What is "normal" CEA?

[WriterGirl1969]

I had an appt with Onc today, and got my pathology / staging. Since I was getting blood work, I asked whether it included another CEA count (post-surgery). It did not. I requested it, but when the Onc discussed with me he said my pre-surgery count was 3.11, which is considered "normal," and getting another "normal" reading post-surgery would not provide much useful information.

I have seen others post CEA counts that are only 1.x, so I'm concerned and want to be sure that the information I'm getting is correct. Should I insist on an additional CEA count, or is he right that it doesn't really matter much at the levels I'm already at?

Thanks,
Tracy (aka Writer Girl)

[Nik Colon]

Most say <2.5 for non smoker and <5.0 for smoker. I have heard slight variences, but that is the common.

[WriterGirl1969]

Most say <2.5 for non smoker and <5.0 for smoker. I have heard slight variences, but that is the common.

Hmmm. Thanks Nik. I'm a non smoker, so his statement isn't making me feel confident right now. I also have some serious questions about his recommendations on treatment, given that he told me "Americans" don't seem to absorb the Xeloda well so it's less effective than the 5 FU. That doesn't match all the information, studies, opinions etc. I've seen here doing a search.

Time for a second opinion, I think.

[Jack&KatiesMommy]

There are two testing methodologies used to test for CEA. One has an upper limit of 2.5 for a non-smoker...the other method has an upper limit of 5.0 for a non-smoker.

[WriterGirl1969]

Ah, so it's possible this was just a different method of CEA testing then. OK - thank you so much.
I think I'll check with my surgeon and see what she thinks of the information / test results then. If she agrees, I'll ease off the gas pedal.

[rp1954]

These single point cutoff values on biomarkers are easily improved by your individual data series.
e.g. if CEA preop is 3.2 with a subsequent pathological staging, and a few weeks after curative surgery, CEA is 1.1, then that high/low biomarker range is far more useful than statistical cutoffs alone. Several points at a value or on a trend, are desirable.

Likewise, for many people, they could profitably do this pre-op/postop baseline for several common biomarkers like CA199, LDH, AFP, quantitative D-dimer and others that I've mentioned. Inflammation markers like ESR and hsCRP help identify inflammation effects in your blood data and potentially could help minor adjustments. You are potentially adding extra life chances with improved data series. Even if your current onc today can't read the data well, it can be useful to others, life saving later, even years later. We make decisions partly based on early blood data from 5-6 years ago. I curse about the blood data not taken then because of uninforming, -ed medical advice that has required me to dig it out myself, slowly.

My personal belief is that most oncologists have not invested the time to develop skill with these markers for CRC patients, that conventional chemo or RT disrupts many biomarkers' series during and for a while after treatment, might alarm people over chemo itself, are historically pessimistic about futility of more treatments, are poor at controlling inflammation sources, and are unwilling to buck outside influences (cost managers, ASCO, insurers, etc).

Some of us with experimental backgrounds, like SamT, have added anti-inflammatories and mild immune therapies, along with high frequency and intensive bloodwork to self-identify and solve deadly problems that normally evade timely therapeutic response. Continuous, lower dose chemo backbones like ADAPT (daily capecitabine + celecoxib) may help yield less noisy blood data too.

Should I insist on an additional CEA count, or is he right that it doesn't really matter much at the levels I'm already at?
Although statistics for your cancer pathology are favorable, safety is to consider the fraction that do recur. Bloodwork matters to catch problems early and to identify successful treatments. These blood data are best kept together on a spreadsheet. If you don't want to confront the doctor, it is possible to order it yourself, like at Life Extension. Personally, I prefer to consult doctors that can contribute or at least follow the story.

[WriterGirl1969]

Although statistics for your cancer pathology are favorable, safety is to consider the fraction that do recur. Bloodwork matters to catch problems early and to identify successful treatments. These blood data are best kept together on a spreadsheet. If you don't want to confront the doctor, it is possible to order it yourself, like at Life Extension. Personally, I prefer to consult doctors that can contribute or at least follow the story.

Thank you so much, rp.
I will definitely talk to my surgeon about this on Friday, and see if I can get some support from her or at least get pointed to an Onc who will listen to my requests more openly. If not, then I'll just have to get more firm about it. I don't mind confronting the Onc, I just wanted to be sure I was being logical and my concerns were founded. I found all of your info to be absolutely invaluable, and will save it all off to make sure I'm doing the best things possible early on.

[coolzan71]

Just wanted you to know that the CEA is not always an indicator of disease. My initial CEA was 50 when I had 12 liver tumors. Then went down to no higher than 3 while I was NED. Then when I had my re occurrence in my brain, lungs, spine and cervix the CEA never went up above 3.5. So in my case CEA values are worthless. I rely much more on my PET scans. Good luck.

