Hey CancerDad-

I had my colonscopy and endoscopy today. I would like your opinion on this. When it was over with the doctor told me they found an abnormal polyp, it's the reason I've been bleeding and losing blood, so we now know the source of the anemia. The ployp is embedded in the wall of my colon, on the right lower side, (same area where my mom's cancer started), after the colonscopy, he wanted to send me down to have an abd/pelvic ct right after the procedure, I told them I went to the ER Friday 2/17 and it showed nothing, not the diverticulisitis they suspected, and nothing in my my other organs, however, I do have a kidney stone. Then he says he wants to see me in a week, then he changes his mind and said no, this Thursday. He did some blood work, a CBC, I am still losing blood, and then he ordered a CEA. I didn't know he was ordering the CEA until I asked the nurse that was taking my blood. I asked him if he thought it was cancer and he said he didn't want to say anything either way. I asked him if he was leaning more towards one way than the other, and he didn't want to say. Regardless, I have to have surgery to remove that part of my colon, because if he tries to take it out, it could preforate my colon. Plus, I am going back to see him on Thursday, the biospy won't be back by then, and the blood test might not be either. He asked me if I wanted to have surgery down here, I told him I didn't know but I do know a surgeon down here that's pretty good, but he's a general surgeon. I think that I am going to get a second opinion and have a colon rectal surgeon that specializes in this type of surgery. I am in the MD area, but I am going to probably go to DC, does anyone have any great docs they could recommend in the DC area?

Regarding the CEA, how does that work? Levels and such? What's normal and what's not?

Thanks in advance.

From what I understand it's good to have a CEA done before surgery. If there's no cancer found then you'll have a good base number for the future and if there is cancer found there will be a number to use to tell if any treatments are working? I'm sure CD knows more about this than I do so I'm sure he'll come along to clarify this. I wish I would have had a CEA done before surgery just to have a number. Some of my doctors like me to keep getting this test done every 3-6 months and others don't have much faith in it. My readings now 3 years after initial surgery for rectal cancer range betweem 1.2 - 1.8.

Hi Christy,
Sorry for the delay in responding... I've been busy with my own appointments! I'm glad they found the source of the bleeding, and that you went through with the procedure. If you need a resection, I would DEFINITELY recommend a colorectal surgeon. But, from what you've said, I wouldn't rush into anything... I don't know that it's necessary. Wait until the path report comes back. He MUST have biopsied the polyp, I'm assuming.

CEA's are good to draw... see if your level is elevated. It COULD be indicative of a colorectal tumor, and will aid in monitoring if that is the case. Depending on what histology/path comes back as, I would consider a trans anal excision... we'll talk more once it's back. It doesn't matter if it's penetrating the wall... as long as it is non-cancerous (even some cancerous ones can be removed this way too!)...and that it's within reach of working through the anus. As you know, MOST colorectal cancers are slow growing, so you have time to figure things out, especially since he couldn't even take an educated guess as to the histology... most GI's have seen enough abonormal polyps to be able to tell you if they SUSPECT it may be suspicious. Weird. Don't freak yet, though. As I said, you do still have time for other opinions, and most importantly, for that biopsy to come back. Let me know when it does.

Again, sorry I couldn't respond sooner. I'll try to stay on the ball as I don't have appointments for the rest of the week.

Fondly,
CancerDad

I believe CEAs are also influenced by inflammatory conditions in the colon. So if you don't have cancer, but have an inflammatory condition, the CEA could be elevated anyway. Normal range is 0 - 3.5 for non smoker and 0 - 5.5 for smokers. Some colon cancers produce large amounts of CEA, some don't. I had stage III but my baseline CEA prior to surgery was only 1.2, so as you can see, the CEA is just an indicator not a definitive marker. I am almost 3 years post-surgery and get my CEA checked every 2 months. When I asked why since it never showed anything when I had cancer, the Oncologist responded it is the direction of the CEA over time, not the precise number that is important; and also, should there be a recurrence, spread or new colon cancer, it might be reflected in a changing CEA. Many times a rising CEA will indicate a cancer that is not clinically detectable for another 5 months. Other times it means absolutely nothing, except to get you upset and worried.

Anyway, relax and think positive until you have a reason not to.
Best Wishes
Leslie

CEA's are carcinioembryonic antigen which is ONLY secreted by the unborn fetus, and if there is a cancerous tumor present. ESR (erythrocyte sedementation rates) are values that are raised when there is inflammation SOMEWHERE in your body. Hope that helps to clarify. The CEA value rises only for certain people (in about 70-75% of the population) and if risen at diagnosis is a good diagnostic tool for an oncologist to see if a recurrence has occurred. Otherwise follow-up with CT/PET scans is mandatory because in some instances CEA's don't even rise with recurrence even if they were elevated to begin with.

Cancer Dad:
There are other causes of increased CEA levels. Information below is just one of several references to this information.

Interpretation
Normal
Non-smokers: <2.5 mg/ml
Smokers: <5 ng/ml
Increased
Benign disease unlikely if >10 ng/ml
Distant metastasis most likely if >100 ng/ml

Causes of increased CEA

Benign causes

Tobacco abuse
Peptic Ulcer Disease
Inflammatory Bowel Disease
Pancreatitis
Hypothyroidism
Cirrhosis


Malignant causes

Colon Cancer
Breast Cancer
Gastric Cancer
Lung Cancer
Pancreatic cancer
Bladder Cancer
Cervical Cancer
Melanoma
Lymphoma


Not specific
Seen in other adenocarcinoma
Sensitivity varies by tumor stage and differentiation
CEA not increased in poorly differentiated tumors
Increased in <25% of Duke A or B stage Colon Cancer
Increased in 50% with Duke C stage Colon Cancer
Increased in 75% of Duke D stage Colon Cancer

(From the Family Physician website: from Book Gastroenterology , Laboratory Chapter on CEA)

Ask ANY other oncologist and they will give you the same response I gave regarding CEA levels and usefuelness as a diagnostic factor. Christy has already posted that she has been dx Stage 1 on another post.
CEA levels are generally NOT looked at for the following that you posted and generally reserved as a test for known malignancies:

Peptic Ulcer Disease
Inflammatory Bowel Disease
Pancreatitis
Hypothyroidism
Cirrhosis [/B]

Check out the bible for physicians... the Merck Manual for further information.
There are other tests for the maladies you listed. Tobacco use can raise CEA levels, again, depending on the individual. Thanks for the input.

Regards

Cancer Dad:
I'm not saying that CEA is used as a test for other malignancies. In my original post I stated that it is an indicator, albeit not a terriby good one,and is certainly not to be used as a diagnostic test for ANY condition. I just wanted to clarify that it is possible for a benign condition like an inflammation to elevate the CEA (as does smoking), that it can be influenced by other than tumor secretion. My point is that a rise in CEA does not automatically mean there is tumor activity - it is a very rough indicator that for some people is correlated with their colon cancer activity. Enough of this theoretical talk.

By the way, I hope you are feeling better and that the testing you mentioned in another thread is going well.

Regards,
Leslie

Talking of CEA's.. I had a heap of blood tests done yesterday.. Because Im sooo tired all the time now.. and end up on the couch most afternoons not being able to do much physically. I thought my gp would have only done FBe's iron etc, which she did, but also added the CEA and a random glucose as well. Anyway wont find out the results till next Tuesday..
Will let u know the results
Maz

Thanks for all your insight and support, it really helps knowing they're are others in the same condition as I, Thanks again to all of you, hugs :)