From the Guidelines
Yes, CEA can be elevated in conditions other than cancer. While CEA is commonly used as a tumor marker, particularly for colorectal cancer, elevated levels can occur in several non-cancerous conditions, as noted in the 2006 ASCO update of recommendations for the use of tumor markers in gastrointestinal cancer 1. These include:
- Inflammatory bowel diseases like gastritis, peptic ulcer disease, and diverticulitis
- Liver diseases such as liver diseases
- Chronic obstructive pulmonary disease
- Diabetes
- Any acute or chronic inflammatory state
- Other non–cancer-related causes of elevated CEA, such as chemotherapy-associated CEA increases, which may be related to treatment-induced changes in liver function 1. It's essential to consider these factors when interpreting CEA levels, as elevated CEA levels should not be used alone for cancer diagnosis but rather as part of a comprehensive evaluation that includes other diagnostic tests and clinical assessment. The 2006 ASCO guidelines recommend measuring CEA at the start of treatment for metastatic disease and every 1 to 3 months during active treatment, with persistently rising values above baseline prompting restaging 1. However, caution should be used when interpreting a rising CEA level during the first 4 to 6 weeks of a new therapy, since spurious early rises may occur, especially after oxaliplatin use 1.
From the Research
CEA Elevation in Non-Cancerous Conditions
- CEA levels can be elevated in various non-cancerous conditions, including lung fibrosis, pancreatic diseases, uremia, chronic obstructive pulmonary disease, Alzheimer's disease, and benign lung diseases 2, 3.
- A study found that patients with 42 different diseases had significantly increased serum CEA levels compared to healthy controls, with the highest median levels observed in lung fibrosis, pancreatic cancer, uremia, and chronic obstructive pulmonary disease 2.
- Benign lung diseases, such as chronic obstructive pulmonary disease, pneumonitis, and interstitial lung disease, can also cause CEA elevations, with a positive rate of 5.99% reported in one study 3.
- CEA levels can also be elevated in healthy individuals older than 65 years, with a median level ranking 24th out of 49 diseases studied 2.
Factors Influencing CEA Elevation
- Age is a significant factor influencing CEA elevation, with older patients more likely to have elevated CEA levels 2, 3.
- Comorbidities, such as diseases of the circulatory system, endocrine diseases, and respiratory or heart failure, can also contribute to CEA elevation 3.
- Smoking and certain comorbidities can cause false-positive CEA results in colorectal cancer patients 4.
Clinical Implications
- CEA measurement is not sufficient to confirm or rule out cancer, and should be used in conjunction with other diagnostic tools 5, 6.
- Elevated CEA levels can indicate recurrence or metastasis in cancer patients, but can also be caused by non-cancerous conditions 2, 6, 4.
- A comprehensive analysis of CEA levels, including consideration of age, comorbidities, and other laboratory data, is necessary to accurately interpret results 3, 4.