Increasing CEA

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Dennyp
Posts: 39
Joined: Thu Oct 29, 2020 9:28 pm

Increasing CEA

Postby Dennyp » Tue May 17, 2022 5:34 pm

I had a CT scan today with oral contrast (shortage of IV contrast) scan was clean, my CEA is elevated. It has never gone above 4 but has steadily increased over the last 3 visits. In the past she said don’t worry as CEA isn’t an indicator for me, today it was 5.7. I am hoping it’s an anomaly. I’m meeting with my doctor tomorrow. Does anyone have any thoughts?
5/19 IIIC sigmoid cancer 2/25 lymph nodes positive
5/19 surgery
7/19 FOLFOX 6 months
9/20 recurrence to single lymph node
10/20 FOLFIRI 5 rounds
1/21 surgery to remove lymph node
4/21 CT NED
8/21 CT NED
11/21 CT NED
2/22 CT NED
5/22 CT NED

prayingforccr
Posts: 352
Joined: Sun Jun 28, 2020 4:44 pm

Re: Increasing CEA

Postby prayingforccr » Tue May 17, 2022 6:42 pm

Dennyp wrote:I had a CT scan today with oral contrast (shortage of IV contrast) scan was clean, my CEA is elevated. It has never gone above 4 but has steadily increased over the last 3 visits. In the past she said don’t worry as CEA isn’t an indicator for me, today it was 5.7. I am hoping it’s an anomaly. I’m meeting with my doctor tomorrow. Does anyone have any thoughts?


My oncologist says “We don’t treat blood tests, we treat images.”

I feel you.

viewtopic.php?f=1&t=66093
11/19: colonoscopy
12/19: diagnosed with stage 3 rectal cancer 6+cm tumor
1-3/20: 20 sessions of radiation, mon-fri capecetibine+clinical trial drug m3814
7/20: 8 treatmentsFOLFOX
11/20: Primary tumor had complete response. Possible tumor deposits on latest mri. Biopsy negative for cancer.
5/21: Multiple lung nodules (3-6mm) on ct scan
10/21: md anderson gives me 1 year without treatment/3 years with folfiri/avastin (refused)
3/22 No growth in nodules 6 months
7/22 beginning sbrt and immunotherapy

Rock_Robster
Posts: 690
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Increasing CEA

Postby Rock_Robster » Tue May 17, 2022 6:54 pm

Well technically I think you’d meet some peoples’ criteria for a review, which is 3 consecutive increases with one of those being above 5.7. However a ‘review’ in this case usually means imaging, which you’ve done and all was good - so I’d say in this case it’s good news! As you now doubt know CEA can bounce around for many reasons - I think the key now would be to keep a close eye on it and consider more/earlier investigations if the trend continues.

Have you ever done ctDNA / Signatera testing?
40M Australia
2018 Dx RC, 12cm high
G2, EMVI, LVI. 4 liver mets
pT3N1aM1a Stage IVa. MSS NRAS G13R
CEA: Nov-18= 14; then <2. Jun-22: 5
11/18 FOLFOX x6
3/19 Liver resection
5/19 25x pelvic IMRT radiation
7/19 ULAR & ileo (reversed)
8/19 Liver lesion
8/19 FOLFOX, FOLFOXIRI, FOLFIRI x7
12/19 Liver resection
NED
11/21 Liver met & celiac node; 2-3 tiny lung things
12/21 PVE
3/22 Nodal spread & 3 liver mets. Lymphadenectomy
4/22 Liver SBRT
6/22 Liver looks good. Still some small lung things

Dennyp
Posts: 39
Joined: Thu Oct 29, 2020 9:28 pm

Re: Increasing CEA

Postby Dennyp » Tue May 17, 2022 7:33 pm

Rock_Robster wrote:Well technically I think you’d meet some peoples’ criteria for a review, which is 3 consecutive increases with one of those being above 5.7. However a ‘review’ in this case usually means imaging, which you’ve done and all was good - so I’d say in this case it’s good news! As you now doubt know CEA can bounce around for many reasons - I think the key now would be to keep a close eye on it and consider more/earlier investigations if the trend continues.

Have you ever done ctDNA / Signatera testing?


