Indian Journal of Cancer
Home  ICS  Feedback Subscribe Top cited articles Login 
Users Online :23187
Small font sizeDefault font sizeIncrease font size
Navigate here
  Search
 
  
Resource links
   Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
   Article in PDF (255 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   References

 Article Access Statistics
    Viewed783    
    Printed23    
    Emailed0    
    PDF Downloaded108    
    Comments [Add]    

Recommend this journal

 

  Table of Contents  
LETTER TO THE EDITOR
Year : 2014  |  Volume : 51  |  Issue : 4  |  Page : 452
 

Carcinoembryonic antigen levels in colorectal cancer: Are we too preoccupied?


Department of Surgical Oncology (GI Surgery), Tata Medical Center, Kolkata, West Bengal, India

Date of Web Publication1-Feb-2016

Correspondence Address:
Dr. G Aggarwal
Department of Surgical Oncology (GI Surgery), Tata Medical Center, Kolkata, West Bengal
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.175344

Rights and Permissions



How to cite this article:
Aggarwal G, Roy M K, Banerjee S. Carcinoembryonic antigen levels in colorectal cancer: Are we too preoccupied?. Indian J Cancer 2014;51:452

How to cite this URL:
Aggarwal G, Roy M K, Banerjee S. Carcinoembryonic antigen levels in colorectal cancer: Are we too preoccupied?. Indian J Cancer [serial online] 2014 [cited 2019 Dec 6];51:452. Available from: http://www.indianjcancer.com/text.asp?2014/51/4/452/175344


Sir,

The dependence on carcinoembryonic antigen (CEA) levels both in the pre-operative as well as post-operative follow-up period in the management of colorectal cancer has remained a matter of debate world-wide. Are we too dependent on the CEA levels and what are the questions that still remain unanswered, is what we would like to draw the attention of the oncological fraternity to, through our letter.

CEA, an oncofetal antigen, ever since its detection, has become one of the most used markers in colorectal cancer to the extent of influencing management protocols as well.[1]

CEA as a baseline pre-operative investigation and subsequent 3 monthly CEA estimation in the post-treatment phase is an accepted standard of care.[1],[2]

However, there are still several questions that remain unanswered:

Do the pre-operative CEA levels corroborate with the severity/stage/extent of colorectal disease?

Does a pre-treatment baseline CEA level also corroborate with post-treatment levels?

If not, then how can post-operative 3 monthly CEA be used as a marker of recurrence in those patients with low to normal pre-operative levels? In these, is there a role of investigations such as a routine positron emission tomography (PET)-computed tomography (CT) scan or earlier CT scans/colonoscopies?

Huh et al.[3] reported that pre-operative CEA levels (cut-off 5 ng/mL) were significant only for TNM stage II cancers. However, others showed that the pre-operative CEA level was an independent predictor of disease-free survival only in stage III.[3]

A novel concept put forth by Jeon et al.[4] is of individualization of cut-off values of preoperative CEA levels, seemingly a more practical approach to management.

Multicenter randomized trials are thus mandatory to bridge this gap in the hiatus of knowledge.

Until and unless these questions are answered, our reliance on CEA levels (albeit supportive) would continue to remain. As said, it is always better to "err on the side of caution," especially in the oncology setup.

 
  References Top

1.
Duffy MJ. Carcinoembryonic antigen as a marker for colorectal cancer: Is it clinically useful? Clin Chem 2001;47:624-30.  Back to cited text no. 1
    
2.
Huh JW, Oh BR, Kim HR, Kim YJ. Preoperative carcinoembryonic antigen level as an independent prognostic factor in potentially curative colon cancer. J Surg Oncol 2010;101:396-400.  Back to cited text no. 2
    
3.
Park YA, Lee KY, Kim NK, Baik SH, Sohn SK, Cho CW. Prognostic effect of perioperative change of serum carcinoembryonic antigen level: A useful tool for detection of systemic recurrence in rectal cancer. Ann Surg Oncol 2006;13:645-50.  Back to cited text no. 3
    
4.
Jeon BG, Shin R, Chung JK, Jung IM, Heo SC. Individualized cutoff value of the preoperative carcinoembryonic antigen level is necessary for optimal use as a prognostic marker. Ann Coloproctol 2013;29:106-14  Back to cited text no. 4
    




 

Top
Print this article  Email this article
 

    

  Site Map | What's new | Copyright and Disclaimer
  Online since 1st April '07
  2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow