CEA jump from 2.8 to 33 in 6 weeks -- what to make?

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hopefulandstrong
Posts: 40
Joined: Fri Apr 19, 2019 7:11 pm

CEA jump from 2.8 to 33 in 6 weeks -- what to make?

Postby hopefulandstrong » Thu Sep 05, 2019 1:10 pm

Friends -

Need some support here. I was prepared for some bouncing around of CEA -- but this feels like a pretty significant jump. Could this be a blip? Love to hear any stories.

Thanks
54, female
1/8/19 DS Stage 4 with Liver Mets
1/11/19 Successful Colon Resect -- 12 inches of transverse colon removed
2/9/19 PET scan with disease confined to liver
2/18/19 Started Folfox -- CEA 70
5/1/19 -- Scans show progression -Switch to Folfiri
5/8/19 - BRAF mutation -- switch again to Triplet Therapy: Encorafenib, Binimetinib, Cetximab
6/13/19 - CEA dropped from 214 to 22
7/16/19 - CEA 2.8
8/1/19 - CT scan reveals 4 liver mets shrunk -- all under 3.1 CM.

Jacques
Posts: 497
Joined: Sun Dec 28, 2014 10:38 am
Location: Occitanie

Re: CEA jump from 2.8 to 33 in 6 weeks -- what to make?

Postby Jacques » Thu Sep 05, 2019 1:44 pm

CEA levels (stable trend)
o Normal range, non-smokers: < 3.5 ng/mL
o Normal range, smokers: < 5 ng/mL
o 5 ng/mL – 9 ng/mL : slighty above normal – most likely a benign inflammation
o 10 ng/mL – 19 ng/mL - low threshold for mets (probable indicates a met; will require further testing)
o 20 ng/mL - 35 ng/mL - most likely metastatic; moderate tumor burden
o > 35 ng/mL – most certainly metastatic; large tumor burden

Source: https://coloncancersupport.colonclub.com/viewtopic.php?f=1&t=60075&p=476909#p476909


Rate of change of CEA
http://coloncancersupport.colonclub.com/viewtopic.php?t=53702&p=426284#p426284
Last edited by Jacques on Thu Sep 05, 2019 3:31 pm, edited 1 time in total.

Claudine
Posts: 88
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: CEA jump from 2.8 to 33 in 6 weeks -- what to make?

Postby Claudine » Thu Sep 05, 2019 1:53 pm

Sorry to read that Hopefulandstrong - that's the kind of thing I'm always dreading whenever my husband gets a new blood test before his biweekly chemo... Have you talked to your oncologist? When are you scheduled for a new scan?
Wife of Dx 04/2018 (51 yo). MSS, KRAS mutated G12A
No primary, lytic tumor L4 vertebrae, CEA 10
Radiation 04/2018
Resection small intestine 05/18 (activity on PET scan, no cancer found - Krohn's disease)
Xelox * 6, 05/2018 to 10/2018
6.7 cm hypermetabolic left adrenal mass 03/14/2019, 4.4 cm 05/21/2019
SBRT L4 02/2019
Folfiri + Avastin
CEA since 03/15: 58, 17, 10, 6.4, 5, 4.8, 4.2, 3.6, 3.2, 3.3, 3.2, 3.7, 4.3
Scan 05/21: Multiple small lung nodules shrinking or stable compared to 03/14 scan.

hopefulandstrong
Posts: 40
Joined: Fri Apr 19, 2019 7:11 pm

Re: CEA jump from 2.8 to 33 in 6 weeks -- what to make?

Postby hopefulandstrong » Thu Sep 05, 2019 3:12 pm

Thanks Jacques and Claudine -

This is brand new news. Have calls into all the clinicians and am asking for a scan. Most recent one was about 5 weeks ago, so I suspect they are going to try to persuade me to wait a few more weeks, and another CEA to gauge a trend rather than a blip. Not sure what will be visible on a scan -- but I think it's worth the trouble. I have a very aggressive mutation, and while I responded magnificently to the triplet therapy in the first two months -- very dramatic drops in CEA -- it's possible that even this treatment has run its course.

