Carcinoembryonic antigen (CEA) levels in benign gastrointestinal disease states

Abstract

Elevated circulating CEA levels occur in patients with benign gastrointestinal and hepatic disorders. These are usually less than 10 ng/ml. Of clinical importance is the influence of liver disease on the interpretation of CEA. At least 50% of patients with severe benign hepatic disease have elevated CEA levels, most often active alcoholic cirrhosis, and also chronic active and viral hepatitis, and cryptogenic and biliary cirrhosis. Patients with benign extrahepatic biliary obstruction may have increased plasma CEA, the highest in patients with co-existent cholangitis and especially liver abscess. The liver appears to be essential for the metabolism and/or excretion of CEA. Hence, liver work-up is needed to assess any patient with an elevated CEA. A damaged liver may further augment elevated CEA levels due to cancer. The increased circulating CEA observed in some patients with active ulcerative colitis tends to correlate with severity and extent of disease and usually returns to normal with remission. CEA levels also may be mildly elevated in patients with pancreatitis and in adults with colonic polyps. Smoking may contribute to the increased CEA levels seen in patients with alcoholic liver disease and pancreatitis. Therefore, in interpreting mildy elevated circulating CEA levels in patients with GI tract diseases, one must consider benign as well as malignant etiologies.

A General Cutoff Level Combined With Personalized Dynamic Change of Serum Carcinoembryonic Antigen Can Suggest Timely Use of FDG PET for Early Detection of Recurrent Colorectal Cancer

“…9 However, benign elevation of CEA level is not uncommon; it could be related to smoking, gastritis, peptic ulcer disease, diverticulitis, liver disease, chronic obstructive pulmonary disease, diabetes, and any acute or chronic inflammatory state. [10][11][12][13][14][15][16] Therefore, further evaluation is necessary, especially in the CRC patients with posttherapy elevated CEA level; the added imaging or laboratory tests can also help identify the site of recurrent disease. The additional testing may include abdominal and pelvic CT, chest CT, colonoscopy, and, in some cases, 18 F-FDG PET scan.…”

Diffuse Peritoneal Chlamydial Infection Presenting as Possible Ovarian Peritoneal Carcinomatosis in an Adolescent Female

“…Only after exploratory laparotomy with findings of chronic inflammation, final pathology negative for malignancy, and positive cervical chlamydial PCR was the correct diagnosis made. CA-125 and CEA may be elevated in several benign and inflammatory conditions (e.g., endometriosis and ulcerative colitis, respectively) and therefore have a poor specificity for malignant conditions [9,10]. Chlamydial PID should be considered in a sexually active female presenting with ascites and adnexal mass, and ought to be included in the differential diagnosis along with peritoneal carcinomatosis.…”

Detection of micrometastases in peritoneal washings of gastric cancer patients by the reverse transcriptase polymerase chain reaction

“…With the conclusion of this pilot study, we have begun to quantify mRNA with the use of a Nanodrop ND-1000 spectrophotometer (Wilmington, DE, USA). Additionally, there are benign causes for elevated CEA: smoking [26], infl ammatory conditions including infections [27], infl ammatory bowel disease [28], hypothyroidism [29], and pancreatitis and cirrhosis [30]. Levels can be raised transiently with radiation therapy [31].…”