Re: CEA count

May 9, 2003

- I don't have a clue about CEA counts but I do have a question

about them. When my husband was told he had a 'mass' in his abdomen but

before we knew it was cancer, a CEA test was run and his CEA count was 0

(zero). That's one of the reasons why I was shocked when the surgeon

found a 6.5 x 5.5 x 2.5 cancerous tumor (in other words - a large tumor,

not an itty-bitty thing).

We had been told the 0 CEA was a good thing. Now I wonder if a future

CEA with a 0 count will mean anything. I'm sure a rising count would

not be good news but another 0 wouldn't give me much comfort at this

point.

I hope someone can answer both our questions.

Best wishes for a great outcome,

Peggy

brian_meis wrote:

> Hey guys,

>

> sorry I haven't been here more, but I did have a quick question

> regarding the CEA count. Basically, my dad had part of his colon

> removed in December. They were able to reattatch and everything was

> looking wonderful. The radiologist did some bloodwork, and found

> his CEA count to be elevated again, to a count of 6.4. The guy said

> that normally, it should be a 3, but his was as high as 12 when he

> was at his worst with the cancer. He finished chemo last month, and

> we are all really surprised that he would have to be concerned with

> a reoccurance so soon. They had pretty well thought he was cancer

> free as of last month. Is there a lot of hope that something else

> could have caused the elevation or is this pretty likely to be a

> return visit from the cancer?

>

> He gets a cat-scan on Fri (1 wk) - the wait sucks...

>

May 9, 2003

Hi guys,

I think the answers to your questions are in the snips below....CEA

is less likely to be elevated in non-metastatic cancer, so that is

why they cannot use it as a screening test for CC or any other

cancer. Not surprising for a stage II to have " normal " CEA.

There are even some metastatic cancers which have " normal " CEA; it

has been postulated that these are related to what is

called " cellular differentiation " . Different types of tissue -

liver, lung, etc. have cells which " look " under the microscope very

different or " differentiated " from each other. Cancer cells are

classified as well, moderate, or poorly differentiated depending on

how much of the structure they have retained from the cell of

origin. So, with poorly differentiated cells, they are a wild mess

and you could not tell by looking at them what organ they came from.

Well differentiated cells would more closely resemble their original

source, maybe could even identify this source by examining the cancer

cells.

Anyway, the theory is that some poorly differentiated cancers don't

express CEA for some reason (see below).

CEA can be elevated in smokers (up to 5), can be elevated without

tumors visible on scans, and this situation can go on for months (as

has been the case for some here). There are other things such as

infections which could cause SLIGHT rise in CEA.

Key thing to look for is 2 or 3 measurements in a row showing

rise...that tends to indicate growing tumor. Stable but elevated is

USUALLY not as much cause for concern...

<<We had been told the 0 CEA was a good thing. Now I wonder if a

future CEA with a 0 count will mean anything. I'm sure a rising

count would not be good news but another 0 wouldn't give me much

comfort at this point>>

Definitely IS a good thing...just not a " guarantee " . Unfortunately,

few guarantees on anything in Cancerworld...everything is a

probability. Probability of recurrence may be high or may be low,

but in the final analysis its all just a guess and no one can say for

sure what will happen.

Best,

**********************************************************************

REFERENCES:

http://www.med.mcgill.ca/mjm/issues/v03n01/cea.html

[snip]

Concentrations of 2.5-5.0 ng/ml (depending upon the assay used) are

commonly considered cut-off points for distinguishing normal from

abnormal levels of serum or plasma CEA. In two large surveys of

apparently healthy persons, 85 to 87% had serum antigen levels of

less than 2.5 ng/ml, 95 to 98% had levels of less than 5 ng/ml and

virtually no one had a level greater than 10 ng/ml (74, 75). CEA

concentrations are, in general, more often raised in smokers than in

non-smokers (73,76), and more frequently elevated in men than in

women (77). The same is true for older subjects when compared with

younger individuals (78,79). Racial differences in the frequency of

serum elevations of CEA have been suggested (80) but not established.

Although guidelines for the appropriate use of CEA assays have been

reported, Fletcher (81) argues that physicians in practice apparently

have greater confidence in the practical value of CEA measurements

than do " experts " in the field. In one study in 1979, over 50% of

physicians believed that a CEA assay was worthwhile for initial

detection of colonic cancer and that elevated serum levels of CEA in

a non-smoking person without symptoms should prompt an aggressive

search for colonic cancer. Both premises were questioned by

investigators in the CEA field at that time (82).

