Carcino Embryonic Antigen (CEA)

Cancer

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Fasting Required

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CEA is a glycoprotein involved in cell adhesion, normally produced in fetal development

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Carcino Embryonic Antigen (CEA) - Comprehensive Test Guide

Why is it done?
- CEA is a protein produced by certain tumor cells and some normal tissues. It is primarily used as a tumor marker to detect and monitor various cancers, particularly colorectal cancer.
- Cancer Screening and Detection: Monitoring for colorectal, lung, breast, pancreatic, ovarian, and gastric cancers
- Cancer Prognosis: Elevated levels at diagnosis may indicate more advanced disease
- Treatment Monitoring: Tracking response to cancer therapy and detecting recurrence during follow-up care
- Recurrence Detection: Rising CEA levels after treatment may indicate cancer recurrence
- Typical Timing: Baseline testing before treatment, regular intervals during and after therapy, and as part of long-term cancer surveillance
Normal Range
- Standard Reference Range: Less than 2.5-5.0 ng/mL (nanograms per milliliter), depending on laboratory standards
- Smokers: May have reference ranges up to 10 ng/mL due to increased baseline CEA production
- Units of Measurement: Nanograms per milliliter (ng/mL) or micrograms per liter (μg/L)
- Interpretation:
- Normal Result: Level below the upper limit of normal suggests absence of cancer, though does not completely exclude malignancy
- Elevated Result: Level above normal range may indicate cancer presence, recurrence, or other benign conditions
- Borderline Values: May warrant repeat testing or additional investigation
Interpretation
- Mildly Elevated (5-10 ng/mL): May indicate smoking, benign liver disease, inflammatory bowel disease, or early-stage malignancy
- Moderately Elevated (10-50 ng/mL): Suggests possible malignancy or significant benign pathology; typically warrants investigation
- Markedly Elevated (>50 ng/mL): Highly suggestive of advanced cancer or extensive benign disease; requires prompt clinical evaluation
- Rising Trend Over Time: Serial increases suggest disease progression or recurrence, even if absolute values remain in mild elevation range
- Falling Trend After Treatment: Generally indicates good response to therapy; normalization suggests effective cancer treatment
- Factors Affecting Results:
- Smoking Status: Smokers typically have 2-3 times higher CEA levels
- Benign Conditions: Cirrhosis, hepatitis, inflammatory bowel disease, peptic ulcer disease, pneumonia, chronic obstructive pulmonary disease
- Age: Levels tend to increase slightly with age
- Clinical Significance: CEA is most useful as a serial marker rather than a single absolute value; trends are more clinically significant than individual results
Associated Organs
- Primary Organ Systems:
- Gastrointestinal Tract: Most commonly associated with colorectal cancer; also stomach, pancreas, and biliary system cancers
- Respiratory System: Elevated in lung cancer and chronic respiratory diseases
- Reproductive System: Associated with breast, ovarian, uterine, and prostate cancers
- Hepatic System: Elevated in liver cancer and hepatic metastases
- Conditions Associated with Abnormal Results:
- Malignancies: Colorectal (most common), lung, breast, ovarian, pancreatic, gastric, liver, and biliary tract cancers
- Benign Gastrointestinal Diseases: Crohn's disease, ulcerative colitis, peptic ulcer disease, polyps
- Hepatic Conditions: Cirrhosis, hepatitis, fatty liver disease
- Pulmonary Conditions: Chronic obstructive pulmonary disease, pneumonia, tuberculosis
- Potential Complications Associated with Abnormal Results:
- Metastatic Disease: Very elevated levels suggest cancer spread to distant organs
- Treatment Resistance: Rising levels despite treatment may indicate chemotherapy resistance
- Poor Prognosis: Markedly elevated levels at diagnosis correlate with reduced survival rates
Follow-up Tests
- Additional Tests Based on Elevated CEA:
- Imaging Studies: CT scan of abdomen/pelvis, MRI, positron emission tomography (PET) scan, chest X-ray
- Colonoscopy: For suspected or confirmed colorectal cancer; biopsy may be performed
- Endoscopy/Upper GI Imaging: For suspected gastric or esophageal cancer
- Tissue Biopsy: Definitive diagnosis of malignancy; histological confirmation
- Laboratory Tests: Liver function tests, complete blood count, other tumor markers (CA 19-9, PSA, CA-125)
- Monitoring Frequency:
- During Treatment: Every 1-3 months depending on treatment protocol
- Post-Treatment Surveillance: Every 3-6 months for first 2-3 years, then annually for 5 years
- Long-term Follow-up: Annually or as clinically indicated based on individual risk
- Related Complementary Tests:
- CA 19-9: For pancreatic and gastrointestinal cancers
- CA-125: For ovarian and other gynecologic cancers
- PSA (Prostate Specific Antigen): For prostate cancer monitoring
- AFP (Alpha-Fetoprotein): For liver cancer surveillance
Fasting Required?
- Fasting Required: No - fasting is not required for CEA testing
- Specimen Collection: Simple blood draw from a vein, usually in the arm
- Timing: Can be done at any time of day
- Medications: No specific medications need to be avoided before testing; continue regular medications as prescribed
- Patient Preparation:
- Notify Laboratory: Inform laboratory personnel of smoking status, as this affects interpretation
- Comfortable Positioning: Sit comfortably for 5 minutes before blood draw to ensure accurate results
- Serial Sampling: If multiple CEA levels are being drawn over time, try to use same laboratory and phlebotomy team for consistency
- Additional Notes:
- Results: Typically available within 24-48 hours
- Stability: Baseline levels should be established before cancer diagnosis or treatment when possible
- Consistency: Serial measurements should be taken at similar times during circadian rhythm for better trend analysis

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