From the Guidelines
Elevated Carcinoembryonic Antigen (CEA) levels are primarily associated with colorectal cancer, but can also be elevated in several other conditions, including gastric, pancreatic, lung, and breast cancers, as well as non-malignant conditions such as inflammatory bowel disease, pancreatitis, and liver cirrhosis, as noted in studies such as 1 and 1.
Conditions Associated with Elevated CEA Levels
- Colorectal cancer: CEA is most commonly elevated in colorectal cancer, with levels often correlating with tumor burden and disease progression 1.
- Gastric cancer: Elevated CEA levels can also be seen in gastric cancer, although the specificity and sensitivity of CEA for gastric cancer are lower compared to colorectal cancer.
- Pancreatic cancer: CEA levels can be elevated in pancreatic cancer, particularly in cases of cholangiocarcinoma, as mentioned in 1.
- Lung cancer: Elevated CEA levels can be seen in lung cancer, especially in non-small cell lung cancer.
- Breast cancer: CEA levels can be elevated in breast cancer, particularly in cases of metastatic disease.
- Non-malignant conditions: CEA can be elevated in various non-malignant conditions, including:
- Inflammatory bowel disease
- Pancreatitis
- Liver cirrhosis
- Peptic ulcer disease
- Chronic obstructive pulmonary disease
- Smoking can also cause mild CEA elevation, as noted in general medical knowledge.
Clinical Utility of CEA
- CEA is not recommended as a screening test for cancer in the general population due to its limited specificity, as stated in 1.
- CEA is most valuable for monitoring treatment response and recurrence in patients with known CEA-producing cancers, particularly colorectal cancer, where rising levels may indicate disease recurrence before it's detectable by imaging, as discussed in 1.
From the Research
Conditions Involving Elevated CEA
Elevated Carcinoembryonic Antigen (CEA) levels are associated with various conditions, including:
- Colorectal cancer: Studies have shown that higher preoperative CEA levels are associated with advanced or metastatic disease and thus poorer prognosis 2, 3.
- Other types of cancer: Such as lung cancer, pancreatic cancer, and rectum cancer, which have been found to have high median levels of serum CEA 4.
- Noncancer diseases: Including lung fibrosis, uremia, chronic obstructive pulmonary disease, and Alzheimer's disease, which have also been associated with increased serum CEA levels 4.
- Aging: Healthy individuals older than 65 years old have been found to have higher median levels of serum CEA 4.
Specific Conditions with Elevated CEA
Some specific conditions that involve elevated CEA levels include:
- Colorectal cancer with liver metastases: Patients with liver metastases have been found to have higher CEA and alkaline phosphatase levels than patients with only localized disease 3.
- Mucinous adenocarcinoma and signet-ring cell carcinoma: These histopathologic types of colorectal cancer have been found to have different associations with preoperative serum CEA levels and oncologic outcomes 5.
- Classical adenocarcinoma: Elevated CEA levels have been found to be associated with poor prognosis and increased liver metastases in this type of colorectal cancer 5.
Patterns of Elevated CEA
Elevated CEA levels can occur in different patterns, including:
- Transient elevation: A temporary increase in CEA levels, which can occur in patients without recurrence 6.
- Repeated elevation: Multiple increases in CEA levels over time, which can occur in patients without recurrence 6.
- Persistent elevation: A continuous increase in CEA levels, which can occur in patients with recurrence 6.