venous invasion, there may not be notable CEA drainage from the tumor by the portal vein effluent blood.
Journal of Clinical Pathology, 1982
Carcinoembryonic antigen (CEA), secretory component (SC), and epithelial IgA were traced by paired immunofluorescence staining in 102 large bowel carcinomas from 99 patients. The immunohistochemical results were evaluated semiquantitatively in relation to histological tumour grade, clinicopathological stage, and preoperative plasma CEA concentration. CEA expression was significantly increased (p less than 0.05) in the following order: histologically normal colon mucosa, transitional mucosa adjacent to tumours, neoplastic epithelium; the reverse was true for the expression of SC and epithelial IgA (p less than 0.01). CEA was significantly more abundant in the moderately and poorly differentiated tumors than in the well differentiated ones (p less than 0.05), whereas the latter showed better expression of SC (p less than 0.05) and epithelial IgA (p approximately 0.06). In the transitional mucosa, CEA staining tended to be inversely related to histological tumour grade, whereas SC and epithelial IgA were significantly better seen in this zone when the adjacent tumour was well differentiated than when it was moderately or poorly differentiated (p less than 0.01). Furthermore, the expression of SC and epithelial IgA in the transitional mucosa decreased with increasing invasiveness of the tumours, whereas the opposite relation was indicated for CEA expression. Plasma CEA concentrations were not clearly correlated with histological levels than the localised well differentiated tumours tended to be associated with lower levels than the localised moderately differentiated ones (p approximately 0.06). Moreover, the latter variety was associated with lower plasma CEA concentrations than disseminated tumours of comparable differentiation (p less than 0.01).
Changes of Serum CEA Level after Resection of Colorectal Carcinoma
Journal of Surgical Sciences, 2019
Introduction :Carcinoembryonic antigen is the most commonly used tumour associatedantigen in the management of patients with colorectal carcinoma. The test appearsuseful to determine prognosis and to monitor patients with colorectal carcinoma for earlyrecurrence, persistent elevation of CEA for a month after operation suggests thepresence of occult metastatic disease. Objective: The study was done to compare pre and postoperative CEA level in colorectalcarcinoma patient and to analyze the relationship of CEA and different Dukes stage inpre operative period of colorectal carcinoma patients. Methods: This cross-sectional and cohort study was performed to look at the change inCEA level among 97 colorectal carcinoma patients in pre and post operative state in thedepartment of surgical oncology, NICRH from January 2010 to June 2012. Results :Statistically significant changes was found in pre and postoperative CEA levelin colorectal carcinoma patient (p
European journal of cancer, 1980
Thirty-nine patients with colorectal cancer and normal preoperative levels of carcino-embryonie antigen (CEA ) were followed up with serial CEA determinations and with complete clinical and laboratory work-ups for the detection of tumor recurrence, for at least 1 yr after surgery. The same schedule for serum CEA assay and other clinical and laboratory tests was followed, for comparison, in 32 colorectal cancer patients with elevated preoperative serum CEA titers, and in whom surgery had been followed by a return to normal of the CEil values. In the follow-up group with negative preoperative serum CEA values, 66.7°:o of the patients had normal serum CEA titers, and 60°,; were free from symptoms of tumor recurrence after l yr from surgery. Whereas, 28.2% oft& patient~ of this group showed a steady rise of their serum CEA levels after periods ranging from 3-12months from surgery; this serum CEA elevation preceded in nine of these patients other evidence of tumor recurrence by 3-5 months in the average. The above pattern was superimposable to that observed in the patients with positive preoperative serum CEA, about one third of whom exhibited a steady rise of serum CEA to abnormal values (as an early indicator of tumor recurrence) in the first year after surgery.
Medical Archives, 2020
Introduction: Many evidence indicates that Carcinoembryonic antigen (CEA) and Carbohydrate antigen 19-9 (CA 19-9) have strong reactivity with tumor cells and may serve as a useful marker in identifying patients with colorectal cancer (CRC). Objectives: The goal of this study was to evaluate the relationship between preoperative concentration of serum levels of CEA and CA 19-9 and progression of colorectal cancer. Methods: The retrospective study included 80 patients operated for colorectal cancer at the Clinic for General and Abdominal Surgery, Clinical Center of University of Sarajevo, from 2013 to 2018. The following clinical and laboratory parameters were observed: age, sex, preoperatively measured concentrations of CEA and CA 19-9 antigens, CRC localization, postoperative histopathological findings and CRC stage (TNM classification). All of the data above were processed by relevant statistical methods, with an accepted level of statistical significance of p <0.05. Results: The highest serum levels of CEA and CA 19-9 were observed in stage IV of CRC. Average CEA and CA 19-9 values did not differ significantly between tumor stages (p>0.05). Preoperatively measured serum concentrations of CEA and CA 19-9 in patients with CRC were significantly correlated (rho = 0.328, p = 0.001). An increase in the depth of tumor invasion of the intestinal wall tumor (pT) is followed by an increase in the serum value of the CEA marker, but this ratio was not statistically significant (rho=0.194, p=0.080), while the relationship between depth of intestinal wall invasion and serum level of CA 19-9 was significantly positive correlation (rho = 0.252, p = 0.024). However, the linear regression analysis model showed that serum levels of CEA and CA 19-9 could not be predictors of CRC stage and depth of tumor invasion of the intestinal wall (p> 0.05). Conclusion: Preoperatively measured serum values of CEA and CA 19-9 cannot indicate the specific stage and histopathological size of the CRC.
