The Significance of Elevation of Serum Carcinoembryonic Antigen (CEA) Levels in Inflammatory Diseases of the Intestine

Human chorionic gonadotropin and alpha chain of glycoprotein hormones in patients with inflammatory bowel disease

In twenty patients with Crohn's disease and ten patients with ulcerative colitis serum levels of human chorionic gonadotropin and the common alpha-subunit of glycoprotein hormones were determined by radioimmunoassay. In contrast to published data, all serum samples except one revealed levels within the normal range of 148 controls (human chorionic gonadotropin levels up to 3.9 IU/l, alpha-subunit up to 3.8 micrograms/l). Neither the serum levels of human chorionic gonadotropin nor of the alpha-subunit differed significantly between patients with Crohn's disease (median/maximum: 0.9/4.4 IU/l; 0.7/3.6 micrograms/l) and ulcerative colitis (1.0/3.4 IU/l; 0.8/2.2 micrograms/l). Furthermore, the serum levels studied in patients with active (0.9/3.0 IU/l; 0.7/3.5 micrograms/l) and inactive (0.9/4.4 IU/l; 0.8/3.6 micrograms/l) Crohn's disease and in patients with active (1.1/3.4 IU/l; 0.9/2.2 micrograms/l) and inactive (0.9/2.9 IU/l; 0.8/1.3 micrograms/l) ulcerative colitis were not significantly different. There was no relationship of the duration of the disease or a bowel resection to the serum levels of human chorionic gonadotropin or the alpha-subunit. It is concluded that both parameters are not useful as markers in patients with Crohn's disease or ulcerative colitis. The normal serum levels found in patients with inflammatory bowel diseases indicate human chorionic gonadotropin as a highly specific marker for malignant diseases.

Effect of secretin and cholecystokinin-pancreozymin on plasma CEA concentration in patients with pancreatic carcinoma and pancreatitis

Plasma CEA concentration before and after administration of secretin and cholecystokinin-pancreozymin has been determined in 89 patients with neoplastic or inflammatory pancreatric disease and other neoplastic and nonneoplastic disorders. The purpose of the study was to expore the specificity and sensitivity of such a provocation tests. Some rise of the plasma CEA concentration after hormonal stimulation could be observed in several patients in the various groups. However, none of the 37 patients with nonpancreatic disease who had a basal CEA concentration of 6 micrograms/l or less had a maximal CEA concentration above 13 micrograms/l after the stimulation whereas 7 out of 31 patients with pancreatic disease (3 with pancreatic carcinoma and 4 with chronic pancreatitis) showed such an elevation of plasma CEA concentration. Thus, the provocation test showed a satisfactory specificity for pancreatic disease but a low sensitivity. It is suggested that the possibility of an effect of physiologically released gastrointestinal hormones should be considered when "unexplained" high CEA values are found in plasma samples from nonfasting patients.

Carcinoembryonic antigen concentrations in undiagnosed patients

Serum carcinoembryonic antigen (C.E.A.) levels were measured in 381 undiagnosed patients who presented with clinical problems commonly associated with gastrointestinal malignancy. The results were compared with the final diagnosis after follow-up for up to 5 years to see whether C.E.A.-testing added any useful information. Of 307 patients presenting with upper gastrointestinal symptoms, lower gastrointestinal symptoms, or irom deficiency anaemia, C.E.A. levels greater than 20 ng/ml indicated malignancy in 5 but in 3 of these malignancy was also diagnosed after routine investigation. Of 74 patients presenting with obstructive jaundice, hepatomegaly, or abnormal liver function, malignancy was diagnosed in 38. In 9 of these patients the diagnosis of malignancy could otherwise have been reached only by laparotomy. The serum-C.E.A. thus reached only by laparotomy. The serum-C.E.A. thus seems to be of value in the assessment of liver disease but not in patients with gastric or colonic symptoms or iron-deficiency anaemia.

Carcinoembryonic antigen (CEA) levels in benign gastrointestinal disease states

Elevated circulating CEA levels occur in patients with benign gastrointestinal and hepatic disorders. These are usually less than 10 ng/ml. Of clinical importance is the influence of liver disease on the interpretation of CEA. At least 50% of patients with severe benign hepatic disease have elevated CEA levels, most often active alcoholic cirrhosis, and also chronic active and viral hepatitis, and cryptogenic and biliary cirrhosis. Patients with benign extrahepatic biliary obstruction may have increased plasma CEA, the highest in patients with co-existent cholangitis and especially liver abscess. The liver appears to be essential for the metabolism and/or excretion of CEA. Hence, liver work-up is needed to assess any patient with an elevated CEA. A damaged liver may further augment elevated CEA levels due to cancer. The increased circulating CEA observed in some patients with active ulcerative colitis tends to correlate with severity and extent of disease and usually returns to normal with remission. CEA levels also may be mildly elevated in patients with pancreatitis and in adults with colonic polyps. Smoking may contribute to the increased CEA levels seen in patients with alcoholic liver disease and pancreatitis. Therefore, in interpreting mildy elevated circulating CEA levels in patients with GI tract diseases, one must consider benign as well as malignant etiologies.