Thanks for the response. I haven’t done any testing other than testing of the tumor. My oncologist felt it was too late to do signatera (I forget the exact reason).
5/19 IIIC sigmoid cancer 2/25 lymph nodes positive
5/19 surgery
7/19 FOLFOX 6 months
9/20 recurrence to single lymph node
10/20 FOLFIRI 5 rounds
1/21 surgery to remove lymph node
4/21 CT NED
8/21 CT NED
11/21 CT NED
2/22 CT NED
5/22 CT NED

Rock_Robster
Posts: 690
Joined: Thu Oct 25, 2018 5:27 am
Location: Brisbane, Australia

Re: Increasing CEA

Postby Rock_Robster » Tue May 17, 2022 10:45 pm

Dennyp wrote:My oncologist felt it was too late to do signatera (I forget the exact reason).


Interesting, could be perhaps because there is no fresh tumor tissue to test - but ctDNA testing is generally done by blood test anyway. If they wanted genomics to compare against you would likely have stored tissue somewhere.
40M Australia
2018 Dx RC, 12cm high
G2, EMVI, LVI. 4 liver mets
pT3N1aM1a Stage IVa. MSS NRAS G13R
CEA: Nov-18= 14; then <2. Jun-22: 5
11/18 FOLFOX x6
3/19 Liver resection
5/19 25x pelvic IMRT radiation
7/19 ULAR & ileo (reversed)
8/19 Liver lesion
8/19 FOLFOX, FOLFOXIRI, FOLFIRI x7
12/19 Liver resection
NED
11/21 Liver met & celiac node; 2-3 tiny lung things
12/21 PVE
3/22 Nodal spread & 3 liver mets. Lymphadenectomy
4/22 Liver SBRT
6/22 Liver looks good. Still some small lung things

rp1954
Posts: 1593
Joined: Mon Jun 13, 2011 1:13 am

Re: Increasing CEA

Postby rp1954 » Wed May 18, 2022 1:15 pm

My oncologist says “We don’t treat blood tests, we treat images.”


I think this can be a particularly deficient strategy for LN. My wife's LN were greatly undersized and numerically misunderstood on scans, images (hi res on a new 128 slice CT and then PET+CT) vs physical reality, despite a lot of skill amongst 4+ radiologists that read them for us and the best surgical teams.

Lest I sound bitter, not at all - I exploited these differences and misconcenptions to get my wife a second surgery, as multiple para-aortic LN were normally classed as inoperable then. Whereas the surgeon was shocked by the actual conglomerated mass(es) and post-op with pathology. The principal surgeon subsequently thought the LN operation was likely going to "be a waste of time" without early chemo at 5days (We were faster at 24 hr). Our blood work for the previous year was spot on for the number of major LN (~2 cm) and their relative sizes. Not so much for hi res CT plus a PET/CT.

I would do the the Signatura, and the other blood tests I've mentioned previously to get some idea where you are.
Reporting the liver panels and broader inflammation panels gives some idea of interferences, and sometimes, cancer.

"Std" cancer monitoring on blood always reminds me of someone I knew in college.
She had breast cancer, where "std" practices for "curative" post-op blood monitoring were (now? vs 2003-5) even more lax.
By the time drs finally pulled blood markers a year or so later, her CEA (a secondary marker in BrCA) was almost 400, as well as a disaster in the regular BrCA markers.
watchful, active researcher and caregiver for stage IVb/c CC. surgeries 4/10 sigmoid etc & 5/11 para-aortic LN cluster; 8 yrs immuno-Chemo for mCRC; now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher, peaking ~2011-12, taper to almost nothing mid 2018, mostly IV C

prayingforccr
Posts: 352
Joined: Sun Jun 28, 2020 4:44 pm

Re: Increasing CEA

Postby prayingforccr » Wed May 18, 2022 6:39 pm

“ My oncologist says “We don’t treat blood tests, we treat images.”

She’s useless and runs a chemo mill.

I havent listened to one word from her in over a year and a half.

My cea bumped up to 5.2 (all time high) prior to my previous scans, and I was expecting the worst.

No growth/cavitations.

Hopefully it’s due to shedding/die off.

None of them considered 5.2 to be crazy abnormal but it freaked me out.

Another time, out of the blue, my Can I call you in a little bit? 19-9 came in at 85 having never been higher than 20.

Next scan it was 12.

“ Try not to worry about” is isn’t any comfort at all.

