Use of CA 19-9 in the Early Detection of Recurrences in Colorectal Cancer: Comparison with CEA

Abstract

The serum levels of CA 19-9 were determined in the follow-up of 370 patients with colorectal cancer and compared with CEA. An increase in CA 19-9 preceded clinical diagnosis of recurrence in 25% of 72 patients. The mean time between the rise in CA 19-9 and clinical diagnosis of relapse was 3.7 months (median 3). Sensitivity of CA 19-9 in the early diagnosis of recurrence was much lower than that obtained for CEA (75%). Only 1 patient had elevated CA 19-9 levels and normal CEA.

Correlation of CEA but not CA 19-9 as serum biomarkers of disease activity in a case of metastatic rectal adenocarcinoma

“…Among patients who www.tandfonline.comexperience normalization of CEA following treatment, a repeat elevation is both sensitive and specific for detecting recurrent disease. 19,22 This tumor marker is often the earliest indicator of recurrence, preceding clinical and radiographic evidence in 3-quarters of cases. [9][10][11][12] As a result, current ASCO guidelines recommend that CEA measurements be routinely obtained at 3 month intervals during postoperative surveillance and at 1-3 month intervals during systemic treatment for metastatic CRC.…”

“…While several studies indicate that its sensitivity and specificity rival that of CEA, 24,25 most suggest that CA 19-9 is vastly outperformed with respect to these measures. 19,26 Furthermore, CA 19-9 elevation trails radiographic detection of recurrent disease in 75% of instances, often by several months. 19,25,26 This tumor marker is also of questionable value in evaluating response to treatment.…”

“…19,26 Furthermore, CA 19-9 elevation trails radiographic detection of recurrent disease in 75% of instances, often by several months. 19,25,26 This tumor marker is also of questionable value in evaluating response to treatment. One study of nearly 1000 patients undergoing treatment for CRC found that decreasing CA 19-9 was concordant with radiographic response to treatment in only one-third of patients.…”

“…Prior studies have established that elevated pre-treatment CA 19-9 is most common in patients with advanced disease [15][16][17] and independently predicts impaired survival regardless of disease stage. 18 Despite this, research suggests that this tumor marker is of questionable value in the early detection of CRC recurrence 19 and most clinical guidelines do not endorse routine monitoring of CA 19-9. 7,20,21 Nonetheless in clinical practice there are situations where CEA is not elevated while the CA 19-9 can be elevated as a marker of CRC disease activity.…”

Evaluation of recurrent disease in the re-staging of colorectal cancer by 18F-FDG PET/CT: Use of CEA and CA 19–9 in patient selection

“…The poor performance of this biomarker compared with CEA has been reported, with serum CA 19-9 being greater than normal in only 20-40% of metastatic CRC cases (6). In the post-operative follow-up, additional CA 19-9 measurements do not increase the likelihood of detecting recurrence and monitoring the levels of this sole biomarker during chemotherapy (CHT) is not sufficient (7).…”