CEA and Stage II

[Vol]

Resection in the morning.

Plan right now is to get full surgical path and ask for oncotypedx.

Is CA19-9 valuable for colon cancer or is it only for pancreatic?

I know my CEA is 6.9. I found this on PubMed. Any thoughts on how to react to this? How should it should impact my thoughts on chemo/radiation if I'm stage II (as I hope and MRI point to)?

Abstract
INTRODUCTION:
Recent reports have reopened discussion of the prognostic value of elevated pre-treatment carcinoembryonic antigen (CEA) levels in colorectal cancer. Due to the discrepancies in the published results, we aimed to analyze the possible predictive value of CEA, both overall and in different tumoral stages in our environment.

PATIENTS AND METHODS:
We retrospectively studied 303 consecutive patients with colorectal cancer resected with curative intent by analysing tumor-related mortality. The frequency of patients with increased CEA levels (> 5mg/l) was registered. Univariate and multivariate analyses of survival curves were performed, comparing patients with increased CEA levels and those with CEA levels within normal limits, both in the overall series and in the different pTNM tumoral stages.

RESULTS:
Frequency of patients with CEA>5mg/l was 31%. The median clinical follow-up was 83 months. A poor survival rate was registered in the multivariate analysis of the whole series in patients with high CEA levels: hazard ratio (HR)=1.81; 95% confidence interval (95% CI)=(1.15-3.10); P=.012. This predictive value was only maintained in stage II in the survival analysis of the distinct tumoral stages (n=104): HR=3.02; 95% CI=(1.22-7.45); P=.017.

CONCLUSIONS:
Before treatment, 31% of our patients with colorectal cancer resected with curative intent had pathological CEA values. In the overall series, a high pretreatment CEA level showed an independent prognostic value for poor survival. When pTNM tumoral stages were analyzed separately, CEA level had predictive value only in pTNM II tumors.

[cathy123]

Well, I have read that high preop cea is a negative prognostic marker, but yours isn't all that much above average. I would wait and get the full biopsy report then make a decision. My cea was low but I had lymphovascular invasion plus one preradiation node that was iffy, so decided to go forward with chemo. It was a tough choice. Hopefully all your other results are good. Good luck with surgery tomorrow!

As far as ca19-9. I asked both my surgeon and onc about it and they said they don't order that for colon cancer. I know others here have found it helpful though.

[Lydia666]

I am a newbie so i don't have much advice. I wish you an easy surgery and succesful and a speedy recovery. If you can, stay away from google- it only plays with your brain. See what stage you really are after surgery and go from there. See what your docs say as to what next but from what i see we all have a mixture of good and bad factors in our diagnosis, and nobody can predict how long we will live. When i search on google, i basically want to find only good news about what i have and that's just not going to happen. In addition, the studies we read are either not that good ( my doc said what u find on google is usually not approved to be in serious journals) or we don't understand them anyway and we retain whatever makes sense to us but it might not even be what they are saying.
We all have a chance, someone here said, as long as you are alive, there is a chance.

[DarknessEmbraced]

Good luck with your surgery tomorrow. Also wish you a speedy recovery.

[Crystald]

Good luck on your surgery & a fast recovery. Once the dust settles and you have more info look to this forum for help. These folks are the best source for information.

[curious56]

CEA, like many drugs, is one of those good/bad things. If CEA isn't a marker for you, it can be harder to figure out if the cancer is recurring. But, folks with "normal" pre-surgical CEA values do tend (according to this study) to have better survival rates. Did you see how MUCH better? I have never found any answers. It could be, like with some chemos, that increased survival rates are measured by an extra month or two RATHER than years.

After surgery, they will do the CEA test again. If your test returns to normal within 1 to 2 months, THAT is a pretty good indicator that they got IT all! Could still be rogue cells roaming around -- that is why Cimetidine is recommended. You cannot have chemo for about 5 to 6 weeks AFTER surgery.