It could also be that the very dramatic drop was the fluke -- which would disappointing, but somehow less frightening.
54, female
1/8/19 DS Stage 4 with Liver Mets
1/11/19 Successful Colon Resect -- 12 inches of transverse colon removed
2/9/19 PET scan with disease confined to liver
2/18/19 Started Folfox -- CEA 70
5/1/19 -- Scans show progression -Switch to Folfiri
5/8/19 - BRAF mutation -- switch again to Triplet Therapy: Encorafenib, Binimetinib, Cetximab
6/13/19 - CEA dropped from 214 to 22
7/16/19 - CEA 2.8
8/1/19 - CT scan reveals 4 liver mets shrunk -- all under 3.1 CM.

stu
Posts: 1183
Joined: Sat Aug 17, 2013 5:46 pm

Re: CEA jump from 2.8 to 33 in 6 weeks -- what to make?

Postby stu » Thu Sep 05, 2019 3:42 pm

I would be inclined to hold onto your very recent scan results . Both times my mum has had chemo her markers showed a drop before suddenly rising . Her scans were significant shrinkage both times .

Given your scan was very recent I would not jump to a conclusion just yet .

However I totally understand that it causes an anxiety spike and you need some kind of investigation to give you reassurance.

Take care ,
Stu
supporter to my mum who lives a great life despite a difficult diagnosis
stage4 2009 significant spread to liver
2010 colon /liver resection
chemo following recurrence
73% of liver removed
enjoying life treatment free
2016 lung resection
Oct 2017 nice clear scan . Two lung nodules disappeared
Oct 2018. Another clear scan .

NHMike
Posts: 2204
Joined: Fri Jul 21, 2017 3:43 am

Re: CEA jump from 2.8 to 33 in 6 weeks -- what to make?

Postby NHMike » Fri Sep 06, 2019 10:29 am

My CEA rose to a little above normal values on chemo and my oncologist said that he starts to get concerned over 15. But he ordered a scan anyways which found nothing.

I would want a scan at 33.
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8, 2/12 1.2
MSS, KRAS G12D
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal
2/19: Clean CT

hopefulandstrong
Posts: 40
Joined: Fri Apr 19, 2019 7:11 pm

Re: CEA jump from 2.8 to 33 in 6 weeks -- what to make?

Postby hopefulandstrong » Fri Sep 06, 2019 10:40 am

Thanks Guys -

If the scan shows no change, that will put my mind at ease.

I am wondering if I might have a chemistry that is particularly sensitive to stress -- having just completed a move and getting adjusted to a new place.
54, female
1/8/19 DS Stage 4 with Liver Mets
1/11/19 Successful Colon Resect -- 12 inches of transverse colon removed
2/9/19 PET scan with disease confined to liver
2/18/19 Started Folfox -- CEA 70
5/1/19 -- Scans show progression -Switch to Folfiri
5/8/19 - BRAF mutation -- switch again to Triplet Therapy: Encorafenib, Binimetinib, Cetximab
6/13/19 - CEA dropped from 214 to 22
7/16/19 - CEA 2.8
8/1/19 - CT scan reveals 4 liver mets shrunk -- all under 3.1 CM.

Rikimaroo
Posts: 246
Joined: Tue Dec 20, 2016 8:48 pm

Re: CEA jump from 2.8 to 33 in 6 weeks -- what to make?

Postby Rikimaroo » Fri Sep 06, 2019 11:09 am

I don't want to scare you but my CEA gradually went up from .8 to 22. Over a course of six months and the pet scan showed clear, then after six months the pet scan showed something in the pelvic region. My CEA has been a good indicator for me. They put me back on Chemo FOLFIRI and now my CEA is 1.5, but I will have to possibly do surgery next month for curable intent and hopefully once and for all put this thing to bed.

If your CEA has been a good indicator for you most likely your facing a recurrence. I hope not and I hope its a false positive, but seeing the trend on how this works, typically its not a good sign, just being real my friend.