Currently available CEA assays cannot be used as screening tests

(strictly defined as procedures for detection of disease in

asymptomatic individuals) for colorectal cancer, insofar as false-

negative tests can be obtained. For example, in earlier stages of

colorectal cancer (Dukes Stages A and , CEA level is less likely to

be elevated. By contrast, assays for CEA more readily detect advanced

colorectal cancer of Dukes Stages C and D (74,81,83-85). Again due to

the lack of sensitivity of existing tests, CEA assays perform no

better in screening for other cancers commonly associated with

elevated CEA levels

http://consensus.nih.gov/cons/028/028_statement.htm

It should be remembered, moreover, that the correlation between

increasing plasma CEA levels and progressive cancer is not always

perfect and that a normal CEA cannot be taken as evidence of

localized disease or remission. About 15 to 20 percent of patients

with proved malignancies never have elevated plasma levels. Such

false negatives may be related to the degree of tumor

differentiation. Poorly differentiated colorectal carcinomas, for

example, tend to be associated with a reduced proclivity for CEA

expression and release.

May 9, 2003

so, he was stage 3 - it had perforated the colon...what is

considered to be " normal " at this point after having the colon

partially removed. Sorry, I'm not quite as intellegent as you, nor

have I the wide vocab you seem to, so I am a bit confused by your

response. I know it's not black and white...just curious what shade

of gray...

thanks!!

> Hi guys,

>

> I think the answers to your questions are in the snips

below....CEA

> is less likely to be elevated in non-metastatic cancer, so that is

> why they cannot use it as a screening test for CC or any other

> cancer. Not surprising for a stage II to have " normal " CEA.

>

> There are even some metastatic cancers which have " normal " CEA; it

> has been postulated that these are related to what is

> called " cellular differentiation " . Different types of tissue -

> liver, lung, etc. have cells which " look " under the microscope

very

> different or " differentiated " from each other. Cancer cells are

> classified as well, moderate, or poorly differentiated depending

on

> how much of the structure they have retained from the cell of

> origin. So, with poorly differentiated cells, they are a wild

mess

> and you could not tell by looking at them what organ they came

from.

> Well differentiated cells would more closely resemble their

original

> source, maybe could even identify this source by examining the

cancer

> cells.

>

> Anyway, the theory is that some poorly differentiated cancers

don't

> express CEA for some reason (see below).

>

> CEA can be elevated in smokers (up to 5), can be elevated without

> tumors visible on scans, and this situation can go on for months

(as

> has been the case for some here). There are other things such as

> infections which could cause SLIGHT rise in CEA.

>

> Key thing to look for is 2 or 3 measurements in a row showing

> rise...that tends to indicate growing tumor. Stable but elevated

is

> USUALLY not as much cause for concern...

>

> <<We had been told the 0 CEA was a good thing. Now I wonder if a

> future CEA with a 0 count will mean anything. I'm sure a rising

> count would not be good news but another 0 wouldn't give me much

> comfort at this point>>

>

> Definitely IS a good thing...just not a " guarantee " .

Unfortunately,

> few guarantees on anything in Cancerworld...everything is a

> probability. Probability of recurrence may be high or may be low,

> but in the final analysis its all just a guess and no one can say

for

> sure what will happen.

>

> Best,

>

*********************************************************************

*

>

> REFERENCES:

>

> http://www.med.mcgill.ca/mjm/issues/v03n01/cea.html

>

> [snip]

> Concentrations of 2.5-5.0 ng/ml (depending upon the assay used)

are

> commonly considered cut-off points for distinguishing normal from

> abnormal levels of serum or plasma CEA. In two large surveys of

> apparently healthy persons, 85 to 87% had serum antigen levels of

> less than 2.5 ng/ml, 95 to 98% had levels of less than 5 ng/ml and

> virtually no one had a level greater than 10 ng/ml (74, 75). CEA

> concentrations are, in general, more often raised in smokers than

in

> non-smokers (73,76), and more frequently elevated in men than in

> women (77). The same is true for older subjects when compared with

> younger individuals (78,79). Racial differences in the frequency

of

> serum elevations of CEA have been suggested (80) but not

established.

>

> Although guidelines for the appropriate use of CEA assays have

been

> reported, Fletcher (81) argues that physicians in practice

apparently

> have greater confidence in the practical value of CEA measurements

> than do " experts " in the field. In one study in 1979, over 50% of

> physicians believed that a CEA assay was worthwhile for initial

> detection of colonic cancer and that elevated serum levels of CEA

in

> a non-smoking person without symptoms should prompt an aggressive

> search for colonic cancer. Both premises were questioned by

> investigators in the CEA field at that time (82).

