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Dr. Andrew Rynne

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Exp 50 years

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Is increase in CEA readings after colon tumor surgery normal?

Answered by
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Dr. Prashant Sharma

Oncologist, Surgical

Practicing since :2003

Answered : 177 Questions

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Posted on Thu, 7 Aug 2014 in Cancer
Question: My dad had surgery to remove colon tumor in march. He was dukes c1.

Only three weeks ago he started xeloda.

However his cea reafing may was 3, XXXXXXX 4 and
Now july its 5. We worried re the rise. Can this b mets?
doctor
Answered by Dr. Prashant Sharma 15 hours later
Brief Answer:
may be

Detailed Answer:
Hi XXXXXXX madam.

I am sorry to know about your father's condition. I need more details about his condition so that I am better able to help.

The most important fact here is baseline level of CEA, which will make a reference value. so I would like to know the CEA value before surgery.
Another point is your father is a smoker, but is he smoking presently also?

Otherwise in my experience a progressive rise in CEA level after surgery is of concern if there is no other pathology in body.

So please reply with the details.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Prashant Sharma 50 minutes later
Yes he is a smoker so i know that cea can be bit high, but the concern is the rise from 3,4 and now 6.

He had surgery in march to remove tumor and the scans prior to surgery were clear
doctor
Answered by Dr. Prashant Sharma 13 minutes later
Brief Answer:
CEA level before surgery?

Detailed Answer:
Thanks for your reply madam.

But still I'm unanswered. I can understand that the scans were clear that's why a radical surgery was done.

I would still like to know .....
1. the CEA level before surgery.
2. does your father smoke presently after surgery.
Your answers will help in further discussion

Thanks
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Prashant Sharma 14 minutes later
No cea test done prior to surgery. Yes he still smokes.
doctor
Answered by Dr. Prashant Sharma 22 minutes later
Brief Answer:
Described below

Detailed Answer:
Hi madam.

The rise in CEA is small but progressive. The better idea is to ask him stop smoking and do CEA after 1 month of such gap. There are nicotine chewing gums available which may help him in coming out of addiction (the trade names of which differ in different cities).

As scans were clear in march, with such slow rise in CEA, the scans if done will be clear still. Because the imaging can't detect tumors of less than 5 mm.
The CEA level is an indirect indicator of tumor burden.

The following information would be important:

1. give some time to xeloda to act. At least two to three cycles of chemotherapy should be taken in full dose before assigning a drug as ineffective. Rise in cea on xeloda will directly indicate that tumor is resistant to xeloda.

2. the imaging should help us in treatment. Unnecessary imaging will increase cost of treatment only. So at present even if we find a small tumor somewhere, the treatment will be same before we assign xeloda ineffective.

Hope it helps.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Prashant Sharma 15 minutes later
So at present it is not the case that there mets in
Liver, lungs etc?

Does the rise mean cancer cells are lurking in the body?

But usually a cea should not rise right like this progressively. Even in may he smoked and it was 3 then.
doctor
Answered by Dr. Prashant Sharma 30 minutes later
Brief Answer:
Nothing can be said definitely

Detailed Answer:
Madam,

Don't imagine so much on cellular level, neither I can see nor you.

You are right that CEA should not rise progressively. But we should rule out that it is due to smoking.

You will not get any thing in book as to what should be done when CEA is slowly rising in such a way. The answer to your question can be given by experience only. In my experience this is alarming. But presently I can't say that it is due to mets or due to smoking. there is no test to rule out mets even. So better idea is to stop the factor in our control i.e. smoking. Now with time if cea still rises it will indicate disease.

But what will you do if you find a disease inside- surgery or heavy chemotherapy. (the answer will solve your anxiety) if you opt for chemotherapy, why only xeloda is given presently, that too only for last 15 days not earlier. If you want surgery for operable metastasis then only early imaging is helpful. If you will continue same treatment, no need of imaging, just do CEA after 1 month.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Prashant Sharma 17 minutes later
I dont think
Its smoking as it would not rise right in three months from 3-6.?

If it were mets would cea not b even higher ?
doctor
Answered by Dr. Prashant Sharma 15 minutes later
Brief Answer:
You may be right.

Detailed Answer:
madam,

As I said CEA is an indicator of burden of disease. If burden is small, CEA will be low. If tumor cells are multiplying, CEA will go on increasing. The rate of increase in CEA will depend upon the speed of progression of tumor. If you stop the progression, CEA will be static. If you kill tumor cells, CEA will come down. Slow rise in CEA may indicate a very slow progression in disease, which is difficult to quantify and in my experience difficult to see on imaging now.