Ask for a new blood panel.
11/19: colonoscopy
12/19: diagnosed with stage 3 rectal cancer 6+cm tumor
1-3/20: 20 sessions of radiation, mon-fri capecetibine+clinical trial drug m3814
7/20: 8 treatmentsFOLFOX
11/20: Primary tumor had complete response. Possible tumor deposits on latest mri. Biopsy negative for cancer.
5/21: Multiple lung nodules (3-6mm) on ct scan
10/21: md anderson gives me 1 year without treatment/3 years with folfiri/avastin (refused)
3/22 No growth in nodules 6 months
7/22 beginning sbrt and immunotherapy

Dennyp
Posts: 39
Joined: Thu Oct 29, 2020 9:28 pm

Re: Increasing CEA

Postby Dennyp » Thu May 19, 2022 6:19 am

The plan is to do another CEA in a month. If it’s still elevated we’ll do a PET scan.
5/19 IIIC sigmoid cancer 2/25 lymph nodes positive
5/19 surgery
7/19 FOLFOX 6 months
9/20 recurrence to single lymph node
10/20 FOLFIRI 5 rounds
1/21 surgery to remove lymph node
4/21 CT NED
8/21 CT NED
11/21 CT NED
2/22 CT NED
5/22 CT NED

Claudine
Posts: 694
Joined: Tue Mar 12, 2019 2:41 pm
Location: Montana

Re: Increasing CEA

Postby Claudine » Thu May 19, 2022 9:07 am

Yes to the PET. My husband had repeatedly “clear” CT scans with very elevated CEA until a PET revealed a rectal tumor - those are apparently difficult to see on CTs; had he gotten a PET sooner, it would have been smaller and easier to deal with...
Good luck, I hope it’s a fluke and the CEA drops back down!
Wife of Dx 04/18 (51 yo). MSS, KRAS G12A, no primary
Lytic met L4 vertebrae, EBRT 04/18, SBRT 02/19
Resect small intestine 05/18 (no cancer - Crohn's)
Failed adjuvant Xelox ; Folfiri + Avastin 03/19 to 01/20
6.7 cm left adrenal mass 03/19, successful resection 02/20
Multiple small lung nodules (03/19) now gone/calcified
L3-L4-L5 fusion surgery and partial corpectomy 05/20
CEA since 03/19: high 81.1, low 3.2, now 66
MRI 2/11/22: rectal adenocarcinoma pT3 pN0 stage 2A
LAR surgery April 11

Capri
Posts: 79
Joined: Thu Apr 19, 2018 5:59 pm

Re: Increasing CEA Following this thread

Postby Capri » Sat May 28, 2022 9:02 am

My son's been doing great. CT earlier this year and colonoscopy were all clear. Latest CEA up to 1.5 from 0.9. Bothersome to me, not too much to him. His onco is following him closely and ordered another CT. We'll go from there.
Mom to son 46 yo at Dx (2017)
11/17 sigmoid tumor found on colonoscopy
1/18 Robotic resection, Adenocarcinoma, Stg. IIIA T3 N1 MX, mod. differentiated, margins clear
2/18 - 7/30/18 Port placed; completed 12 cycles of FOLFOX
6/18 Put on Early surveillance CT,PET scan-normal. Neuropathy has started.
10/18 Port removed
11/2/18 Clean colonoscopy; 11/20 CT normal.
3/2019 Abdominal CT normal
9/2019 Chest, abdomen, pelvis CTs "unremarkable".

Rikimaroo
Posts: 408
Joined: Tue Dec 20, 2016 8:48 pm
Location: Florida

Re: Increasing CEA

Postby Rikimaroo » Sun May 29, 2022 1:13 pm

my cea was .8 and kept rising it is a sign that cancer is growing. Not trying to scare you but usually that's what it means. Scans are king thought and until something shows nothing to worry about. If your CEA has been a good indicator for you and its creeping up that means your cancer is growing typically. If you CEA is not a good indicator for you I would ignore it.
RC T3N1M0 12/16
MSS - NRAS Mutation
Chemo Rad, CCR - W&W 5/2017
Recurrence 11/2017
CT Scan 11/2017 Liver Met 5.5cm Stable, Stage IV
LAR/Liver Resect 4/2018
Reversal 10/18
CEA highest 500, lowest .8 throughout process, waiting for latest
Recurrence left vesical/pelvic sidewall - 10/7/2019 resect perm bag,
CEA rise Feb/May 3.7, 8.8, 30, Recurrence in Pelvic
CEA 40 right now, but was 57, so folfiri to beat it back down.
Lots of chemo for the past 4 years.

