Is CEA analysis of value in screening for recurrences after surgery for colorectal carcinoma?

Abstract

The progress of 139 patients operated upon for cure of colorectal carcinoma, was followed postoperatively with a standardized protocol. A CEA test was performed for comparison with other parameters. Median observation time was four years. When an upper limit for CEA of 7.5 micrograms/1 was allowed, sensitivity was found to be 78 per cent, specificity 91 per cent, and predictive value of an elevated CEA concentration, 83 per cent. In general, CEA measurement traced recurrence six months before clinical diagnosis. In only a few cases was recurrence first heralded by an abnormality in other blood chemistry test results. CEA may thus be used in postoperative screening for recurrence even though most recurrences, when detected, are not curable.

Management of Locally Recurrent Rectal Cancer

“…Small number of these is fit enough, with resectable recurrence and no distant metastases. Earliest possible detection of local recurrence is usually achieved by a set of tests that usually include physical examination, CEA and Ca 19-9 measurements, endoscopy and imaging (CT, NMR, ERUS and FGD-PET scan) (Beart RW 1983;Carlsson U 1983). Usually, only one of these tests raises doubt that local recurrence may be present.…”

“…The decision for salvage surgery should be brought on the basis of: -Patients general health-the patient should be fit enough for potentially extensive surgery. -Necessary surgical expertise should also be available for these operations, which should be undertaken in the specialized centers were a multidisciplinary team is available (Carlsson U 1983). The most important issue in this matter is to decide when to avoid surgical treatment.…”

Serial Determinations of Serum CEA in Monitoring Management of Patients with Colorectal Carcinoma

“…After apparently complete surgical resection of co lorectal carcinoma, serum CEA, if elevated before surgery, should have fallen to the normal range [5,[12][13][14][15][16][17][18][20][21][22][23]. The present data and other reports indicate that its failure to fall into the normal range was an indication of an incomplete resection irrespec tive of the view of the surgeon that a curative resection had been made; and that a subsequent rise of serum CEA did signal a recurrence of the cancer [5,[12][13][14][15][16][17][18][20][21][22][23].…”

“…The interpretation of longitudinal serum CEA levels has been conditioned upon the desire to act on the evidence of recurrence provided by the test [12,18,[20][21][22][23][28][29][30], After all. we are convinced that the CEA test may act on the evidence of disease-free course as well.…”

2. Colorectal Cancer

“…Occasionally, long lead times may occur at a stage when the recurrent tumor is still local ized and resectable [11,12]. Even though numerous immunohistological and serial se rum studies have not assisted in the discrim ination of patients with premalignant or be nign conditions [13], in those at high risk of developing malignancies (e.g.…”