What is the significance of elevated Carcinoembryonic Antigen (CEA) levels in patients with uterine fibroids?

CEA and Uterine Fibroids: Clinical Significance

Direct Answer

CEA is not routinely elevated in patients with uterine fibroids and should not be used for screening, diagnosis, or surveillance of benign gynecologic conditions including fibroids. 1

Understanding CEA in the Context of Fibroids

CEA Has No Established Role in Fibroid Evaluation

• The American Society of Clinical Oncology explicitly recommends against using CEA for screening, diagnosis, staging, or routine surveillance in gynecologic conditions. 1
• CEA is primarily a tumor marker for gastrointestinal and certain other malignancies, not gynecologic pathology. 2
• Only 50-60% of patients with metastatic disease (from appropriate cancer types) have elevated CEA levels, demonstrating its limited sensitivity even in malignancy. 1

When CEA Might Be Elevated Despite Fibroids

If CEA is elevated in a patient with known fibroids, consider alternative explanations:

• Gastrointestinal pathology - CEA elevation warrants evaluation for colorectal or other GI malignancies, not attribution to the fibroid. 3
• Inflammatory conditions - Gastritis, peptic ulcer disease, and liver diseases can elevate CEA. 3
• Age-related increases - CEA levels naturally increase with age, further confounding interpretation. 1
• Concurrent infections - One case report documented elevated CEA (400 μg/L) in multivisceral tuberculosis that resolved with treatment, despite a coexisting fibroid. 4

The Correct Tumor Marker for Fibroids: CA-125

CA-125, not CEA, may be elevated in patients with uterine fibroids:

• Over one-third (10/26) of patients with uterine fibroids had elevated CA-125 levels (>90th percentile) in one study. 5
• CA-125 levels correlated positively with fibroid volume as assessed by ultrasound. 5
• Hysterectomy or GnRH analogue therapy significantly decreased CA-125 levels in fibroid patients. 5
• CA-125 elevation in fibroids is thought to result from peritoneal distension by the enlarged uterus. 5

Clinical Algorithm When CEA is Elevated in a Fibroid Patient

Do not attribute elevated CEA to the fibroid. Instead:

1. Confirm the elevation by retesting to verify the result. 3
2. Evaluate for gastrointestinal malignancy with CT chest/abdomen/pelvis and colonoscopy if age-appropriate. 3
3. Consider non-malignant causes including liver disease, inflammatory bowel disease, and metabolic disorders. 3
4. Assess for other primary cancers where CEA may be relevant (breast, lung, pancreatic). 2, 3

Important Caveats

• One case report described markedly elevated CA19-9 (>1000 U/mL) with positive FDG-PET uptake in a uterine fibroid, which normalized post-hysterectomy - this demonstrates that other tumor markers (not CEA) can occasionally be elevated with fibroids. 6
• CEA has been studied in cervical cancer where it correlates with stage and can predict recurrence, but this is distinct from benign fibroids. 7, 8
• The presence of fibroids on imaging (ACR Appropriateness Criteria) does not include CEA measurement in the diagnostic or treatment planning algorithm. 2

Bottom Line for Clinical Practice

If you encounter elevated CEA in a patient with fibroids, the fibroids are coincidental - pursue standard CEA workup for malignancy. 1, 3 The fibroid itself does not explain or cause CEA elevation, unlike CA-125 which has documented association with fibroid size and resolves with fibroid treatment. 5