Serial carcinoembryonic antigen (CEA) blood levels in patients with ulcerative colitis

Fifty-seven patients with ulcerative colitis were folloued 1-49 months (mean, 18 months) with serial CEA determinations during periods of remission, mild relapses, and severe relapses. Elevated CEA titers correlated with activity and possibly extent of disease: 12% of patients with proctitis, 47% of patients with left-sided colitis, and 60% of patients with transverse or universal colitis had elevated CEA titers during a flare. Moreover, 24% of patients with mild flares and 86% of patients with severe flares had elevated CEA titers. Ninety-two percent of patients with extensive disease and severe flares had elevated CEA titers. Elevated CEA titers were correlated with histologic findings in three patients. Inflammation of mucosa was demonstrated by colonoscopy and confirmed by biopsy in one patient with persistently elevated CEA titers during clinical remission. In two other patients with active disease whose CEA titers fell prior to colectomy, marked denudation of colonic mucosa was noted. In this study, a transiently elevated CEA titer indicated either clinically active ulcerative colitis or active inflammation of colonic mucosa.

The possible role of the carcinoembryonic antigen (CEA) and other carcinofetal antigens in maligant and benign diseases of the gastrointestinal tract

In the present review we have discussed antigens, principally the CEA, which have their well defined place in the clinical management of the (malignant) diseases of the gastrointestinal tract. Though the immunological diagnosis of neoplasia is one of the research areas where the most effort and hopes are invested, it is also there, that the carcinofoetal antigens have the least usefullness at the moment. However, studies like those undertaken by Edgington and Plow are probably pointing out if not proving, that even relatively simple procedures like further purification of the antigen can improve its tumor specificity and consequently its diagnostical value (1975). Following their results the final verdict is not spoken yet as to whether CEA (or any other CFA) will even be more than an adjunctive tool in the diagnosis of malignant tumors specially those of the G.I. tract. The 0.6% of "false" positives these authors have obtained in their series with their highly purified CEA-S (against the 30% usually seen with classical CEA preparations) are provocative: one will have to discuss the question, on which grounds the decision "false positive" has been reached and whether these cases are not simply "clinically silent", hence true positive observations. The problem then would be shifted away from the CEA test (or any other CFA test) toward the improvement of all the other conventionally employed diagnostical measurements, which should allow the early confirmation--and localization--of a beginning neoplasia, which has been screened out by an immunological test. Until this is not warranted, the CEA test has its definite place and vocation at the present time in the follow-up of the treated cancer patient, whatever therapy he has received.

The CEA concentration in duodenal fluid in patients with pancreatic disease

The CEA concentration in duodenal fluid after secretin-CCK stimulation has been investigated in 16 patients with pancreatic disease (6 with pancreatic carcinoma and 10 with chronic pancreatitis), 9 with non-pancreatic disease, and 10 control subjects. The purpose was to study whether the determination of CEA in duodenal fluid during the secretin-CCK test can give any additional information for the diagnosis of pancreatic disease and for differentiation between pancreatitis and carcinoma. We found that high values of CEA in duodenal fluid do not necessarily indicate pancreatic carcinoma. Moreover, the level may be elevated in non-pancreatic disease.

Carcinoembryonic antigen: clinical application

Carcinoembryionic antigen (CEA) a glycoprotein extracted from colonic cancer tissue (beta-globulin electrophoretic mobility, sedimentation coefficient 7 to 8S, and mol wt approximately 200,000) can be detected and measured by radioimmunoassay. Clinical evaluations of CEA determination have given the following results: In health: (1) Serum CEA level is not influenced by sex, age, blood type, time of blood sampling, or family history of cancer; (2) serum CEA level is influenced by a history of smoking or inflammatory disease of the bowel, lung, pancreas, and other organs (occasionally, a CEA level as high as 10 ng/ml is noted); and (3) currently, CEA positivity is defined as greater than 2.5 ng/ml, however, 5 ng/ml may be more realistic. In cancer: (1) CEA level may be increased in primary cancer of the gastrointestinal (GI) tract as well as in non-GI neoplasia; (2) the CEA test is not recommended for screening to detect early cancer; (3) serum CEA level depends on the stage of the neoplasia and usually is not influenced by the grade of differentiation; and (4) markedly increased (greater than 25 ng/ml serum CEA values are highly suggestive of metastatic cancer, particularly hepatic metastasis. In biological fluid: The CEA or CEA-like activity can be measured in gastrointestinal secretions. Quantitative studies of CEA levels in such fluids may yield more information than is obtainable from studies of serum. However, this possibility needs more study at present. Therefore, the currently available CEA tests cannot replace any of the now standard diagnostic methods for cancer detection. This use for assessment of therapy in selected patients or for following those known to be a high risk for cancer appears promising in preliminary studies, but clinical value, if any, remains to be determined.

The present status of DEA in diagnosis, prognosis, and evaluation of therapy

Despite nonspecificity for the diagnosis of colon cancer, the assays for CEA widely studied to date may be useful in the management of patients with colorectal cancer by aiding detection of colonic cancer and especially of widespread metastases to the liver. Use of serial quantitative measurements may also be useful in determining persistence of residual or metastatic tumor after apparently complete surgical resection, in enabling detection of recurrence at an earlier stage than may be otherwise possible, and in helping to evaluate the effects of chemotherapy, provided that the assays are used only in context with complete clinical and laboratory findings, including cancer staging, histopathologic findings, assessment of liver status, and with appreciation of methodologic complexities. Both the further investigation of the clinical use of CEA and the intensified search for more specific markers are encouraged by the findings to date.