The Value of CEA and CA 19-9 in Detecting Cancer in a Group of High-Risk Subjects with Gastrointestinal Symptoms

Clinical significance of tumor markers in patients with type 2 diabetes: a retrospective observational study

Aim

To cross-sectionally and longitudinally investigate the association between tumor markers (Cancer embryonic antigen (CEA) Carbohydrate antigen 19-9 (CA19-9)) and malignancies in type 2 diabetes patients without evidence of malignancy.

Materials and Methods

The study included 707 patients admitted for the treatment of diabetes from 1 August 2010 to 1 September 2018. Serum CEA and CA19-9 levels were measured for screening of malignancies at admission. Abdominal ultrasonography, computed tomography, and endoscopy were performed for close examination. The percentage of patients diagnosed with malignancy was calculated, and among those without malignancy, the incidence of malignancies was examined after discharge.

Results

A total of 26 patients (3.7%) were newly diagnosed with malignancy during hospitalization. The optimal cut-off value of CEA and CA19-9 by receiver operating characteristic analysis was 5.0 ng/mL and 75 U/mL, and their positive predictive values (PPV) were 8.7% and 22.5%, respectively. The addition of CA19-9 to age, smoking status, body mass index, and glycated hemoglobin significantly improved classification performance for malignancy using net reclassification improvement (0.682, 95% CI 0.256-1.107) and integrated discrimination improvement (0.150, 95% CI 0.007-0.294). Among 681 patients without malignancies during hospitalization, 30 patients (4.4%) developed malignancies during an average follow-up of 3.9 years. CA19-9 (hazard ratio: 1.005, 95% CI: 1.003-1.008) was associated with the development of malignancies.

Conclusions

PPV of serum CEA and CA19-9 for detecting malignancy was high in type 2 diabetes patients with poor glycemic control. Measuring CA19-9 was found to be valuable to cross-sectionally and longitudinally detect malignancies.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13340-022-00594-x.

Clinical utility of serum tumor markers in the diagnosis of malignant intestinal occlusion. A prospective observational study

AIM

The aim of the present observational study was to evaluate the diagnostic accuracy of CEA, CA 19-9 and CA 72-4 in patients with bowel obstruction.

METHODS

One-hundred three patients admitted to an emergency unit with clinical and radiological signs of intestinal occlusion of unknown origin were prospectively studied. Patients submitted to emergency surgery were excluded. All patients underwent standard diagnostic procedures and serological assay of tumor markers.

RESULTS

Colorectal cancer was diagnosed in 22 patients (21.4%), while 81 patients (78.6%) presented a benign condition. The sensitivity of CEA, CA 19-9 and CA 72-4 for colorectal cancer was 36.4%, 31.8% and 9.1%, respectively. Marker specificity was 91.4%, 90.1% and 95.1%, respectively. The combination of CEA and CA 19-9 increased the sensitivity to 45.5% but decreased the specificity to 83.9%. The overall accuracy was 79.6%, 77.7% and 76.7%, respectively. All positive cancer cases had advanced disease. All patients with CEA levels >10 ng/mL or CA 19-9 >100 U/mL had colorectal cancer.

CONCLUSIONS

Even in a highly selected population, tumor marker sensitivity was rather low and specificity incomplete. However, elevated levels may guide the diagnostic and therapeutic course in patients with obstructing colorectal cancer.