Does everyone's CEA go up during chemo

[Sams wife]

I know they said inflammation or smoking or whatever would make it go up. Hubby started chemo in July I think. Has to do it till January. We are past the middle but CEA is higher than when he stared. Kinda freaking me out.

I've tried to stay busy to not worry about it, but it's not working. : )

[chrisin]

This is called "cea surge", "cea flare" phenomena. Median time to peak is about 4 weeks (2-10 weeks range), median time to baseline - 11 weeks. Recent reports say that cea is simply upregulated by chemotherapy, but actually it could be progression too.

"The surge lasted 4–18 weeks, exceeding 11 weeks in 7/10 patients. CEA level was above baseline after 12 weeks from initiation of treatment in 2/10 patients."
http://meeting.ascopubs.org/cgi/content ... suppl/3615

In case of microscopic disease, a small amount of CEA could be released by the liver as a response to chemotherapy. I have read it somewhere but it's hard to find it now.

[Sams wife]

Thank ya. Quick answer : ) I forgot about it meaning chemo is working too. I'm going to try to follow the study on my iPhone. Yay : )

They have asked about when he is getting scans the last 2 weeks. He had one after surgery so they want to wait till Nov. of course that's making me nervous too

[Sams wife]

This is called "cea surge", "cea flare" phenomena. Median time to peak is about 4 weeks (2-10 weeks range), median time to baseline - 11 weeks. Recent reports say that cea is simply upregulated by chemotherapy, but actually it could be progression too.

"The surge lasted 4–18 weeks, exceeding 11 weeks in 7/10 patients. CEA level was above baseline after 12 weeks from initiation of treatment in 2/10 patients."
http://meeting.ascopubs.org/cgi/content ... suppl/3615

In case of microscopic disease, a small amount of CEA could be released by the liver as a response to chemotherapy. I have read it somewhere but it's hard to find it now.

I wonder when initiation of treatment for hubby is. This second Chemo I would assume?
I guess I just need to worry when it is time.
There isn't any "one step ahead" of cancer. Time will come soon enough. I'm guessing November.

Edited: I guess I will have to wait 4 months!

"These findings suggest that a rise in CEA after initiation of chemotherapy, unless lasting > 4 months, cannot be used as an indicator of progressive disease"

[rp1954]

SW, what is/was his serum CA19-9 ? With an elevated CEA, and a CA19-9 above 22 (sort of an approximate genetic limit to healthy peoples' CA19-9) before chemo, we decided to add cimetidine to maintenance chemo (no -ox/-iri) for at least a yr, or until we had definitive tissue testing on the path samples. If the maximum serum CA19-9 part had been 2 - 22, we would have pressed the tissue testing for cimetidine harder, sooner while using the cimetidine.

Matsumoto (2002), and some other Japanese MD-PhDs since, indicated that tissue tests with CA19-9 and e-selectin mAbs (CSLEX1 or FM93 then) were a pretty definitive test for curative adjuvant treatment of Duke's B/C CRC with 5FU + cimetidine, for patients likely to recur. Duke's B/C translates as ca stage II/III. We would have quit CIM if serum CA19-9 solely reflected a "benign CA19-9 disease" dx (like pancretitis or something ductal).

[Sams wife]

SW, what is/was his serum CA19-9 ? With an elevated CEA, and a CA19-9 above 22 (sort of an approximate genetic limit to healthy peoples' CA19-9) before chemo, we decided to add cimetidine to maintenance chemo (no -ox/-iri) for at least a yr, or until we had definitive tissue testing on the path samples.

We would have quit CIM if serum CA19-9 solely reflected a "benign CA19-9 disease" dx (like pancretitis or something ductal).

We didn't test it (CA19-9). Didn't really have the money to push for it after radiation, before surgery.
But we ended up at the ER 3 weeks ago. His pancreatic enzymes were elevated. I think the test for CEA was 2 weeks ago. No one told me. I just saw it on docs computer last week.

I had forgotten already but I guess I need to make sure they test his pancreas this week.
Need to have them print out results from the first of the year too, I guess. I read somewhere the patient portal only keeps them for a year.

[Deb m]

Sams wife,

My husband's cea went from 3.2 to 5.7 while he was on chemo. It was just after his 7th treatment. It wasn't till about one month after all his chemo was completed that it went back down to 3.0. Our oncologist told us that if it's just a one time spike and stays at that level through out treatment, not to worry. He said if it continues to rise each time it's checked while on chemo, them it could be a problem. It should probably be checked again in a few weeks, and if it goes up again then I would think further investigating needs to be done.

