Recurrence with normal CEA??

[Mpas0281]

Hi all, my husband is almost nine years out from a diagnosis of t2N0m0 rectal cancer. Had an ultra low anterior resection with no chemo as stage one on advice of multiple oncologists we saw.

He has had a couple of months of lethargy and a couple of weeks of intermittent bad headache with poor appetite and headache. Because of this, had an MRI brain and blood tests. Results today showed a normal MRI brain (no tumours) and undetectable CEA however his liver function (ALT/AST) is deranged in the hundreds.

Our family doctor thinks might be a viral illness (although he hasn’t had any symptoms except bad headaches) but also wants to look for rectal cancer recurrence with a CT of his chest abdomen and pelvis.

I feel pretty worried. We have three small children.

My question is- has anyone had a recurrence with completely normal CEA?

[roadrunner]

The symptoms are so non-specific that I wouldn’t be particularly worried, but CEA doesn’t work that way. I had metastatic disease for years without any measurable CEA. I know it’s worrisome, but do the scan. Most likely it’ll
Be fine. If it’s not, you need to know that, too.

[Edited to add: I had pulmonary mets, not liver disease. Others with liver recurrences may have a different view, though I still think CEA just isn’t a good marker for some folks.]

[zephyr]

Ditto and agree with what roadrunner wrote. Don't focus on CEA when you make a decision; do the scan. You need to know either way, and CEA is not a useful measure for many people.

[I_will_fight]

A couple of thoughts and questions (probably not worth much)

I guess the fact that the Liver enzymes are elevated makes you think that your husband might have Liver Metastasis, however liver mets very often cause CEA to elevate and your husband does not have that.

https://pmc.ncbi.nlm.nih.gov/articles/P ... gen%20(CEA)%20is%20expressed,tumor%20marker%20in%20cancer%20patients.

"Carcinoembryonic antigen (CEA) is expressed in most gastrointestinal, breast, and lung cancer cells. Overexpression of CEA is closely associated with liver metastasis, which is the main cause of death from colorectal cancer. CEA is widely used as a diagnostic and prognostic tumor marker in cancer patients."

Did your husband's primary CRC cause CEA elevation? What about other markers such as CA19.9 and CA125? Were they elevated? Have they been tested this time?

CA125 is often associated with peritoneal metastasis and CA19.9 is used for other GI cancers as well. Can yuo ask your healthcare provider to include them in your husband next blood tests?

Good luck!

Javi

[utahgal7]

Hi,

Yes, you can have a recurrence with normal CEA. It has happened to me twice (right lung and brain).

I, too, agree with all of the previous comments here. I just wanted to add a few things. First, I would press for an MRI. I was told by my oncologist that MRI shows more detailed imaging of the liver. Secondly, other than elevated liver enzymes, does your husband have any other symptoms that leads you to believe that his CRC has returned and to his liver? I agree with Javi, if your husband had liver metastasis, his CEA would likely be elevated. Although I don't have any personal experience with liver mets, I have a CRC friend that does. When her cancer spread to her liver, her skin became jaundiced and extremely itchy. She was very tired, experienced nausea, loss of appetite and weight loss. ALL of her liver enzymes were elevated, not just a select few. Thirdly, is there any reason to not believe what your family doctor is telling you i.e. that your husband likely has a viral illness?

Let us know how things turn out,

Paige

[Mpas0281]

Thanks all for your responses.

He had a CT chest abdomen and pelvis on Friday morning and we get the results Monday morning. Oncologist suggests PET scan even if CT is normal.

In answer to some of the questions- he hasn’t had jaundice or itchy skin but has had a marked loss of appetite and weight loss over a few weeks. I suppose a virus might do that too. Headache has been prominent feature but MRI brain is normal. No fevers or sore throat etc to suggest a virus.

We haven’t had to deal with scanxiety for a few years so a bit out of practice with it all.

Fingers crossed

[beach sunrise]

I agree with everyone's take on CEA marker. I Will Fight gave you reliable alternative markers to CEA and I might add GGT & AFP to go along with standard liver markers also.