Rising CEA after stage II colorectal cancer

Last Modified: September 26, 2004

Dear OncoLink "Ask The Experts,"
I was diagnosed in July 2001 with Stage II colorectal cancer, at age 33. I underwent surgery, radiation & chemotherapy. I was running CEA's of 1.9, but the last blood work just came back at 3.6. I was just wondering if there are any other factors that can lead to an increase in my CEA level?

Timothy C. Hoops, MD, Clinical Assistant Professor of Medicine in the Gastroenterology Division at the University of Pennsylvania and Director of Gastroenterology at Penn Medicine at Radnor, responds:

Following CEA levels alone is not sufficient as a follow-up of colon cancer and it is important to also have CT scans and repeat colonoscopies. Since you were treated with radiation therapy, I must assume you probably had rectal cancer . This is important because rectal cancers tend to have higher rates of local recurrence than other colon cancers that come back at more distant sites. A CEA of 3.6 is probably still normal but if it were to continue to increase, a careful evaluation for recurrent disease would be necessary. If you recently had that evaluation, it is a reasonable approach to repeat the level in a couple of months. If you haven't had a formal evaluation including a CT scan and physical examination, you should contact your physician to further discuss follow-up evaluations.

You are correct that other factors, such as smoking, do influence CEA levels. Other cancers can also lead to an elevated CEA and if it continues to rise without a colorectal source, it might be necessary to expand the search to other sites.

I would stress that this is a trend of elevation, but this number is too low to say anything specifically about recurrent colorectal cancer. You will need time to see if this is just a "normal" bump or whether this represents a true trend.