Laboratory test · Cancer-related checks
CEA
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CEA
Description:
Sample: Serum, plasma (Li-heparinate, citrate plasma).
Blood is collected into a vacuum tube (vacutube) with a red cap and no additives, a vacuum tube containing gel, or a vacuum tube (vacutube) with a green cap (Li-heparinate).
The sample (serum, plasma) is stable at -20°C for 6 months, at 4 – 8°C for 7 days and at 15 – 25°C for 1 day.Carcinoembryonic antigen (CEA) is structurally a complex glycoprotein with a molecular mass of 20.000, associated with the plasma membrane of tumour cells, from which it can be released into the blood. It belongs to the group of oncofetal antigens normally secreted during embryonic and fetal development in gastrointestinal tissue and the pancreas as a cell-surface antigen, from which it is secreted into body fluids. In adults, CEA is found at very low concentrations, but tumours may secrete it again in greater amounts. Carcinoembryonic antigen (CEA) is not an organ-specific tumour marker, but is nevertheless one of the best-known and most recognised tumour markers. Its determination can be used in various tumours and has the greatest value in colorectal, pancreatic, gastric, breast and liver carcinoma, medullary thyroid carcinoma and bronchial carcinoma.
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CEA is used:
- when carcinoma is suspected,
- for monitoring treatment,
- for monitoring disease recurrence after treatment.
EA is most often used to monitor treatment success in patients with carcinoma. It is used in patients who have had surgery to assess the response to treatment and whether disease has recurred. In patients with smaller and earlier-stage tumours, the CEA concentration is low, while values are high in patients with advanced tumours or tumours that have spread throughout the body. When the CEA concentration reaches the reference range after treatment, the tumour producing CEA is considered to have been removed. If the CEA concentration remains elevated, this indicates that the tumour has remained or returned. If carcinoma has spread through the body (metastases), the CEA concentration may be found in other body fluids, not only in blood.
Determination:
Clinical significance:
Carcinoma cells readily produce large amounts of carcinoembryonic antigen (CEA): Elevated values may also be found in healthy people. CEA is used to monitor treatment of colorectal carcinoma, particularly when the tumour has metastasised outside the colon. Some other diseases may also cause increased CEA secretion.
CEA usually returns to normal 1-2 months after surgery.
Carcinoembryonic antigen (CEA) is also used to monitor disease recurrence after treatment. Research shows that a rise in CEA levels precedes clinical signs of recurrence by several months. Its determination should therefore be performed frequently: at least every three months and, if possible, monthly or every other month.
Because the CEA concentration may also be elevated in carcinomas other than colon carcinoma, its level can be used to monitor progression of those diseases and the response to treatment.
Although CEA was first recognised in patients with colon carcinoma, an abnormal blood CEA level is specific neither to colon carcinoma nor to malignant disease in general. Elevated CEA values may also be found in various other cancers, including melanoma, lymphoma and carcinoma of the pancreas, stomach, cervix, kidney, thyroid, liver, ovary, lung and breast; however, it is most often used in colon diagnostics, particularly in metastatic disease. CEA may also be elevated in non-malignant diseases (benign conditions), for example hepatitis, cirrhosis, pancreatitis and inflammatory diseases of the gastrointestinal tract and lungs. In benign diseases, the CEA concentration is most often 0.25 micro g/L within 10 days, which means that local recurrence has occurred. In metastases, the CEA increase is >1 micro g/L within 10 days.
1) Physiological changes in serum (plasma) CEA concentration
2) Pathological changes in serum (plasma) CEA concentration
A) Increased serum (plasma) CEA concentration in:
Uterine adnexa, unspecified / Acute myeloid leukaemia / Alcoholism / Anal polyp: Rectal polyp / Benign neoplasms of the brain and CNS / Biliary liver cirrhosis, unspecified / Liver diseases; Hepatic diseases / Kidney disease / Benign neoplasm of the breast / Benign neoplasm of the colon, rectum, anus and anal canal / Hepatocellular carcinoma; Liver cell carcinoma / Hodgkin’s disease / Infection / Bile duct stone without inflammation of the bile duct or gallbladder / Kidney carcinoma, malignant neoplasm of the kidney / Renal cell carcinoma / Carcinoma in situ of the breast / Bladder carcinoma, malignant neoplasm of the bladder / Prostate carcinoma / Small-intestine carcinoma / Testicular carcinoma, malignant neoplasm of the testicle (testis) / Uterine carcinoma, malignant neoplasm of the uterus / Colorectal carcinoma / Chronic lymphocytic leukaemia (CLL) / Chronic myeloid leukaemia / Chronic hepatitis / Chronic viral hepatitis C / Malignant diseases / Malignant neoplasms of the intrahepatic bile ducts / Malignancy of unspecified site (primary, secondary); Tumour metastases; secondary malignant neoplasms / Medullary thyroid carcinoma / Non-small-cell lung carcinoma / Non-Hodgkin lymphoma (Non-Hodgkin’s lymphoma) / Pancreatitis / Secondary malignant neoplasm of the liver; carcinoma metastases in the liver / Small-cell lung carcinoma (microcellular) / Squamous cell carcinoma (squamous, planocellular) / Viral hepatitis / Malignant neoplasm of the uterine cervix (cervix) / Malignant neoplasm of the large intestine (colon), colon carcinoma (large intestine) / Malignant neoplasm of the breast / Malignant neoplasm of the pancreas, pancreatic carcinoma, pancreas carcinoma / Malignant neoplasm of the oesophagus, oesophageal carcinoma / Malignant neoplasm of the liver, liver carcinoma, liver cell cancer / Malignant neoplasm of the liver,(metastases) unspecified / Malignant neoplasm of the adrenal gland / Malignant neoplasm of other and unspecified urinary organs / Malignant neoplasm of the ovary (Ovarian carcinoma) / Malignant neoplasm of the thyroid / Malignant neoplasm of connective and soft tissue, unspecified (Sarcoma) / Malignant neoplasm of the terminal large intestine (rectum), Rectal carcinoma / Malignant neoplasm of the stomach, stomach carcinoma, gastric cancer / Malignant neoplasm of female genital organs, unspecified / Malignant neoplasm of the gallbladder
B) Reduced serum (plasma) CEA concentration in:
Risk factors:
Low values:
- Biotin if more than 5 mg is given daily
- Haemolysis
- Kidney transplantation (failure and rejection of the kidney transplant)
- Values up to 13% lower in EDTA plasma
Elevated values:
- Alcoholism
- Obesity
- Haemodialysis
- Human anti-mouse antibodies
- Smoking
Result:
Reference range (depending on method, sex and age) :
Women and men: less than 4.6 micro g/L (less than 4.6 ng/ml)
Non-smokers: less than 4.6 micro g/L (less than 4.6 ng/ml)
Smokers: less than 10 micro g/L (less than 10 ng/ml)
Conversion factor (Conv – SI): ng/mL x 1 = mg/L
Conversion factor (SI – Conv): mg/L x 1 = ng/ml
CEA
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