Riki
RC T3N1M0
MSS - NRAS Mutation
Chemo Rad, CCR - W&W 5/2017
Recurrence 11/2017
CT Scan 11/2017 Liver Met 5.5cm Stable, Stage IV
Port Scheduled for 12/2017, folfox - avastin 12/2017
Blood Clot in Neck 1/2018, stop avastin, continue FolFox
LAR/Liver Resect 4/2018
Chemo Finish 8/2018
Reversal 10/18
CEA - 12/16 26.1, 1/17 32.2, 3/17 6.6, 11/17 500.5, 12/17 638.5, 1/3/18 424.8, 1/16/18 163.5, 1/31/18 62.2, 2/18 21.1, 3/18 14, 4/18 .8, 10/18 1.2, 12/18 3.2, 2/8 11.4, 3/6 22

hopefulandstrong
Posts: 40
Joined: Fri Apr 19, 2019 7:11 pm

Re: CEA jump from 2.8 to 33 in 6 weeks -- what to make?

Postby hopefulandstrong » Fri Sep 06, 2019 11:33 am

Right. This is why I'm reacting as I am. I do think it's important to note that I am in the middle of treatment. And so far, we don't have a trend -- just a dramatic rise from the last test -- which had equally dramatic drop from the one before that. Most of what I'm reading on CEA involves folks monitoring things following treatment. As I look at signatures, I do see a few bounces 60 to 45, back up to 56 and so forth. This is why my ONC nurse is imploring to "not freak out" without a trend. But I haven't seen anyone get down to 2.8 then bounce back up.

If there is anyone here for whom that has been the case, I would love to know your story.

Thanks so much,
54, female
1/8/19 DS Stage 4 with Liver Mets
1/11/19 Successful Colon Resect -- 12 inches of transverse colon removed
2/9/19 PET scan with disease confined to liver
2/18/19 Started Folfox -- CEA 70
5/1/19 -- Scans show progression -Switch to Folfiri
5/8/19 - BRAF mutation -- switch again to Triplet Therapy: Encorafenib, Binimetinib, Cetximab
6/13/19 - CEA dropped from 214 to 22
7/16/19 - CEA 2.8
8/1/19 - CT scan reveals 4 liver mets shrunk -- all under 3.1 CM.

NHMike
Posts: 2204
Joined: Fri Jul 21, 2017 3:43 am

Re: CEA jump from 2.8 to 33 in 6 weeks -- what to make?

Postby NHMike » Fri Sep 06, 2019 12:00 pm

hopefulandstrong wrote:Right. This is why I'm reacting as I am. I do think it's important to note that I am in the middle of treatment. And so far, we don't have a trend -- just a dramatic rise from the last test -- which had equally dramatic drop from the one before that. Most of what I'm reading on CEA involves folks monitoring things following treatment. As I look at signatures, I do see a few bounces 60 to 45, back up to 56 and so forth. This is why my ONC nurse is imploring to "not freak out" without a trend. But I haven't seen anyone get down to 2.8 then bounce back up.

If there is anyone here for whom that has been the case, I would love to know your story.

Thanks so much,


I went over my results and there was a slow progression from starting treatment until one month after treatment. The high value, 4.5 where 3.8 is the normal limit, was about a month after the end of treatment. It turns out that my CEA correlated to my exercise levels (I track it with a smartwatch and Garmin Connect keeps my records forever). There are some other known factors that raise CEA, at least anecdotally. I don't think that there are research studies as it is hard to measure a lot of factors.
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8, 2/12 1.2
MSS, KRAS G12D
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal
2/19: Clean CT

Jacques
Posts: 497
Joined: Sun Dec 28, 2014 10:38 am
Location: Occitanie

Re: CEA jump from 2.8 to 33 in 6 weeks -- what to make?

Postby Jacques » Fri Sep 06, 2019 12:54 pm

hopefulandstrong wrote:... so I suspect they are going to try to persuade me to wait a few more weeks, and another CEA to gauge a trend rather than a blip....

Just a note to say that what you call a "blip" is often called a TRANSIENT ELEVATION OF CEA in the scientific literature.

Thus, you can get more information about these blips with Google-search by using the keywords TRANSIENT ELEVATION OF CEA.

stu
Posts: 1183
Joined: Sat Aug 17, 2013 5:46 pm

Re: CEA jump from 2.8 to 33 in 6 weeks -- what to make?

