Plasma levels of carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), and human chorionic gonadotropin (hCG) were measured in 253 patients with gynecologic malignancies and in 317 patients with benign gynecologic diseases. Plasma concentrations of each of these antigens were elevated in a significantly (p less than 0.001) greater number of patients with invasive gynecologic cancers than in the control population. Carcinoembryonic antigen was the most commonly elevated marker, followed by AFP and hCG. Prior to therapy, over 85% of patients with ovarian or cervical cancer had elevated plasma levels of one or more antigens. Specifically, CEA was most often elevated in patients with mucinous adenocarcinomas of the ovary and endocervix. Alpha-fetoprotein was most often increased in patients with germ cell or stromal tumors of the ovary and in patients with large-cell nonkeratinizing cervical cancers. In contrast, hCG concentrations were highest in patients with serious cystadenocarcinomas of the ovary and in patients with keratinizing squamous cell carcinomas of the cervix. Plasma antigen levels were directly related to tumor differentiation and stage of disease, and generally returned to normal eight to 12 weeks following therapy. Effective plasma and tumor antigen screening during initial evaluation of patients with gynecologic tumors should help to identify the most appropriate antigen for immunodetection procedures and for serial plasma determinations following therapy.

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We have measured serial carcinoembryonic antigen (CEA) titers in 92 patients, randomly selected from the patient population of a Radiotherapeutic Clinic, to correlate with clinical and follow-up evaluation. 57 out of 92 patients had positive CEA levels (2.5 ng/ml) or 62% of proven cancer patients. In this series, 67% (63/92) showed positive correlation between the curves of CEA levels and the clinical evaluation of disease activity. A simple computerized program was designed with the data collection directed to identifying parameters and trends of different groups. Breast CA showed 89% correlation; lung carcinoma showed 80%; large bowel 75%, and other organs showed less. This assay is a prototype study of human response to therapy in relation to tumor antigen and host response, as measured by a nonspecific tumor associated antigen.

Carcinoembryonic antigen (CEA) has been thought to be a diagnostic and prognostic indicator of colorectal cancer. Initial descriptions of CEA as a tumor specific antigen suggests a relationship between tumor CEA and circulating plasma CEA. To define the relationship between CEA and colorectal carcinoma, we have studied the CEA concentration of preoperative plasma, tumor tissue, and normal bowel distant from tumor in 35 patients who had clinically curative resections. Tumor histology was evaluated for Dukes class, histologic grade, necrosis, and vessel invasion. Regression analysis yielded no evidence of correlation between tumor CEA and plasma CEA. No correlation could be shown between tumor concentration of CEA and the histological parameters previously noted. CEA was found in all specimens of normal bowel. Furthermore, in 34% of the cases studied, the tumor CEA was not significantly higher than in normal bowel. No significant difference was shown when histopathological findings were compared to normal and abnormal plasma CEA values. These findings suggest the following conclusions: CEA is not tumor specific. Increased levels of CEA in tumor tissue are not a constant finding in colorectal carcinoma. Tumor levels of CEA do not appear to correlate with histologic degree of tumor differentiation. Elevated plasma levels of CEA do not necessarily connote elevated tumor tissue levels of CEA, and conversely, normal plasma levels of CEA do not necessarily mean low levels of tumor CEA.

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