These cea levels are the most nerve wracking blood test I can think of! I really hope it's just a one time chemo spike and all turns out ok. Since your a stage 2, I would think odds are in your favor that it's not a progression in his cancer.

deb m

[lpas]

My CEA was 1.0 prior to starting chemo and rose to 3.0 by July, when my treatment was complete (now 2.5). CA19-9 was only 12.6 after two infusions but 44.5 when I finished up (now 38.4). Since that time I've had two clean scans, so hopefully the rise was attributable to chemo-related inflammation and lots of dead cancer cells. I guess only time will tell for sure. Both numbers definitely seem to be taking their time coming back down.

If I recall correctly, there are several here who've found that their baseline CEA is permanently a little higher after chemo.

[heidym21]

keep watch, if it keeps going up you should tell the doctors. It happen to my mom it kept going up and the doctors didn't listen and guess what happen her cancer spread and she is not doing so well. So pls tell your doctors, and if they don't listen then go into another doctor.

[Sams wife]

Deb m
"He said if it continues to rise each time it's checked while on chemo, them it could be a problem"

Good. I'll watch for that. It is nerve wracking now that it went up : )

iPas. My auto correct put iPad!
"I guess only time will tell for sure. Both numbers definitely seem to be taking their time coming back down."

I figure that too. I will be nervous the whole time if it stays up : ) glad your scans were ok

Heidi. I definatley will be watching now. Can't believe I missed it 2 wks ago. I was just trying to calm down & wait.
They are watching lung things so I'm already just waiting for something to happen.
Hurry up & wait, hurry & wait.

[Nik Colon]

For me, it went down on folfox, on folfiri it went up then down toward end, still not as low as it got on folfox the. A few numbers are in my sig

[AnonSurvivor]

My CEA doubled from 6.65 to 13.8 over six months of FolFox + avastin after surgery which included the removal of half of my liver. CEA dropped back to the 6s. I was NED the entire time, though, and have been for three years since surgery. 4-5 months after I stopped chemo, CEA spiked to 17 for a month, but over the 20 months since that spike, it is back down to the 3s.

DX 10/2012
pT4aN2bM1a
27/32 LN
Surgery 10/2012 @ Mass General
12 cycles folfox + avastin @ Yale-New Haven
8 cycles fluorouracil + avastin @ Yale-New Haven
NED since 10/2012

[Sams wife]

For me, it went down on folfox, on folfiri it went up then down toward end, still not as low as it got on folfox the. A few numbers are in my sig

After seeing your signature, I had asked about CEA & smoking ( when we first started this ) Nurse said it didn't have anything to do with that. Now this nurse says it can be from smoking, inflammation or chemo. It's just annoying. Every time I ask, the answer changes.

I hope you get to feeling better. My belly has been messed up all year, but for about 3 weeks now mine has been in knots, feeling like throwing up all day long. Didn't want to post on yours because I'm not the patient, but idk. I can see how after treatment people are like "what now". I'll probably be that way. Makes me wonder if hubby will. He doesn't usually say much.
Maybe after dentist & dr you will feel better. And be able to relax for the weekend. Good luck today on scan (I think).

[Sams wife]

My CEA doubled from 6.65 to 13.8 over six months of FolFox + avastin after surgery which included the removal of half of my liver. CEA dropped back to the 6s. I was NED the entire time, though, and have been for three years since surgery. 4-5 months after I stopped chemo, CEA spiked to 17 for a month, but over the 20 months since that spike, it is back down to the 3s.

DX 10/2012
pT4aN2bM1a
27/32 LN
Surgery 10/2012 @ Mass General
12 cycles folfox + avastin @ Yale-New Haven
8 cycles fluorouracil + avastin @ Yale-New Haven
NED since 10/2012

Must have been some kind of bug? I know Dianne had went through that a few months ago. By the time this happens to us, I will have forgotten about this whole conversation & freak out probably. : ) I just remembered Dianne's when yours spiked for a month.
I guess I just start thinking about cancer & not the answers. I'll have to stop doing that!

[AnonSurvivor]

My CEA doubled from 6.65 to 13.8 over six months of FolFox + avastin after surgery which included the removal of half of my liver. CEA dropped back to the 6s. I was NED the entire time, though, and have been for three years since surgery. 4-5 months after I stopped chemo, CEA spiked to 17 for a month, but over the 20 months since that spike, it is back down to the 3s.

DX 10/2012
pT4aN2bM1a
27/32 LN
Surgery 10/2012 @ Mass General
12 cycles folfox + avastin @ Yale-New Haven
8 cycles fluorouracil + avastin @ Yale-New Haven
NED since 10/2012

Must have been some kind of bug? I know Dianne had went through that a few months ago. By the time this happens to us, I will have forgotten about this whole conversation & freak out probably. : ) I just remembered Dianne's when yours spiked for a month.
I guess I just start thinking about cancer & not the answers. I'll have to stop doing that!

I suspect the CEA spikes were attributable to my liver regenerating from the surgery, especially after the end of chemo. I actually never got sick during chemo, which I suspect was due in part to my diet and exercise efforts -- I treated chemo like a 42-week competitive athletic event.