Clean scans but CEA of 15.6 ! Seen this yet?

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skb
Posts: 58
Joined: Tue Mar 28, 2017 2:00 pm

Clean scans but CEA of 15.6 ! Seen this yet?

Postby skb » Mon Jul 19, 2021 12:39 pm

Yesterday, my latest scan results came out (chest, abdomen and Pelvis)- MRI and PET and they were clean. No evidence of disease. But the CEA had a value of 15.6

My CEA has never been high. Even during diagnosis, it was <0.5. My doctor has added another blood test for CEA this week and if he sees a high, he will order a colonoscopy. I hope I do not have a met in my neck, head or limbs. I feel fine and do not have any symptoms.

Usually my blood is drawn prior to my scans. But this time, it was immediately after the scans during which contrasts were injected. Could that affect CEA? Could covid vaccination affect CEA?

Anyone experienced this yet?
Last edited by skb on Wed Jul 21, 2021 4:17 pm, edited 2 times in total.
3/21/17: Dx T3N0M0- distal rectal cancer, 4.5cm tumor, 2.5 cm from anal verge
4/18 to 5/22/17: chemoradiation - Xeloda 1800mg twice a day for 25 days, 200 Cgy/day
6/28/17: biopsy shows no cancer
8/09/17: MRI - no primary tumor left, starts wait and watch
8/17/17 to 12/1/17: mop-up chemo with Folfox and oxaliplatin (IV infusion), every two weeks
5/19 expanding right lung nodule, 8mm
8/19 VATS wedge
9/19, 12/19, 4/20, 7/20, 1/21- Clean CT, MRI, NED
7/17/21- Clean scans, CEA 15.6 !
7/22/21- CEA 17.3 !

Hooandtrue93
Posts: 11
Joined: Tue May 11, 2021 10:28 pm

Re: Cleans scans but CEA of 15.6 ! Seen this yet?

Postby Hooandtrue93 » Mon Jul 19, 2021 2:39 pm

I don't know about your specific questions but do you think a ctDNA test might be helpful or is something worth bringing up to your doctor?
28 year old, son of 62 year old mom
Stage 3B Duodenal Adenocarcinoma.
7/13 lymph nodes positive
02/22/2021: Whipple Surgery
04/08/2021: Port Surgery. CtDNA test sample taken (positive)
04/13/2021: Folfox-6 begins for 6 months

skb
Posts: 58
Joined: Tue Mar 28, 2017 2:00 pm

Re: Cleans scans but CEA of 15.6 ! Seen this yet?

Postby skb » Tue Jul 20, 2021 11:45 am

I found all these links collected by some other individuals in another thread

Stage IV patient with increasing CEA: wait-and-see? viewtopic.php?f=1&t=62401
Beckman-Coultier CEA assays viewtopic.php?f=1&t=61400
How important is CEA? viewtopic.php?f=1&t=56664
What is it with CEA levels? viewtopic.php?f=1&t=55107
Rising CEA and Clear PET Scans viewtopic.php?f=1&t=55000
What is your tumor marker (CEA)? viewtopic.php?f=1&t=53916
Should I be Worried about this CEA Number? viewtopic.php?f=1&t=51146
Cea results posting.php?mode=reply&f=1&t=65324
Should I be worry about rise on my CEA level posting.php?mode=reply&f=1&t=65324
Help! Confusing CEA viewtopic.php?f=1&t=49169
Scared- CEA elevated slightly. viewtopic.php?f=1&t=48813
CEA level viewtopic.php?f=1&t=48463
CEA Rising but still in normal range UPDATE viewtopic.php?f=1&t=47238
CEA question viewtopic.php?f=1&t=48035
Cea readings- confussed viewtopic.php?f=1&t=46914
CEA creeping up viewtopic.php?f=1&t=46622
Why are CEA levels tested every three months? viewtopic.php?f=1&t=46638
CEA viewtopic.php?f=1&t=46455
CEA Number: viewtopic.php?f=1&t=46350
Help me understand CEA viewtopic.php?f=1&t=43873

Maybe someone will turn this into a sticky?