[Jacques]

There are two testing methodologies used to test for CEA. One has an upper limit of 2.5 for a non-smoker...the other method has an upper limit of 5.0 for a non-smoker.

On my lab printout it lists the name of the manufacturer of the CEA assay (Roche Diagnostics) as well as the upper limits for normal (English translation given below):

Test : C.E.A.
Method: Electrochemiluminescence - Cobas - Roche Diagnostics

• For non-smoking patients, the upper normal limit is 3.8 ng/ml (5.0 ng/ml if the patient is over 40 years of age)
• For patients who are current smokers, the upper normal limit is 5.5 ng/ml (6.5 ng/ml if the patient is over 40 years of age)

Normally, the name of the assay or the test machine is given in a footnote in the lab report, and the normal range information is given in the report itself.
Maybe you could double-check your lab printout to see if it contains any of this information in a footnote.
.

“What is "normal" CEA?”

My interpretation - If your CEA is reported as 3.11 ng/ml and the oncologist says that it is within the normal range, then this suggests that your lab test might have been done using the Roche Diagnostics assay method and that your upper normal limit would then be 5.0 ng/ml.

[dianetavegia]

Labcorp's normal for a young person is high normal of 3.9 for a non smoker.

I've never seen a lab report that mentioned persons over 40 but had read of studies of people who had NEVER had cancer but were age 65 and up having CEA's which we would consider above the high norm. They followed these people thru death and autopsy results showed no cause for the elevated CEA's other than age.

[WriterGirl1969]

Just thought I would update that during my onc visit today I met with the nurse practitioner, and asked again about CEA just to see if they planned to ever recheck it or not. She gave me two interesting pieces of information. One is that, since they consider my pre-surgery CEA in the normal range, they would not expect it to be a good indicator of cancer recurrence in my particular case, and normally hesitate to get a count that might cause undue concern. The other is that my initial CEA was 1.13 -- What???

What I figure is that my onc doctor either gave me a different variation of the reading, or they tested it more than one way with more than numeric result. Either way, the 1.13 makes a LOT more sense when they say normal.

All that being said, they are willing to do another one if I really want one, just to get a new base line. I like this nurse practitioner.

[Travelgirl]

Well I did my three month check up Tuesday, and the colon surgery department said my CEA was 2.4 before surgery and three months later again the same 2.4.

They said that was good. My blood work looked perfect. Which is what they like to see.

They also did a CT scan with contrast and that is what they using plus another colonopspy in August which will be 6 months after surgery.

I am not sure if they treat all colon cancers everywhere the same?

How do you feel overall?

[uioplaid1]

There are two testing methodologies used to test for CEA. One has an upper limit of 2.5 for a non-smoker...the other method has an upper limit of 5.0 for a non-smoker.

On my lab printout it lists the name of the manufacturer of the CEA assay (Roche Diagnostics) as well as the upper limits for normal (English translation given below):

Test : C.E.A.
Method: Electrochemiluminescence - Cobas - Roche Diagnostics

• For non-smoking patients, the upper normal limit is 3.8 ng/ml (5.0 ng/ml if the patient is over 40 years of age)
• For patients who are current smokers, the upper normal limit is 5.5 ng/ml (6.5 ng/ml if the patient is over 40 years of age)

Normally, the name of the assay or the test machine is given in a footnote in the lab report, and the normal range information is given in the report itself.
Maybe you could double-check your lab printout to see if it contains any of this information in a footnote.
.

“What is "normal" CEA?”

My interpretation - If your CEA is reported as 3.11 ng/ml and the oncologist says that it is within the normal range, then this suggests that your lab test might have been done using the Roche Diagnostics assay method and that your upper normal limit would then be 5.0 ng/ml.

Hi,
Where did you see this information? I never had a Siemens assay result over .8 in 9 years, but my lab just changed to the Roache methodology. It came in at 1.8. I am the one that had to tell my internist that this essentially is no change given the methodology change!
Tom

[dianetavegia]

On my lab printout it lists the name of the manufacturer of the CEA assay (Roche Diagnostics) as well as the upper limits for normal (English translation given below):

Test : C.E.A.
Method: Electrochemiluminescence - Cobas - Roche Diagnostics

• For non-smoking patients, the upper normal limit is 3.8 ng/ml (5.0 ng/ml if the patient is over 40 years of age)
• For patients who are current smokers, the upper normal limit is 5.5 ng/ml (6.5 ng/ml if the patient is over 40 years of age)

I wrote Labcorp last year and questioned why this isn't used in the U.S. and many months later, got a reply that it was up to the AMA to accept any changes in values.

I did find a study done on healthy seniors who had elevated CEA's but when followed thru to death, no cause of the elevation could be found.

Has anyone seen this new info in their area? I believe Jacques is in France.

[NZJay]

My CEA has always been 'elevated' as per my signature. My medical team has never been overly concerned by it.