Anywho, I LIKE statistics. I recommend using the Memorial Sloan Kettering Cancer Center nomogram (they have nomograms for some other cancers, too). It is derived, I believe, by a longitudinal study of colon cancer patients. I ran across the original study some time back -- forgot to bookmark, I guess. Anyway, the MSKCC nomogram is VERY easy to use. There are TWO prediction indicators -- one for Disease Free Probability and the other for Overall Survival Probability. In the Disease Free Probability generator, you can run your personal stats TWICE -- once WITH chemo, once WITHOUT. You will have to wait until you get your pathology report to do this. (Using this nomogram is where I discovered that IF I had been able to tolerate chemo, it would have only given me a 7% difference versus not taking chemo.) I had no choice. You have a choice. IF you decide to do chemo, you "might" want to avoid the Oxaliplatin. I cannot find the specific study right now (forgot to bookmark that, too), but Oxy offers a 1% to 2% better chance than taking standard chemo alone. Oxy has some pretty intense side effects -- mainly neuropathy. Lots of times, this neuropathy doesn't go away. You are still young, working, probably NEED to be able to feel those fingers while working in IT??? Again, YOUR decision. You will make the right choice per your situation. As I said earlier, 5 to 6 weeks before you can do chemo. LOTS of time to study, research, comtemplate.....

Some people with colon cancer are willing to walk through fire for ANY chance at a cure -- even 1% or 2%. Other people look more at quality of life. Some people cannot tolerate chemo. Whether you do OR do not do chemo, there ARE other things out there IF there is a recurrence -- more surgery (if tumors are resectible), RFA, gamma-knife, nano-knife, and more...........the members of this group are EXCELLENT at providing info.

Here is the nomogram link: http://nomograms.mskcc.org/Colorectal/index.aspx

Praying for your surgery! Keep us updated as you are able.

[JDinNC]

I was using the nonorgram the other day and got excited when my results came back 85% survival at five years. Then I read it can't be used with metastatic cancer.....darn!

Nothing can be so depressing then to have a CEA of 4.2 at time of diagnose, moderate diff., no lymph nodes involved.....but one stupid lung tumor. After completing chemo my CEA was 3.8. Now two years out...my CEA had been 2.1.

My oncologist said my CEA wasn't a good indicator...so I ask if he would do a CA-19 which he said No because it wasn't for colon cancer. If you have a 2.1 can you still have a tumor?

So tomorrow I will find out if I'm still NED at the two year mark. Just scares me because my CEA has been dropping but does this mean anything good for me. It's all a head game...

[zx10guy]

This subject just upsets me on so many levels. If you read the various literature out there, you have documents which state low grade well differentiated CRC cells express more CEA than high grade poorly differentiated CRC cells. Then you have the studies talked about here which state high CEA prior to surgery indicates a probability of poor survivability than someone with low/normal CEA. These two things are at odds with each other and no one has provided an explanation on the contradiction. In the end, when this subject comes up, I just go with no one knows.

[curious56]

This subject just upsets me on so many levels. If you read the various literature out there, you have documents which state low grade well differentiated CRC cells express more CEA than high grade poorly differentiated CRC cells. Then you have the studies talked about here which state high CEA prior to surgery indicates a probability of poor survivability than someone with low/normal CEA. These two things are at odds with each other and no one has provided an explanation on the contradiction. In the end, when this subject comes up, I just go with no one knows.

z10guy, I haven't posted about my latest "escapades", nor have I added them to my signature. Seems like my info "might" help you, though, so here goes.

ALL of my CT scans (5 or 6) since 12/12 have been clear. Last one, less than 6 months ago, was declared "super clear". My CEA, however, had continued to rise -- got up to around 170 -- not doubling very fast. I have an autoimmune and my onc suspected/wondered if that might have some significance. Fast forward to this Spring. Doc decided to do a PET/CT scan -- something I wasn't sure I could have due to corn allergies. Turns out the sugar they use ISN'T corn-based, so my appt. was set. ONE area/tumor, about 3 cm in size, had significant uptake on/near/in my right ovary. Surgery was scheduled. When he opened me up, surgeon was quite surprised to find EIGHT tumors of significant size -- my other ovary had a 4 cm tumor, uterus, and ommentum also had turmors that the PET "should" have seen. 6 out of 8 tumors were removed, the others were in areas that are either unresectable OR would cause more problems at this point in time than removal would benefit. I was flummoxed. I asked a really smart cancer researcher from another group. He said that most likely my tumors were low grade, slow growing. Wow! I already knew my tumors were moderately differentiated. I got pretty excited. I know that sounds crazy, but to be Stage IV (some would call me Stage III recurrent, I guess) and be handed "time". When I saw my onc, he said the surgeon had basically turned back the clock. He (and my GP) also said that my tumors were likely low grade and slow growing. The surgeon "debulked" me (I say that I was gutted like a fish). Removal of tumor load is a good thing, apparently. My CEA had already dropped 75% about 3 weeks after surgery. With two small (5mm or so) tumors remaining, it won't go back to normal, but I'm hoping that my bloodwork next month will show a further decline. I now know that CEA is "the" marker for me -- much better than CT/PET scans.