Good Luck
Last edited by skb on Wed Jul 21, 2021 2:11 pm, edited 1 time in total.
3/21/17: Dx T3N0M0- distal rectal cancer, 4.5cm tumor, 2.5 cm from anal verge
4/18 to 5/22/17: chemoradiation - Xeloda 1800mg twice a day for 25 days, 200 Cgy/day
6/28/17: biopsy shows no cancer
8/09/17: MRI - no primary tumor left, starts wait and watch
8/17/17 to 12/1/17: mop-up chemo with Folfox and oxaliplatin (IV infusion), every two weeks
5/19 expanding right lung nodule, 8mm
8/19 VATS wedge
9/19, 12/19, 4/20, 7/20, 1/21- Clean CT, MRI, NED
7/17/21- Clean scans, CEA 15.6 !
7/22/21- CEA 17.3 !

catstaff
Posts: 101
Joined: Wed Mar 03, 2021 11:37 am

Re: Cleans scans but CEA of 15.6 ! Seen this yet?

Postby catstaff » Tue Jul 20, 2021 12:01 pm

As you can see from the large number of links, CEA is a persistently vexatious issue. Memorial Sloan Kettering did a study a while back tracking outcomes of spikes of CEA to values greater than 5 (ignoring smoking status). They found that it was indicative of recurrence in about 50% of the cases; in others it was just an unexplained rise that returned to normal in a short time. Values above 15 were often of malignant origin (so you're right on the borderline there) but not always, whereas >20 it was pretty much always malignancy. So repeating the measurement seems like the appropriate course of action for now, especially since nothing is visible through imaging.

I don't know that CEA fluctuation is particularly well characterized in healthy people so there isn't much to go by there, other than that the normal range has been established.
D/H Dx 10/2019 RC age 61
Clinical T4bN2M1a (common iliac and para-aortic lymph nodes)
MSS KRAS G12D
CRT 11/19-1/20 FOLFOX 3/20-7/20
Pelvic exenteration w/LAR 8/20
ypT4bN0Mx G3 0/14 nodes LVI not seen PNI-
CEA 10/19:20, 1/20-11/20:1.6, 4.3, 3.4, 2.7, 2/21:9.0 3/21:18,40 4/21:28,19, 5/21:13.3,8.6
PET 3/21 recurrence in distal nodes, L5 vertebra, pelvis
FOLFIRI+bev 3/21-

skb
Posts: 58
Joined: Tue Mar 28, 2017 2:00 pm

Re: Cleans scans but CEA of 15.6 ! Seen this yet?

Postby skb » Tue Jul 20, 2021 12:47 pm

thank you catstaff and Hooandtrue93
3/21/17: Dx T3N0M0- distal rectal cancer, 4.5cm tumor, 2.5 cm from anal verge
4/18 to 5/22/17: chemoradiation - Xeloda 1800mg twice a day for 25 days, 200 Cgy/day
6/28/17: biopsy shows no cancer
8/09/17: MRI - no primary tumor left, starts wait and watch
8/17/17 to 12/1/17: mop-up chemo with Folfox and oxaliplatin (IV infusion), every two weeks
5/19 expanding right lung nodule, 8mm
8/19 VATS wedge
9/19, 12/19, 4/20, 7/20, 1/21- Clean CT, MRI, NED
7/17/21- Clean scans, CEA 15.6 !
7/22/21- CEA 17.3 !

Punky44
Posts: 484
Joined: Mon Oct 01, 2018 4:29 pm

Re: Cleans scans but CEA of 15.6 ! Seen this yet?

Postby Punky44 » Tue Jul 20, 2021 11:41 pm

When did you get your vaccine? CEA will pick up any inflammation in the body.
Caregiver to my amazing mom (68 at dx)
10/1/18 DX with rectal cancer; CEA 17
T3N2M0
Total neoadjuvant therapy:
8 rounds Folfox 11/5/18 - 2/11/19
Short course radiation 3/14/19 - 3/20/19
Robotically assisted laparoscopic LAR 3/21/19
Pathology report says yT2N0M0 with 0/38 nodes
6/28/19 Reversal and port out
CEA 2.1; 1.9; 2.6; 2.8; 2.3; 2.4; 3.0; 3.4; 3.1
Latest update: 6/28/21: Clear CT with CEA 3.1 (attributed to emphysema)

Me: 34, first colonoscopy 11/16/18—normal! Come back in 5 years.

skb
Posts: 58
Joined: Tue Mar 28, 2017 2:00 pm

Re: Cleans scans but CEA of 15.6 ! Seen this yet?

Postby skb » Wed Jul 21, 2021 12:44 pm

Hi punky44,
My Covid vaccination was in March/April 2021. That seems quite a long time ago to have any effect on the results.

