Cancer Treatment Today » CEA

CEA, C15-3, Ca 27-29 for breast cancer – pro

M Levin, MD — Mon, 27 Aug 2012 11:42:53 +0000

Lay Summary: Tumor markers are occasionally useful but CEA is not well supported as an aid to monitoring or diagnosing breast cancer.

Tumor markers are measurable biochemicals that are associated with a malignancy. They are either produced by tumor cells (tumor-derived) or by the body in response to tumor cells (tumor-associated). They are typically substances that are released into the circulation and thus measured in the blood. There are a few exceptions to this, such as tissue-bound receptors that must be measured in a biopsy from the solid tumor or proteins that are secreted into the urine. Once cancer is diagnosed, tumor marker levels sometimes help to determine the extent of cancer. Higher levels can indicate more advanced cancer and a worse prognosis in some cases. The patient and their physician may use this information to choose between more or less aggressive treatments.

CEA is a glycoprotein most often associated with colorectal cancer, and used to monitor patients with this type of cancer. Its most popular use is in early detection of relapse in individuals already treated for colorectal cancer. After surgery, serial measurements indicate the surgery’s success and are used to detect early signs of recurrence. It has recently been found to be useful when measured during surgery for colorectal cancer to help determine prognosis and who will benefit from adjuvant treatment. We discuss the three most commonly used markers for breast cancer.

CEA is measured in the blood plasma. It is very non-specific and can be increased in many types of cancer: gastrointestinal, colorectal, ovarian, bladder, cervical, stomach, kidney, lung, pancreatic, liver, prostate, thyroid, melanoma, lymphoma, and breast. People with noncancerous conditions, such as cirrhosis or peptic disease, or inflammatory intestinal conditions such as colitis or diverticulitis, may also have increased levels. CEA levels can be elevated in elderly patients and in those who smoke.

CA 15-3 is produced by cells in the breast and increased levels can be associated with breast cancer. Rarely increased in women with early breast cancer, it may be used to detect recurrence of cancer in women following treatment or mastectomy and to monitor treatment for women with advanced breast cancer. However, adenocarcinomas of the ovary, lung, colon, and pancreas also express elevated CA 15-3 levels. Non-cancerous conditions sometimes associated with elevated CA 15-3 include benign breast or ovarian disease, endometriosis, pelvic inflammatory disease, and hepatitis. Pregnancy and lactation are also related to high CA 15-3 levels.

CA 27-29, also called breast carcinoma-associated antigen, is used as a marker for breast cancer. Eighty percent of women with breast cancer have an increased CA 27-29 level. This marker may be used with other procedures and tumor marker levels such as CA 15-3 to check for recurrences of cancer in previously treated women. Serial measurements monitor treatment response and identify recurrence.

Levels of CA 27-29 may also be increased in cancers of the colon, stomach, kidney, lung, ovary, pancreas, uterus, and liver. Noncancerous conditions associated with elevated CA 27-29 include first trimester pregnancy, endometriosis, ovarian cysts, non-cancerous breast disease, kidney disease, and liver disease.

Gudelines do not support use of CEA markers for diagnosis or monitoring of breast cancer. They do not recommend routine use of CEA in the surveillance of patients with diagnosed breast cancer. For monitoring patients with advanced disease, CEA should not be used alone. For monitoring patients with non-evaluable disease, CEA may occasionally be informative when CA 15-3/BR 27.29 is not. As a marker for breast cancer, CEA is generally less sensitive than CA 15-3/BR 27.29. Most experts consider Ca 15-3 and 27-29 to be of occasional value in breast cancer.

Dnistrian, Catharine M. Sturgeon, Rolf Lamerz, and James L. Wittliff .Practice Guidelines and Recommendations for Use of Tumor Markers in the Clinic ed. by Martin Fleisher, Ann M. AACC 2003

Lyndsay Harris, Herbert Fritsche, Robert Mennel, Larry Norton, Peter Ravdin, Sheila Taube, Mark R. Somerfield, Daniel F. Hayes, and Robert C. Bast Jr American Society of Clinical Oncology 2007 Update of Recommendations for the Use of Tumor Markers in Breast Cancer VOLUME 25 NUMBER 33 NOVEMBER 20 2007

Harris L, Fritsche H, Mennel R, et al. American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol 2007; 25:5287.