>

> Currently available CEA assays cannot be used as screening tests

> (strictly defined as procedures for detection of disease in

> asymptomatic individuals) for colorectal cancer, insofar as false-

> negative tests can be obtained. For example, in earlier stages of

> colorectal cancer (Dukes Stages A and , CEA level is less likely

to

> be elevated. By contrast, assays for CEA more readily detect

advanced

> colorectal cancer of Dukes Stages C and D (74,81,83-85). Again due

to

> the lack of sensitivity of existing tests, CEA assays perform no

> better in screening for other cancers commonly associated with

> elevated CEA levels

>

> http://consensus.nih.gov/cons/028/028_statement.htm

>

> It should be remembered, moreover, that the correlation between

> increasing plasma CEA levels and progressive cancer is not always

> perfect and that a normal CEA cannot be taken as evidence of

> localized disease or remission. About 15 to 20 percent of patients

> with proved malignancies never have elevated plasma levels. Such

> false negatives may be related to the degree of tumor

> differentiation. Poorly differentiated colorectal carcinomas, for

> example, tend to be associated with a reduced proclivity for CEA

> expression and release.

May 9, 2003

Sorry. I think the bottom line is that a CEA of around 6 in a stage

III is PROBABLY a little bit " off " , but that does not necessarily

mean when they do the scan they will see any tumors.

What is considered " high " will vary from lab to lab because the

equipment/process they use to get the numbers are different in

different labs. Roughly, 3 is considered the " upper limit " of normal

(for nonsmokers).

HOWEVER, if your Dad is a smoker, this could POSSIBLY explain an

elevated CEA. CEA's up to around 5 or so are considered " normal " for

smokers. Similiarly, if he has had a recent infection, that could

also cause a slight elevation. So in other words, yes there are

reasons besides cancer which COULD be causing this.

2 or 3 CEA measurements, each a month or so apart and showing a

rising trend, would be a more definite sign of recurrent cancer than

a single elevated measurement.

There are several on this board (perhaps they will comment!) who have

had " slightly elevated " CEA as you are describing, but nothing was

seen on scans repeated at regular intervals for a number of months.

Sorry this may sound a bit vague and fuzzy (it is!), but

unfortunately there are few absolutes when dealing with cancer.

Best,

> so, he was stage 3 - it had perforated the colon...what is

> considered to be " normal " at this point after having the colon

> partially removed. Sorry, I'm not quite as intellegent as you, nor

> have I the wide vocab you seem to, so I am a bit confused by your

> response. I know it's not black and white...just curious what

shade

> of gray...

>

> thanks!!

May 9, 2003

- Once again you have provided clarity in a confused

situation....not only the CEA information but the 'differentiation'

explanation. No wonder I was confused - " poorly differentiated " is good

and " well differentiated " is bad....! Tim's was " moderately

differentiated " which apparently is not as good as " poorly diff'ed " and

not as bad as " well-diff'd " ! :-)

I've now read up to message 1346....almost halfway there...or it is

here! Since joining this group I understand in a whole new way the

meaning to the scripture that says " Rejoice with them that do rejoice,

and weep with them that weep. " Please know you are all in my thoughts

and prayers and I rejoice and weep with each one as updates are posted

Thanks so much. Hope you are feeling well and figuring out what your

next step is.

Peggy

altman23 wrote:

> Hi guys,

>

> I think the answers to your questions are in the snips below....CEA

> is less likely to be elevated in non-metastatic cancer, so that is

> why they cannot use it as a screening test for CC or any other

> cancer. Not surprising for a stage II to have " normal " CEA.

>

> There are even some metastatic cancers which have " normal " CEA; it

> has been postulated that these are related to what is

> called " cellular differentiation " . Different types of tissue -

> liver, lung, etc. have cells which " look " under the microscope very

> different or " differentiated " from each other. Cancer cells are

> classified as well, moderate, or poorly differentiated depending on

> how much of the structure they have retained from the cell of

> origin. So, with poorly differentiated cells, they are a wild mess

> and you could not tell by looking at them what organ they came from.

> Well differentiated cells would more closely resemble their original

> source, maybe could even identify this source by examining the cancer

> cells.

May 9, 2003

Hi Peggy,

<< " poorly differentiated " is good and " well differentiated " is bad>>

No, actually the reverse...poorly differentiated is bad, its more

aggressive, the cells have gone so wild they are not even

recognizable as colon cells. Well differentiated is better, cancer

cells retain some of the properties of normal colon cells. MOST

patients have moderately differentiated...

Tricky stuff, isn't it lol!

<<figuring out what your next step is>>

Thanks for asking...supposed to see the oncologist Monday. Guess he

will ask me what I'm going to do. Will probably try to get a clue

from him if given this history he thinks chemo can slow anything or

not...if so, thinking of Xeloda as best option.

BTW, I know you have a post or two I haven't answered yet (got behind

this week), will do so soon ;o)

Best,

May 10, 2003

Tricky stuff indeed.

" At least I had the 'moderately differentiated' right! " she said

sheepishly.

Peggy :-}

altman23 wrote:

>

> Tricky stuff, isn't it lol!

>

May 12, 2003

CEA is only expressed by some colon cancer tumors. My sisters tumor did not. In

your husband's case it isn't going to be a reliable monitoring test even if the

docs can get a cea count at some point because it is rising and falling in

relation to the cancer.