I have options -- RFA, gamma-knife, nano-knife, more intensive surgery, etc. Doctor says some can do more harm than good at this point -- I concur. So, we are keeping a close watch on things. I'm not worrying -- too busy living life to worry.

For those who know I'm on Cimetidine and are wondering.....I didn't know about Cimetidine for almost 2 months AFTER my resection. So, I'm betting that these mets had already "set up house". I feel really confident that continuing to take Cimetidine cuts my odds of new mets. I also continue to exercise regularly and take D3. All of my docs are quite amazed at my healthy appearance, strength, and excellent bloodwork (well, except for the CEA).

I've heard it here AND other places: think of colon cancer as a chronic disease. Whether you take chemo or not, take good care of yourself. Eat right, take supplements that have been proven to help, exercise, avoid stress..................taking care of your body is just "good business". Colon cancer is enough to deal with -- try to prevent other problems like type 2 diabetes, heart disease, hypertension, obesity, etc. Taking good care of your body just "might" make your immune system strong and smart.

[rp1954]

At diagnosis, we were told "at least stage 2" and pushed toward immediate surgery for an impending obstruction.

Instead we got cimetidine, big vitamin D3, and other natural anticancer agents to use for an immune therapy. We got a better surgeon and a better hospital. We got more tests including CA19-9. The pre-op CA19-9 and CEA indicated to me that cimetidine would probably be a good long term, targeted treatment - statistically, way more beneficial than oxaliplatin without the problems. The primary tumor shrank and a lot of mets died. Some didn't. The operation was a fine success as a first stage treatment, and I believe would have been a commonplace disaster without the cimetidine and immune tx.

As it turned out, things were initially way worse. Mets in bad places, doctors not omniscient, and doctors not communicating well. And there was a lot of confusion. Our success has in large part depended on those extra biomarkers. US doctors seem to know beans about biomarkers beyond CEA for CRC (they are paid not to think otherwise), but clinical and foreign papers help a lot. An adequate set of biomarkers can see troubles long before a scan can, and they can help evaluate chemotherapy, particularly nicer ones like metronomic and immuno-chemotherapies, during treatment.

Clue(lessness) #1: "CA19-9 is only a marker for pancreatic cancer" ZZZzzzzt, ding ding ding. Next.

Extra biomarkers, that have made an important difference for us are CA19-9, AFP, LDH and ESR, for a common pattern of markers in advanced, often fatal CRC. Potentially important markers that did not matter in our case were CA72-4 and CA125. We scouted out a good lab deal at rock bottom prices. CEA, AFP, LDH, CA125, ESR are especially cheap at our lab. Even if insurance sucks rocks, cash payment is not an issue. Those extra blood tests, besides the longevity, pain and suffering part, have helped save us financially.

Our best strategy to find which biomarkers to use, has been to lay down the biomarker barrage, before surgery and then 1-2 weeks after surgery. This helps evaluate the completeness of surgery and gives an idea of the biomarkers range and utility. Later, these initial tests are a reference set for future biomarker changes and (bi)annual recomparisons.

Doing these biomarker tests before surgery is a unique opportunity, and we insist or get them ourselves.

[JDinNC]

When I was told that my CEA was a bad indicator. I looked here for other tests where it was suggested to ask for Ca-19. So I asked my oncologist and he said no because it was for pancreatic cancer....but the interesting part was he mentioned that it was used years before for colon cancer. Until the cancer world changed the testing ..now what harm would it have been to give me the test anyway.?

[zx10guy]

This subject just upsets me on so many levels. If you read the various literature out there, you have documents which state low grade well differentiated CRC cells express more CEA than high grade poorly differentiated CRC cells. Then you have the studies talked about here which state high CEA prior to surgery indicates a probability of poor survivability than someone with low/normal CEA. These two things are at odds with each other and no one has provided an explanation on the contradiction. In the end, when this subject comes up, I just go with no one knows.

z10guy, I haven't posted about my latest "escapades", nor have I added them to my signature. Seems like my info "might" help you, though, so here goes.

