Differing Serum Cea in Primary and Recurrent Rectal Cancer - A Reflection of Histology?

Abstract

BackgroundSerum carcinoembryonic antigen (CEA) levels are not universally measured in colorectal cancers. CEA levels have been reported to be usually normal at time of primary rectal cancer diagnosis but elevated in recurrent disease. The aims of the study were to (1) compare serum CEA levels performed at time of primary and recurrent colorectal tumour diagnosis; and (2) to determine serum CEA levels in rectal cancers at primary diagnosis to analyse potential factors influencing differing CEA levels.MethodsA retrospective analysis of patients treated for colorectal cancers at Modbury Hospital, South Australia was performed. Each admission was reviewed within the electronic database. Serum CEA levels and tumour-related factors were determined in patients who underwent curative surgery for their primary tumour and developed tumour recurrence/metastases within the study period.Results438 patients were treated for colorectal cancer in the study period. In patients who underwent curative surgery and developed a recurrence, serum CEA was elevated in 20% patients at primary diagnosis and in 46.6% patients at recurrence. Only 1 of 30 patients with rectal cancer had an elevated CEA at diagnosis of primary tumour. Tumour relationship to the peritoneal reflection did not appear to play a role.ConclusionsIn rectal cancers, serum CEA levels are often normal at the time of initial diagnosis. However, this should not preclude its use in post-operative surveillance. Serum CEA levels noted in primary rectal cancer appear unrelated to the relationship of the tumour to the peritoneal reflection. Stroma-related factors could possibly be involved and merit further investigation.

The ameliorative effect of Vitamin C in experimentally induced colon cancer in rats

“…The results are in agreement with Umesalma and Sudhandiran, (2010) who reported that, elevation in serum CEA concentration was observed in DMH-induced colon cancer in rats, 1, 2-dimethylhydrazine, a potent carcinogen administered, induced reactive oxygen species (ROS) damage to colon that causes instability of colon cell metabolism, which leads to different changes in tumor markers (CEA and AFP) are representatives of colon function. In addition to, serum CEA was elevated in 20% of patients at primary diagnosis of colon cancer and in 46.6% of patients at reappearance (Chang et al, 2012). Both elevated serum CEA and CA 19-9 levels were associated with the presence CRC.…”

Elevated CEA is associated with worse survival in recurrent rectal cancer

“…On the other hand, initial and recurrent tumor might have different biology. Chang et al failed to demonstrate that location of tumor involvement induces discrepancy between CEA level of primary and recurrent cancer [ 19 ]. Several literatures proposed possible explanations why high CEA level is associated with poor prognosis [ 20 , 21 ].…”

Clinical Usefulness of Serum CYFRA 21–1 in Patients with Colorectal Cancer

“…CEA is manufactured by normal colonic cells and colon carcinoma cells and affected by multiple factors including smoking [6]. Although clinical CEA survey is the most cost-effective indicator for CRC, unusually elevated levels of CEA are frequently reported in smokers [3,[6][7][8] and multiple benign gastrointestinal diseases-including ulcerative colitis, active alcoholic cirrhosis, viral hepatitis, and cryptogenic or biliary cirrhosis-may show increased CEA levels not associated with CRC [6,[9][10][11]. For these reasons, Australia's previous National Health and Medical Research Council (NHMRC) guidelines did not favor routine measurement of CEA for all CRC patients [7].…”