Duodenal carcinoembryonic antigen in patients with benign and malignant diseases: preliminary observations

Carcinoembryonic antigen levels in peritoneal washings can predict peritoneal recurrence after curative resection of gastric cancer

Carcinoembryonic antigen (CEA) levels were determined in the peritoneal washings from 120 patients with gastric cancer and 9 patients with benign diseases. Elevated values (greater than 100 ng/g of protein) were observed in 20 of 25 patients with gastric cancer with visible dissemination and 16 of 25 patients with serosal invasion but no dissemination. The same elevation was found in only 9 of 70 patients with no serosal invasion and none of the patients with benign disease. The 2-year survival rates after curative operation for the patients with and without elevation of CEA levels were 21% (19 patients) and 100% (66 patients), respectively (P less than 0.001). A negative correlation was found between CEA levels and survival times after noncurative operation. These results indicate that the CEA level in peritoneal washings could be a sensitive detector of invisible peritoneal dissemination and a new predictor for the postoperative prognosis of gastric cancer.

Relationship between colorectal liver metastases and CEA levels in gallbladder bile

While computerized tomographic (CT) scanning and intraoperative exploration are both considered accurate measures of liver involvement with metastatic disease, 10% to 30% of colorectal liver metastases remain undetected. Attempting to improve current methods for detecting colorectal liver metastases, CEA levels in gallbladder bile and serum from patients with known liver metastases were determined. One hundred per cent of patients with single and multiple metastases of various dimensions were observed to have gallbladder bile CEA levels strikingly higher than serum values (4.7 to 259 times greater, p = 0.0009). Linear regression analysis of estimated tumor volume and surface area versus gallbladder bile CEA levels predicted that very small tumors (less than or equal to 1 cm3 in volume) might produce detectable levels (9 to 41 ng/mL) of biliary CEA. For this reason, patients who lack clinical and radiologic evidence of distant metastases at the time of primary colorectal resection but who do have elevated gallbladder bile CEA levels (greater than or equal to 10 ng/mL) are being followed for the appearance of occult hepatic metastases.

The effects of colchicine and vinblastine on the biliary excretion of carcinoembryonic antigen

The biliary output of carcinoembryonic antigen (CEA) in bile fistula rats following treatment with the microtubule poisons vinblastine and colchicine increased 3-fold over a 4-hr period. Cytochalasin B and the inactive colchicine derivative lumicolchicine had no effect. These treatments did not effect the rate of CEA clearance from the circulation. Biliary output of low molecular weight fragments from CEA degradation was decreased in the presence of colchicine and vinblastine. Mechanical obstruction of the bile duct for 3 days followed by relief of obstruction resulted in a 3-fold increased output of CEA into the bile. These results are consistent with a paracellular mechanism for CEA transport from blood to bile. Biliary duct obstruction and vinblastine and colchicine probably affect the permeability of junctional complexes between hepatocytes allowing CEA to penetrate more easily.

Carcinoembryonic antigen in the bile in patients with pancreatic and biliary cancer. Correlation with cytology and percutaneous transhepatic cholangiography

The level of carcinoembryonic antigen (CEA) in the bile of 17 patients with benign pancreatic and biliary diseases and 50 patients with pancreatic and biliary cancer were determined by enzyme immunoassay. The bile specimens were obtained at the time of percutaneous transhepatic cholangiography. The bile was centrifuged and the supernatant was used for CEA measurement, while the cell pellet was examined cytologically. High CEA values in the bile were significantly more frequent in patients with pancreatic and biliary cancer than in those with benign pancreatic or biliary diseases; increased CEA concentrations in the bile were observed in 76.0% and 60.0%, respectively, of all the patients and of the patients with localized cancer. The location of the cancer had no influence on the bile CEA level, but the CEA levels in the bile tended to be high when the tumor had distant metastases, or when the biliary tract was completely obstructed. Although patients with pancreatic and biliary cancer had a high CEA value in the bile significantly more frequently, bile CEA measurement is not sufficient to distinguish an individual patient with pancreatic or biliary cancer from those with other disease, since the overlap between the values is too great, and therefore, additional examinations are required. Correct diagnosis of malignancy were made by cytological examination alone, by bile CEA assay alone and visual examination of dye in the biliary tract alone in 72.0, 76.0, and 88.0% respectively, of the patients examined, while the combination of these methods raised the diagnostic rate to 100%.