Carcinoembryonic Antigen Test

Definition

The carcinoembryonic antigen (CEA) test is a laboratory blood study. CEA is a substance which is normally found only during fetal development, but may reappear in adults who develop certain types of cancer.

Purpose

The CEA test is ordered for patients with known cancers. The CEA test is most commonly ordered when a patient has a cancer of the gastrointestinal system. These include cancer of the colon, rectum, stomach (gastric cancer), esophagus, liver, or pancreas. It is also used with cancers of the breast, lung, or prostate.

The CEA level in the blood is one of the factors that doctors consider when determining the prognosis, or most likely outcome of a cancer. In general, a higher CEA level predicts a more severe disease, one that is less likely to be curable. But it does not give clear-cut information. The results of a CEA test are usually considered along with other laboratory and/or imaging studies to follow the course of the disease.

Once treatment for the cancer has begun, CEA tests have a valuable role in monitoring the patient's progress. A decreasing CEA level means therapy is effective in fighting the cancer. A stable or increasing CEA level may mean the treatment is not working, and/or that the tumor is growing. It is important to understand that serial CEA measurements, which means several done over a period of time, are the most useful. A single test result is difficult to evaluate, but a number of tests, done weeks apart, shows trends in disease progression or regression.

Certain types of cancer treatments, such as hormone therapy for breast cancer, may actually cause the CEA level to go up. This elevation does not accurately reflect the state of the disease. It is sometimes referred to as a "flare response." Recognition that a rise in CEA may be temporary and due to therapy is significant. If this possibility is not taken into account, the patient may be unnecessarily discouraged. Further, treatment that is actually effective may be stopped or changed prematurely.

CEA tests are also used to help detect recurrence of a cancer after surgery and/or other treatment has been completed. A rising CEA level may be the first sign of cancer return, and may show up months before other studies or patient symptoms would raise concern. Unfortunately, this does not always mean the recurrent cancer can be cured. For example, only a small percentage of patients with colorectal cancers and rising CEA levels will benefit from another surgical exploration. Those with recurrence in the same area as the original cancer, or with a single metastatic tumor in the liver or lung, have a chance that surgery will eliminate the disease. Patients with more widespread return of the cancer are generally not treatable with surgery. The CEA test will not separate the two groups.

Patients who are most likely to benefit from nonstandard treatments, such as bone marrow transplants, may be determined on the basis of CEA values, combined with other test results. CEA levels may be one of the criteria for determining whether the patient will benefit from more expensive studies, such as CT scan or MRI.

Precautions

The CEA test is not a screening test for cancer. It is not useful for detecting the presence of cancer. Many cancers do not produce an increased CEA level. Some noncancerous diseases, such as hepatitis, inflammatory bowel disease, pancreatitis, and obstructive pulmonary disease, may cause an elevated CEA level.

Description

Determination of the CEA level is a laboratory blood test. Obtaining a specimen of blood for the study takes only a few minutes. CEA testing should be covered by most insurance plans.

Preparation

No preparation is required.

Aftercare

None.

Risks

There are no complications or side effects of this test. However, the results of a CEA study should be interpreted with caution. A single test result may not yield clinically useful information. Several studies over a period of months may be needed.

Another concern is the potential for false positive as well as false negative results. A false positive result means the test shows an abnormal value when cancer is not present. A false negative means the test reveals a normal value when cancer actually is present.

Normal results

The absolute numbers which are considered normal vary from one laboratory to another. Any results reported should come with information regarding the testing facility's normal range.

Abnormal results

A single abnormal CEA value may be significant, but must be regarded cautiously. In general, very high CEA levels indicate more serious cancer, with a poorer chance for cure. But some benign diseases and certain cancer treatments may produce an elevated CEA test. Cigarette smoking will also cause the CEA level to be abnormally high.

Resources

BOOKS

Cooper, Dennis L. "Tumor Markers." In Cecil Textbook of Medicine, edited by J. Claude Bennet and Fred Plum. Philadelphia: W. B. Saunders Co., 1996.