From the Guidelines
A mildly elevated Carcinoembryonic Antigen (CEA) level in the presence of a pelvic mass is concerning and warrants further investigation. The most recent and highest quality study, 1, published in 2016, suggests that a thorough workup is necessary to rule out cancer and determine the appropriate course of action. Here's what you should do:
- Consult with a gynecologist or oncologist immediately for a thorough evaluation.
- Schedule additional tests, including:
- Transvaginal ultrasound
- CT scan or MRI of the pelvis and abdomen
- Complete blood count and comprehensive metabolic panel
- Additional tumor markers like CA-125
- Prepare for a possible biopsy of the pelvic mass. The concern stems from the combination of an elevated CEA and the presence of a pelvic mass, which can indicate potential malignancy, as noted in 1 and 1. CEA is a nonspecific tumor marker that can be elevated in various cancers, including colorectal, ovarian, and other gynecological cancers. However, it's also important to note that CEA can be elevated in benign conditions or due to factors like smoking, as mentioned in 1. The pelvic mass could be benign as well, such as a fibroid or ovarian cyst. Nonetheless, the combination necessitates a thorough workup to determine the appropriate course of action.
From the Research
Carcinoembryonic Antigen (CEA) Levels and Pelvic Mass
- A mildly elevated CEA level in the presence of a pelvic mass may not necessarily be concerning, as elevated CEA levels can occur in patients with benign gastrointestinal and hepatic disorders, such as liver disease, pancreatitis, and colonic polyps 2.
- Studies have shown that mildly elevated CEA levels (less than 10 ng/ml) can be associated with benign conditions, and a single elevated serum CEA level does not justify further diagnostic procedures if clinical signs of a disease are absent 3.
- However, elevated CEA levels have been associated with an increased risk of colorectal cancer, particularly in patients with colorectal adenomata, and may indicate advanced or metastatic disease 4, 5.
- In the context of medullary thyroid cancer, abnormal CEA levels have been associated with tumor progression, lymph node metastases, and distant metastasis 6.
Factors Influencing CEA Levels
- Liver disease, such as cirrhosis and hepatitis, can influence CEA levels, and a damaged liver may further augment elevated CEA levels due to cancer 2.
- Smoking may contribute to increased CEA levels in patients with alcoholic liver disease and pancreatitis 2.
- CEA levels may also be influenced by other factors, such as patient selection and the presence of other diseases, and therefore, interpretation of CEA levels should consider both benign and malignant etiologies 2, 4.
Investigation of Elevated CEA Levels
- Algorithms have been proposed to guide the investigation of patients with elevated CEA levels, including those with a history of colorectal cancer and those with de novo elevated CEA levels 5.
- Further diagnostic procedures, such as imaging studies and biopsies, may be necessary to determine the cause of elevated CEA levels, particularly in patients with clinical signs of a disease or increasing CEA levels 3, 5.