The treatment does't depend on only thinking, we must have solid evidence.

So madam its my humble question that if you think it is due to tumor, what should you suggest, or the options you think should be followed. I think you are bit confused. Be precise, I will explain further.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Prashant Sharma 1 hour later
Ok . Yes im worried n confussed. So if its a slow progression then is it a serious matter n curable?

Does a fast progression follow from a slow progression?

Can anything be done to kill off the slow tumor cells in body , if any?
doctor
Answered by Dr. Prashant Sharma 1 hour later
Brief Answer:
chemotherapy

Detailed Answer:
Hi,

Chemotherapy is the answer to all your questions. the regimen to be decided by your consultant.
a fast progression may rarely follow from slow progression if tumor cells acquire a new mutation, but usually not. we can control speed by chemotherapy to some extent.

Regards,
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Prashant Sharma 2 hours later
So can tjis b cured if there are cells in body?
doctor
Answered by Dr. Prashant Sharma 53 minutes later
Brief Answer:
we can control to some extent

Detailed Answer:
Hi,

If there are cells in body we must quantify them, locate them , accordingly treat them. If no cells are visible only CEA is increasing..... Difficult situation to answer.

In such situation early treatment or waiting for disease to appear will not increase survival. So need not to worry presently. Wait. Just get a USG done to find out tumor.

Repeat CEA after a month or so.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Prashant Sharma 2 hours later
Ok . So can cea rise even if no tumors are visible?

Are tumors different to cells left over from surgery?
doctor
Answered by Dr. Prashant Sharma 18 hours later
Brief Answer:
yes

Detailed Answer:
Hi.
Yes, cea may rise even when you can't see tumor.
The tumor cells present in body may have migrated before surgery or may be left over.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Prashant Sharma 7 minutes later
He saw onco today and they are not doing nothing at present ? We not happy with that
doctor
Answered by Dr. Prashant Sharma 30 minutes later
Brief Answer:
their decision is correct

Detailed Answer:
Hi madam.

I have already given you answer why they did so. No need of imaging as it will be nearly normal.
The treatment will be same even if imaging shows something.
Complete 2 - 3 cycles of xeloda. Then do cea and then imaging.


Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Prashant Sharma 1 hour later
But what if by that time cea has increased further and tumors show up? If the start treatment earlier n scan early then better right?
doctor
Answered by Dr. Prashant Sharma 25 minutes later
Brief Answer:
xeloda is part of treatment

Detailed Answer:
hi,
as i told you, early chemotherapy or chemotherapy after the appearance of tumor will not change the survival.
at present we are not confirm that it is recurrence.
it is a fact that u have started treatment. xeloda is a form of oral chemotherapy.
chemotherapy have side effects also, sometimes severe. so its use should be justifiable and in patients benefit. have trust in ur oncologist. he has taken right decision.
our aim should be to have more life with good quality, not just prolonged life with without quality.
if tumor appears...... its better to fight with a visible enemy as compared to invisible. important is tumor should not be symptomatic.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Prashant Sharma 1 hour later
Ok thx. Why is it that tumor should not be symptomatic?

But the continuous rise suggests recurrence right?
doctor
Answered by Dr. Prashant Sharma 10 hours later
Brief Answer:
small tumor is asymptomatic

Detailed Answer:
Hi. If the tumor is small it will be asymptomatic. If there are multiple small tumors, patient may still be asymptomatic. Disease may not be visible on scans. But cea will rise due to cumulative mass of tumor.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Prashant Sharma 13 hours later
In
Ur experience, can a person have spread of tumor to liver lungs etc with such a rise?
doctor
Answered by Dr. Prashant Sharma 12 hours later
Brief Answer:
usually not

Detailed Answer:
Hi madam.
Low level of cea indicates towards a very low tumor burden.
THis may be called as marker only recurrence.
With lung and liver metastasis cea will be higher usually.
To quantify tumor mass we must have a presurgical reference value for comparison.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Prashant Sharma 11 minutes later
Is 6 regarded low. May was 3 , two minths post surgery
doctor
Answered by Dr. Prashant Sharma 1 hour later
Brief Answer:
yes

Detailed Answer:
yes, 6 should be regarded as low, if we don't know the reference value.
in smokers sometimes even up to 8 is considered normal.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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