Synonym

CEA (Blood)

Tubes

• Red or lavender top tube
• 7 mL of venous blood

Additional information

• State whether patient is a smoker or nonsmoker on the request form
• Heparin use should be withheld for 2 days prior to the test
• Handle sample gently to prevent hemolysis
• Same type of collection container and assay method must be used if serial measurements are to be taken

Info

• Carcinoembryonic antigen (CEA) measures the concentration of an antigen that may be expressed in malignancies that derive from the entodermal (embryonic) or gastrointestinal tissues
• CEA is an oncofetal glycoprotein produced normally by embryonic entodermal epithelium and fetal gastrointestinal tissue. The production stops before birth, but may increase later in endodermally derived adenocarcinomas
• This test is neither organ nor tumor specific; however, in cases of cancer where pre-treatment CEA levels were elevated; this test can be used to monitor for recurrence
• Although this test is a tumor marker, it is not diagnostic or specific as is not recommended as a screening test for any specific disease or cancer
• The percent of patients with various conditions with positive (CEA>3.0 ng/mL) levels are listed below
• Colorectal cancer (57%)
• Gastric cancer (41%)
• Hepatocellular carcinoma (45%)
• Pancreatic carcinoma (59%)
• Biliary carcinoma (59%)
• Inflammatory bowel disease (17%)
• Chronic gastritis/ulcer (14%)
• Cirrhosis/hepatitis (17%)
• Pancreatitis (21%)
• Lung (Non-small cell carcinoma) [87%]
• 95% of healthy non-smokers have a serum CEA of <3.0 ng/mL
• 85% of healthy smokers have a serum CEA of <5.0 ng/mL
• In patients with known malignancy, persistent elevated levels indicate residual or metastatic carcinoma
• Levels >10 ng/mL suggest extensive disease
• Levels >20 ng/mL suggest metastatic disease

Clinical

• CEA is clinically useful in the following conditions:
• To monitor response to antineoplastic therapy in patients with known malignancy and elevated CEA levels
• To assess the adequacy of surgical resection in patients with:
• Medullary thyroid cancer
• Neoplasms of
• Breast
• GI tract
• Lung
• Colorectal
• To monitor progress of treatment or for recurrence of cancers of (where the patient had elevated CEA pre-treatment):
• Colon-Rectum
• Pancreas
• Breast
• Gastric cancer
• GI tract cancers (Others)
• Liver cancer
• Lung cancer
• Cancer of the ovaries
• Cancer of the prostate
• To assist in preoperative staging of colorectal cancer
• To detect recurrence of cancer

• Persistent high levels of CEA suggests residual or recurrent tumor. If levels exceed normal values before surgical resection, chemotherapy, or radiation therapy, their return to normal within 6 wks after surgery is consistent with successful treatment
• The CEA assay complements the use of liver scan for detecting liver metastases
• Used as an adjunct to cytology in the diagnosis of malignant pleural effusions
• CEA has a sensitivity of 63% in colorectal carcinomas and the sensitivity varies at different stages of colon cancer
• Depending on the stage of cancer, CEA values can vary
• Increased in <25% of Dukes A and B stage
• Increased in 50% of Dukes C stage
• Increased in 75% of Dukes D stage
• Not increased in poorly differentiated tumors

Additional information

• Intra-individual variation of as much as 30-35% may be seen in individuals with elevated CEA
• Detection of CEA in other body fluids such as peritoneal or cerebrospinal fluid is suggestive of metastatic disease
• Factors interfering with test results include:
• Hemolyzed specimen
• Smoking (false increase)
• Hemoconcentration
• Related laboratory tests
• Alanine aminotransferase (ALT/SGPT)
• Alkaline phosphatase
• Amylase
• Aspartate aminotransferase (AST/SGOT)
• Biopsy of suspicious tissue
• Chest CT scan
• Chest X-ray
• CSF special studies - CEA
• GGT
• Lipase

Nl Result

Consult your laboratory for their normal ranges as these may vary somewhat from the ones listed below.

• Note that results between assays should be compared if a patient is going to be followed with a different CEA assay

High Result

Conditions associated with elevated serum CEA include:

• >3 ng/mL
• Metastatic or recurrence of colon cancer
• Germ cell tumor
• Pancreatic tumor
• Lung cancer
• Stomach cancer
• Metastatic breast cancer
• Ovarian tumor
• Bladder cancer
• Neuroblastoma
• Leukemia
• Thyroid carcinoma
• Osteogenic carcinoma
• >10 ng/mL: CEA producing tumors
• Abnormal values in other conditions not associated with cancer
• Alcoholic cirrhosis
• Cholecystitis
• Chronic obstructive pulmonary disease (COPD)
• Chronic renal failure
• Cirrhosis
• Fibrocystic breast disease
• Heavy smoking
• Inflammatory bowel disease
• Active ulcerative colitis
• Cholecystitis
• Diverticulitis
• Pancreatitis
• Peptic ulcer
• Pregnancy
• Pulmonary infections
• Rectal polyps

References

• ARUP Laboratories®. Carcinoembryonic Antigen. [Homepage on the internet]©2007. Last accessed on April 26, 2007. Available at URL: http://www.aruplab.com/guides/ug/tests/0080080.jsp
• Bates SE. Clinical applications of serum tumor markers. Ann Intern Med 1991;115:623-38.
• Gulyas M et al. Value of carcinoembryonic antigen (CEA) and cholesterol assays of ascitic fluid in cases of inconclusive cytology. J Clin Pathol. 2001 Nov;54(11):831-5
• Kuusela P, et al. Comparison of a new tumour marker CA 242 with CA 19-9, CA 50 and carcinoembryonic antigen (CEA) in digestive tract diseases. Br J Cancer 1991;63:636-40.
• LabTestsOnline®. CEA. [Homepage on the Internet] © 2001-2006. Last reviewed on June 24, 2006. Last accessed on September 6, 2006. Available at URL: http://www.labtestsonline.org/understanding/analytes/cea/glance.html
• MedlinePlus Medical Encyclopedia®. CEA.[Homepage on the Internet]©2005. Last updated on January 26, 2005. Last accessed on September 6, 2006. Available at URL: http://www.nlm.nih.gov/medlineplus/ency/article/003574.htm#Special%20considerations
• National Library of Medicine. CEA (Carcinoembryonic Antigen): Its Role as a Marker in the Management of Cancer. [Homepage on the Internet] Last accessed on September 6, 2006. Available at URL:http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.section.46291
• Perkins GL et al. Serum tumor markers. Am Fam Physician. 2003 Sep 15;68(6):1075-82. Available at URL: http://www.aafp.org/afp/20030915/1075.html
• Slodkowska J, et al. Expression of CEA and trophoblastic cell markers by lung carcinoma in association with histological characteristics and serum marker levels. Eur J Cancer Prev. 1998 Feb;7(1):51-60.
• Watine J et al. Laboratory variables and stratification of metastatic colorectal cancer patients: recommendations for therapeutic trials and for clinical practice guidelines. Clin Chim Acta. 2004 Jul;345(1-2):1-15.