Prognostic Role of Carcinoembryonic Antigen (CEA) in Colorectal Carcinoma
East African scholars journal of medical sciences, 2022
Background: Preoperative carcinoembryonic antigen (CEA) level is considered as a factor predictive of survival in colorectal cancer patients. Patients with normal (<5 ng/ml) or lower pre-operative CEA levels were reported to have significantly longer survival. Objective: To evaluate the prognostic significance of preoperative CEA levels of patients with colorectal cancer in Taiwan. Methods: Between Jan 2016 and Dec 2017, 39 patients with histologically confirmed colorectal cancers were evaluated retrospectively at the General Surgery Department of Hayatabad Medical Complex Peshawar. All patients had undergone potentially curative surgery. Patients with metastatic diseases were not included. 5-Fluorouracil-based adjuvant chemotherapy was administered if the patients had Dukes' C disease. Reference to the Dukes' classification was according to the classical criteria described in 1932 for carcinoma of the rectum and adapted for use in colonic tumors. Data on gender, age, degree of tumor differentiation, location of the tumor, tumor size, lymph node metastasis, penetration of the bowel wall and preoperative CEA levels were analyzed to deter mine their association with survival. Blood samples for CEA measurement were taken a few days before operation and were analyzed using the radioimmunoassay method. Results: Total 39 patients were included in the study. Age ranged between 30-80 years with a mean age of 55 years. There were 26(66.7%) males and 13(33.3%) females, with male to female ratio of 2:1. Patients with preoperative CEA levels of <5 ng/ml had significantly longer survival than those with preoperative CEA levels of >5 ng/ml. The median 5 years survival rate for patients with preoperative CEA <5 ng/ml was 51.2 months, while 35.5 years for >5 ng/ml patients respectively (p < 0.001). The tumour was primary located at the colon in 23(59%) while the rest was found at the rectum 16(41%). Tumour size was <2cm in 25(64.1%) and >2cm in 14(35.9%) patients. Conclusions: The data from our study indicate that in addition to lymph node metastases and penetration of the bowel wall, the preoperative CEA levels are also an independent prognostic factor in non-metastatic colorectal cancer patients after curative surgery. This could serve as an appropriate modification to the initial Dukes' scheme in colorectal cancer.
Unusual Elevation of CEA in a Patient with History of Colon Cancer
Japanese Journal of Clinical Oncology, 2006
A 35-year-old female received right hemicolectomy for a poorly differentiated adenocarcinoma of the ascending colon with lymph node metastasis (1/28) in February 1997. CEA was 1.68 ng/ml prior to colectomy. Adjuvant chemotherapy with weekly 5-FU and leucovorin intravenously was started following surgery and discontinued after 17 doses in May 1997. She received bilateral salpingo-ophorecctomy for metastatic cancer in August 1999. Intravenous chemotherapy was resumed with weekly 5-FU and leucovorin intravenously in August 1999. CEA was 93.8 ng/ml in November 1999. Intravenous chemotherapy was discontinued after 20 doses and oral chemotherapy with futraful and leucovorin was started in January 2000. CEA was found to be 240.3 ng/ml in December 1999 and then elevated to 1521.3 ng/ml in June 2001, which was 10 months after resection of metastatic ovarian cancer. No metastatic lesions could be detected, however, with image studies. The CEA decreased to 396.6 ng/ml three months later. Futraful was switched to uracil-tegafur (UFUR) in September 2001. The CEA for the patient ranged from 68.5 to 298.9 ng/ml for the following 5 years without aggressive chemotherapy. No evidence of recurrence could be demonstrated by imaging studies. The patient is not a smoker and denied exposure to a smoking environment. She was also not known to have persistent infections, inflammatory bowel disease, pancreatitis, cirrhosis of the liver, or any benign tumors. The current case suggested that: (i) elevation of CEA is not necessarily well correlated with presence of metastatic colon cancer; (ii) some patients may live with elevated CEA for years without evidence of recurrence or metastasis; (iii) aggressive chemotherapy may not be necessary in patients with only elevated CEA.