Dennyp
Posts: 39
Joined: Thu Oct 29, 2020 9:28 pm

Re: Increasing CEA

Postby Dennyp » Sun May 29, 2022 8:00 pm

Rikimaroo wrote:my cea was .8 and kept rising it is a sign that cancer is growing. Not trying to scare you but usually that's what it means. Scans are king thought and until something shows nothing to worry about. If your CEA has been a good indicator for you and its creeping up that means your cancer is growing typically. If you CEA is not a good indicator for you I would ignore it.


Yup, that is my concern. I’m holding onto hope because when I had a huge tumor that obstructed my colon my CEA never rose above 4. When I had a recurrence it didn’t go above 3.5. Also the same time my CEA rose to 5.7, I had a clean scan, although it was with oral contrast not IV contrast.

So it can be said CEA has never been a good marker for me, but as we all know the nature of our individual disease can change. I suspect my next CEA results will not be favorable, but I will remain optimistic.
5/19 IIIC sigmoid cancer 2/25 lymph nodes positive
5/19 surgery
7/19 FOLFOX 6 months
9/20 recurrence to single lymph node
10/20 FOLFIRI 5 rounds
1/21 surgery to remove lymph node
4/21 CT NED
8/21 CT NED
11/21 CT NED
2/22 CT NED
5/22 CT NED

Rikimaroo
Posts: 408
Joined: Tue Dec 20, 2016 8:48 pm
Location: Florida

Re: Increasing CEA

Postby Rikimaroo » Tue May 31, 2022 10:31 am

When my cancer intially started I think my CEA was 32 and it was in my rectum only, once it went to my liver it shot up to 600, it started going down after getting on treatments, etc..So with that being said, your CEA based on your last statement probably is not a good indicator which is a good thing LOL.. I hate CEA anxiety.
RC T3N1M0 12/16
MSS - NRAS Mutation
Chemo Rad, CCR - W&W 5/2017
Recurrence 11/2017
CT Scan 11/2017 Liver Met 5.5cm Stable, Stage IV
LAR/Liver Resect 4/2018
Reversal 10/18
CEA highest 500, lowest .8 throughout process, waiting for latest
Recurrence left vesical/pelvic sidewall - 10/7/2019 resect perm bag,
CEA rise Feb/May 3.7, 8.8, 30, Recurrence in Pelvic
CEA 40 right now, but was 57, so folfiri to beat it back down.
Lots of chemo for the past 4 years.

Dennyp
Posts: 39
Joined: Thu Oct 29, 2020 9:28 pm

Re: Increasing CEA

Postby Dennyp » Tue May 31, 2022 10:30 pm

Rikimaroo wrote:When my cancer intially started I think my CEA was 32 and it was in my rectum only, once it went to my liver it shot up to 600, it started going down after getting on treatments, etc..So with that being said, your CEA based on your last statement probably is not a good indicator which is a good thing LOL.. I hate CEA anxiety.



Thanks, I’m probably making myself nuts about nothing! I hate living in 3 month blocks!!
5/19 IIIC sigmoid cancer 2/25 lymph nodes positive
5/19 surgery
7/19 FOLFOX 6 months
9/20 recurrence to single lymph node
10/20 FOLFIRI 5 rounds
1/21 surgery to remove lymph node
4/21 CT NED
8/21 CT NED
11/21 CT NED
2/22 CT NED
5/22 CT NED

Dennyp
Posts: 39
Joined: Thu Oct 29, 2020 9:28 pm

Re: Increasing CEA

Postby Dennyp » Tue Jun 21, 2022 11:24 am

We’ll, my CEA increased from 5.7 to 6.6 in one month, I’m guessing that’s pretty bad news. Meeting my doctor tomorrow.
5/19 IIIC sigmoid cancer 2/25 lymph nodes positive
5/19 surgery
7/19 FOLFOX 6 months
9/20 recurrence to single lymph node
10/20 FOLFIRI 5 rounds
1/21 surgery to remove lymph node
4/21 CT NED
8/21 CT NED
11/21 CT NED
2/22 CT NED
5/22 CT NED


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