ALL of my CT scans (5 or 6) since 12/12 have been clear. Last one, less than 6 months ago, was declared "super clear". My CEA, however, had continued to rise -- got up to around 170 -- not doubling very fast. I have an autoimmune and my onc suspected/wondered if that might have some significance. Fast forward to this Spring. Doc decided to do a PET/CT scan -- something I wasn't sure I could have due to corn allergies. Turns out the sugar they use ISN'T corn-based, so my appt. was set. ONE area/tumor, about 3 cm in size, had significant uptake on/near/in my right ovary. Surgery was scheduled. When he opened me up, surgeon was quite surprised to find EIGHT tumors of significant size -- my other ovary had a 4 cm tumor, uterus, and ommentum also had turmors that the PET "should" have seen. 6 out of 8 tumors were removed, the others were in areas that are either unresectable OR would cause more problems at this point in time than removal would benefit. I was flummoxed. I asked a really smart cancer researcher from another group. He said that most likely my tumors were low grade, slow growing. Wow! I already knew my tumors were moderately differentiated. I got pretty excited. I know that sounds crazy, but to be Stage IV (some would call me Stage III recurrent, I guess) and be handed "time". When I saw my onc, he said the surgeon had basically turned back the clock. He (and my GP) also said that my tumors were likely low grade and slow growing. The surgeon "debulked" me (I say that I was gutted like a fish). Removal of tumor load is a good thing, apparently. My CEA had already dropped 75% about 3 weeks after surgery. With two small (5mm or so) tumors remaining, it won't go back to normal, but I'm hoping that my bloodwork next month will show a further decline. I now know that CEA is "the" marker for me -- much better than CT/PET scans.

I have options -- RFA, gamma-knife, nano-knife, more intensive surgery, etc. Doctor says some can do more harm than good at this point -- I concur. So, we are keeping a close watch on things. I'm not worrying -- too busy living life to worry.

For those who know I'm on Cimetidine and are wondering.....I didn't know about Cimetidine for almost 2 months AFTER my resection. So, I'm betting that these mets had already "set up house". I feel really confident that continuing to take Cimetidine cuts my odds of new mets. I also continue to exercise regularly and take D3. All of my docs are quite amazed at my healthy appearance, strength, and excellent bloodwork (well, except for the CEA).

I've heard it here AND other places: think of colon cancer as a chronic disease. Whether you take chemo or not, take good care of yourself. Eat right, take supplements that have been proven to help, exercise, avoid stress..................taking care of your body is just "good business". Colon cancer is enough to deal with -- try to prevent other problems like type 2 diabetes, heart disease, hypertension, obesity, etc. Taking good care of your body just "might" make your immune system strong and smart.

Thank you for responding.

I'm aware CEA is a good tool to track trends. It's this trend that can really indicate something going on. This is the consensus among doctors where it's the trend that's most important.

What I was referring to is this contradiction in the various published papers that state having a "high" CEA pre surgery is a prognosticator for lower survival. There's no trend involved here. There's no tie back to the fact that low grade/well differentiated CRC cells express more CEA than high grade/poorly differentiated CRC cells. So why there contradictions? So I still go back to my original statement that we don't really know if a "high" CEA number pre surgery is really a proper indicator of how well someone is going to do.

As for me, I had a scare last year when my CEA number jumped almost a point from the last check 6 months prior. I visited a different oncologist for a second opinion and he agreed to do a retest. The number came back lower to almost the number I got 6 months prior. I was freaked because I didn't know if this recent jump was the start of an upward trend. I can only surmise the rise was due to a recent event I was participating in. I was running around the track on a motorcycle for two days and I guess all the exhaust fumes I was exposed to had contributed to the elevation.

On the topic of the PET scan, when I was first diagnosed, a PET was ordered for me. They wanted to rule out the two lesions showing on the CT scan were tumors but were actually hemangiomas. The PET came back negative for hyper metabolic activity as the SUV uptake for the two lesions were essentially zero. The liver specialist I visited went over the PET results but wanted to be absolutely sure. So he was in the operating room to do a biopsy to definitively rule out lesions as tumors. The biopsies came back negative for any CRC cells.

[Nik Colon]

Best wishes

[Deb m]

Vol,

My husband was a stage II and his CEA was 5.9 before surgery. It remained high all the way thru chemo. It finally came down about one month after he completed chemo. It now fluctuates between 2.5 - 3.1. This past march it was 2.7. He has been NED since February 2011.