When we want to reduce the odds of being months late on detection or surprises, we add extra biomarkers to the basic bloodwork (CBC + CEA + CMP or Chem20). We add some extra chemistry panels to see how stable potential noise factors like inflammation (ESR, hsCRP), sugar (FBG, HgbA1C) and thyroid (TSH) are.
There are a number of recent papers addressing extra markers beyond CEA, for detection or prognosis with peritoneal CRC mets. Basically they use CEA, CA125, LDH, CA19-9, CA72-4, ferritin with varying degrees of sensivitivity and specificity.
I found it interesting that Prof David Morris, a surgical cimetidine pioneer in Oz, analyzed prognosis with a reduced CA199 threshold, starting at 17 units for peritoneal CRC in his group's paper, vs 34 or 37 or 39 units typical for pancan detection, although 17 units is a little low for single time tests' detection
with CA199. Kemeny was using LDH>200 for risk in her paper with CRC liver mets. group with Morris
(abstract only)group without Morris
full paper availableKemeny's paper with LDHbiggest marker batch