Chemoembolization for colorectal cancer metastases to the liver – pro

M Levin, MD — Mon, 27 Aug 2012 02:48:05 +0000

The literature does not contain controlled trials of TACE unresectable hepatic metastases from colon cancer. The outcomes of TACE in the available uncontrolled series appeared similar to outcomes reported of hepatic artery infusion and systemic chemotherapy. The studies do NOT reveal superiority for either TACE or alternatives with respect to complication rates or treatment-related mortality. The outcomes of TACE in the available uncontrolled series appeared similar to outcomes reported of hepatic artery infusion and systemic chemotherapy. The available data also does not show superiority for either TACE or alternatives with respect to complication rates or treatment-related mortality.

AFRQ in 2011 stated: ” Guidelines from the National Comprehensive Cancer Network for metastatic CRC state that ablative therapy for the metastases can be considered when all measurable metastatic disease can in fact be treated. However, the group provides no guidance on which ablative therapy is optimal or on the comparative benefits and harms of the various palliative treatments. A perception of clinical equipoise and limited randomized controlled trial (RCT) data comparing local hepatic therapies31,32 contribute to uncertainty regarding which techniques, either alone or in combination, may be preferable for certain patient groups.”

Hong K, McBride JD, Georgiades CS et al. Salvage therapy for liver-dominant colorectal metastatic adenocarcinoma: comparison between transcatheter arterial chemoembolization versus yttrium-90 radioembolization. J Vasc Interv Radiol 2009; 20(3):360-7. Stuart K, Huberman M, Posner M et al. Chemoembolization for colorectal metastases. Proc Am Soc Clin Oncol 1995; 14:190. Abstract.
Lang EK, Brown CL. Colorectal metastases to the liver: selective chemoembolization. Radiology 1993; 189(2):417-22.
Vogl TJ, Gruber T, Balzer JO et al. Repeated transarterial chemoembolization in the treatment of liver metastases of colorectal cancer: prospective study. Radiology 2009; 250(1):281-9.
AHRQ – http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=1354&pageaction=displayproduct, 2011

Vogl TJ, Gruber T, Balzer JO et al. Repeated transarterial chemoembolization in the treatment of liver metastases of colorectal cancer: prospective study. Radiology 2009; 250(1):281-9.

Ca-125 for breast cancer or to screen for ovarian cancer – pro

M Levin, MD — Fri, 24 Aug 2012 00:47:14 +0000

CA-125 is an important part of the workup for suspicious adnexal masses and for for following treated ovarian cancer. It is not a common marker in clinical use for breast cancer or for screening for ovarian cancer. In one recent study, thirty-three patients had increasing or continuously high concentrations of CA 125. Thirty (91%) of these had involvement of the pleura, either as pleural metastasis or metastasis in surrounding tissue i.e. bone structures in the thorax cavity or lung parenchyma. MUC1 and CEA were elevated in 27 (82%) and 24 (73%) of the 33 patients, respectively. Increased concentrations of these two markers did not relate to the site of metastasis. However, the three tumor markers complemented each other in detecting early metastases. Increased CA 125 was associated with metastasis in or near the pleura, and in stage IV breast cancer it was related to poor prognosis. Another study suggested that it can be elevated with any cancer that involves pleural surface, just like ovarian cancer involves peritoneal surface. As such, Ca-125 can be potentially misleading if used as marker for breast cancer or to screen for ovarian cancer in the absence of findings.

Samuel S et al, .Validation of Referral Guidelines for Women With Pelvic Masses
Obstetrics & Gynecology 2005;105:35-41

Amy C. Dearking et al, How Relevant Are ACOG and SGO Guidelines for Referral of Adnexal Mass?Obstetrics & Gynecology 2007;110:841-848

Lars F. Noruma et al, Elevated CA 125 in Breast Cancer – A Sign of Advanced Disease Tumor Biology Vol. 22, No. 4, 2001

D. Shitrit, B. Zingerman, A. B.-G. Shitrit, D. Shlomi, and M. R. Kramer
Diagnostic Value of CYFRA 21-1, CEA, CA 19-9, CA 15-3, and CA 125 Assays in Pleural Effusions: Analysis of 116 Cases and Review of the Literature Oncologist, August 1, 2005; 10(7): 501 – 507.

J.E. Dodge wt al, Practice Guideline Series, Management of a suspicious adnexal mass: a clinical practice guideline, OncologyVol 19, No 4 (2012)

Michael P. Stany1, G. Larry Maxwell and G. Scott Rose Women’s Imaging Review: Clinical Decision Making Using Ovarian Cancer Risk AssessmentAJR February 2010, Volume 194, Number 2,