I have been reading up some papers online and found that it is preferable that blood tests be preceded by imaging scans if they both occur on the same day. The contrast dye that is injected during imaging tests could interfere with assays used in processing blood results. Here is one such article. https://www.mdlinx.com/article/common-d ... s/lfc-4993
It says- "Iodinated contrast media can affect protein levels in the blood, which can manifest as falsely increased results in protein blood tests or protein urine tests."
And CEA is a protein in blood

I have a repeat blood test tomorrow to check CEA level. Regardless of the outcome, I have learned that it is important to not take the blood test ever immediately following a contrast injection into your bloodstream

SKB
Last edited by skb on Wed Jul 21, 2021 2:11 pm, edited 1 time in total.
3/21/17: Dx T3N0M0- distal rectal cancer, 4.5cm tumor, 2.5 cm from anal verge
4/18 to 5/22/17: chemoradiation - Xeloda 1800mg twice a day for 25 days, 200 Cgy/day
6/28/17: biopsy shows no cancer
8/09/17: MRI - no primary tumor left, starts wait and watch
8/17/17 to 12/1/17: mop-up chemo with Folfox and oxaliplatin (IV infusion), every two weeks
5/19 expanding right lung nodule, 8mm
8/19 VATS wedge
9/19, 12/19, 4/20, 7/20, 1/21- Clean CT, MRI, NED
7/17/21- Clean scans, CEA 15.6 !
7/22/21- CEA 17.3 !

User avatar
beach sunrise
Posts: 500
Joined: Thu Mar 05, 2020 7:14 pm

Re: Cleans scans but CEA of 15.6 ! Seen this yet?

Postby beach sunrise » Wed Jul 21, 2021 1:26 pm

I wonder if they "just forgot" to take cea value before scan and did it after to say they did take it same day?
What type (make/model) scan machine was used? There are differences in image quality.
8/19 RC CEA 82.6 T3N0M0
Neoadj 5FU/rad 6 wk
High dose IVC 1 1/2 wks before surgery. Continue still twice a week
Surg 1/20 APR - margins T4bN1a IIIC G2 MSI- 1/20 LN+ LVI+ PNI-
pre cea 24/post 5.9
FOLFOX
7 rds 6-10 CEA 11.4 No more
7/20 CEA 11.1, 8.8
8/20 CEA 7.8
9/20 CEA 8.8, 9, 8.6
10/20 CEA 8.1
11/20 CEA 8's
12/20 CEA 8's & 9's
ADAPT+++ TM drug
MHL1+
PMS2+
MSH2+
MSH6+
POLD1 , KRAS Q61H
Chem-sens test NCI "Test failed, neo adj CR worked. Not enough ca cells to test"

skb
Posts: 58
Joined: Tue Mar 28, 2017 2:00 pm

Re: Cleans scans but CEA of 15.6 ! Seen this yet?

Postby skb » Wed Jul 21, 2021 1:45 pm

Hi beach rise,
It was a Siemens CT machine. My blood test and CT tests are usually scheduled the same day, the CT following the blood test. This time, the blood test was scheduled after the CT. So the blood was drawn within 10 minutes of me getting a contrast injection (isovue 370 128mm). European hospitals recommend that blood draws be done at least 24 hrs after contrast injection. Some scientific papers suggest at least a 4 hour wait. I am hoping that the CEA was a false result because of interference caused by contrast dye with the assays used to measure CEA. The lack of such patient stories in this forum means that this is very uncommon.

But could just be a real rise in CEA from 2.1 in Jan'21 to 15.6 now (July '21). Sometimes the cancerous nodules or lymph nodes are invisible in CT scans until they reach a certain size. I am hoping that is not the case but it is certainly possible. It is also possible that some new tumor is present somewhere else in the body that was not covered by the scan done on the same day. As you might be aware, sometimes there are differences in the way the images are interpreted by different individuals. I might also request my oncologist to have my scans interpreted by someone else.

At the time of diagnosis in 2017, my CEA was <0.5 and the the doctor said that my CEA marker was not a good indicator of disease. It did not change during chemo or after treatment. However tumors and diseases change over time (especially with mets) and the CEA that was non-expressive in 2017 could have become expressive now.

skb
Last edited by skb on Wed Jul 21, 2021 10:45 pm, edited 1 time in total.
3/21/17: Dx T3N0M0- distal rectal cancer, 4.5cm tumor, 2.5 cm from anal verge
4/18 to 5/22/17: chemoradiation - Xeloda 1800mg twice a day for 25 days, 200 Cgy/day
6/28/17: biopsy shows no cancer
8/09/17: MRI - no primary tumor left, starts wait and watch
8/17/17 to 12/1/17: mop-up chemo with Folfox and oxaliplatin (IV infusion), every two weeks
5/19 expanding right lung nodule, 8mm
8/19 VATS wedge
9/19, 12/19, 4/20, 7/20, 1/21- Clean CT, MRI, NED
7/17/21- Clean scans, CEA 15.6 !
7/22/21- CEA 17.3 !

User avatar
beach sunrise
Posts: 500
Joined: Thu Mar 05, 2020 7:14 pm

Re: Clean scans but CEA of 15.6 ! Seen this yet?

Postby beach sunrise » Wed Jul 21, 2021 6:43 pm

I agree. Get that 2nd read. Hopefully cea level a combo of covid shot and contrast.
I have one node in the upper right found with ct scan measuring 3-4mm but its been there since dx. No ctDNA floating around but I still have a high cea so on the hunt for a surgeon and better scanning machine than the one I have been scanned by all along (GE brand I believe,16 slice).
My protocol is different from yours. I am under surveillance with my surgeon so he just checks kidney function before a scan but he has mentioned also taking a cea level with it. Thanks for pointing out blood draws should be before contrast scan.
8/19 RC CEA 82.6 T3N0M0
Neoadj 5FU/rad 6 wk
High dose IVC 1 1/2 wks before surgery. Continue still twice a week
Surg 1/20 APR - margins T4bN1a IIIC G2 MSI- 1/20 LN+ LVI+ PNI-
pre cea 24/post 5.9
FOLFOX
7 rds 6-10 CEA 11.4 No more
7/20 CEA 11.1, 8.8
8/20 CEA 7.8
9/20 CEA 8.8, 9, 8.6
10/20 CEA 8.1
11/20 CEA 8's
12/20 CEA 8's & 9's
ADAPT+++ TM drug
MHL1+
PMS2+
MSH2+
MSH6+
POLD1 , KRAS Q61H
Chem-sens test NCI "Test failed, neo adj CR worked. Not enough ca cells to test"

skb
Posts: 58
Joined: Tue Mar 28, 2017 2:00 pm

Re: Clean scans but CEA of 15.6 ! Seen this yet?

Postby skb » Thu Jul 22, 2021 7:38 pm

My second CEA reading came up as 17.3, so definitely something is up :(
I am so upset.
Thanks beach sunrise for your kind words of support
3/21/17: Dx T3N0M0- distal rectal cancer, 4.5cm tumor, 2.5 cm from anal verge
4/18 to 5/22/17: chemoradiation - Xeloda 1800mg twice a day for 25 days, 200 Cgy/day
6/28/17: biopsy shows no cancer
8/09/17: MRI - no primary tumor left, starts wait and watch
8/17/17 to 12/1/17: mop-up chemo with Folfox and oxaliplatin (IV infusion), every two weeks
5/19 expanding right lung nodule, 8mm
8/19 VATS wedge
9/19, 12/19, 4/20, 7/20, 1/21- Clean CT, MRI, NED
7/17/21- Clean scans, CEA 15.6 !
7/22/21- CEA 17.3 !

User avatar
beach sunrise
Posts: 500
Joined: Thu Mar 05, 2020 7:14 pm

Re: Clean scans but CEA of 15.6 ! Seen this yet?

Postby beach sunrise » Thu Jul 22, 2021 8:42 pm

Man, I was so hoping it was just a combo of covid and contrast.
I will say my cea has never been close to normal and nothing has ever showed up on scans as malignant. Adding ivermectin to the ADAPT+++ has been a game changer with a very nice cea decline getting close to normal value. So, if nothing is found with you maybe ask about ivermectin added to current protocol.
8/19 RC CEA 82.6 T3N0M0
Neoadj 5FU/rad 6 wk
High dose IVC 1 1/2 wks before surgery. Continue still twice a week
Surg 1/20 APR - margins T4bN1a IIIC G2 MSI- 1/20 LN+ LVI+ PNI-
pre cea 24/post 5.9
FOLFOX
7 rds 6-10 CEA 11.4 No more
7/20 CEA 11.1, 8.8
8/20 CEA 7.8
9/20 CEA 8.8, 9, 8.6
10/20 CEA 8.1
11/20 CEA 8's
12/20 CEA 8's & 9's
ADAPT+++ TM drug
MHL1+
PMS2+
MSH2+
MSH6+
POLD1 , KRAS Q61H
Chem-sens test NCI "Test failed, neo adj CR worked. Not enough ca cells to test"


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