Postby stu » Fri Sep 06, 2019 4:17 pm

My mum had a significant spread to her liver and CEA of 7.2 , if I remember right , at diagnosis. On chemo she went right down to 2 . Yippee we thought . Two months into chemo it did a complete U- turn and popped up to past 11 . Higher than she had ever been . After surgery it went back down .
Her second year she had a recurrence. Her CEA was 5.2 . She had five liver mets of one CM each . She recommended chemo and had an initial drop , two months into it and it more than doubled . The second year we decided to only use the scans for feedback . She shows a recurrence around a CEA of 4 .
Off chemo as she has gotten older it sits between 3.2 and 4.6 .
However last year it went up to 5.6 with no disease . Stayed that way for six months , was scanned again , still no disease then dropped back down . Something else was influencing it .
Hope it’s a false negative due to chemo.
Stu
supporter to my mum who lives a great life despite a difficult diagnosis
stage4 2009 significant spread to liver
2010 colon /liver resection
chemo following recurrence
73% of liver removed
enjoying life treatment free
2016 lung resection
Oct 2017 nice clear scan . Two lung nodules disappeared
Oct 2018. Another clear scan .

teresajj1
Posts: 37
Joined: Sun Mar 27, 2016 7:36 pm
Location: Florida

Re: CEA jump from 2.8 to 33 in 6 weeks -- what to make?

Postby teresajj1 » Sun Sep 08, 2019 8:27 am

At first when I had cancer only in my colon, my CEA never got above 1.9. 2 years later when it spread to my belly in 6 months it went from 1.9 to 447 :shock: . I had cytoreductive surgery 07/18 and since 03/19 its starting to creep back up...3.5, 6.8, 8.6. The CT scans show nothing & my oncologist says all we can do is watch & wait which I hate. My thought is if its rising, I have cancer somewhere, its just not big enough to see yet.
Dx 3/16 @ 36yrs Stage IIIB
RT Hemi-colectomy
T3N1M0. 2/37 lymph nodes
4/2016 Started 12 rounds of 5 FU & Oxi Chemo
7/2016 Stopped chemo after 5 rounds due to chest pain
8/2017 MUYTH Gene
10/2017 Clear CT Scan; CEA 1.9
5/2018 CEA 447 & CA-125 144
6/2018 Stage IV w/drop metastases to peritoneal cavity
7/2018 Cytoreductive surgery & Hipec (3 tumors, 2 nodules on bladder, and ovaries removed)
10/2018 Clear CT
05/2019 Clear CT
07/2019 CEA 8.6

Nikan1
Posts: 1
Joined: Sun Sep 08, 2019 12:50 pm

Re: CEA jump from 2.8 to 33 in 6 weeks -- what to make?

Postby Nikan1 » Sun Sep 08, 2019 1:49 pm

My mom had a spike in her cea level , 4 months after completing adjuvant chemo for stage 3 rectal cancer. It was 40 !!( initially her cea level was 1.8, so we decided it was not a good indicator for her), CT scan showed nothing, it became 73 in next month, then in less than two weeks jumped to 90.Pet scan was ordered, nothing showed up. no polyps no infection no inflammation no thyroid problems ...nothing. My mom was soooo stressed out that stopped any follow up after pet scan, we waited three months to beg her to test her cea level one more time, we got the result and it was 12 !! In next six months it was gradually decreasing to 1.9! The whole story took almost a year.

I understand your fear very well, we had a very tough year with mom’s unexplained high cea level.

(After pet results, my brother who is a pharm.D talked to mom’s onco and they decided that mom can take a low dose of Celebrex (100 mg twice daily) to lessen any hidden inflammation in her body, we don’t know if it really helped in any way, but after three months of taking it ,cea went down to 12.)

Let’s hope that your high cea level is a false alarm.

radnyc
Posts: 380
Joined: Tue Apr 06, 2010 6:32 pm

Re: CEA jump from 2.8 to 33 in 6 weeks -- what to make?

Postby radnyc » Mon Sep 09, 2019 6:49 am

You haven’t had surgery to resect the liver tumors yet? If you’re not out of the woods yet then it’s the main reason your CEA is rising. You need to get to resection.
DX Jan '10, at 47
Feb - colon resection - 2/17 nodes
April - liver mets - Stage 4
3 months Folfox chemotherapy
August '10 liver resection and HAI pump
7 months chemo FUDR HAI and Folfiri systemic
NED since August 2010
Last treatment April '11
HAI Pump removed Dec '15


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