Carcinoembryonic antigen in cancer of the female reproductive system: its detection in serum by a microradioimmunoassay

Predictive value of serial carcinoembryonic antigen levels in long-term follow-up of ovarian cancer

The predictive value of serial levels of carcinoembryonic antigen (CEA) in tumor monitoring was examined in 213 patients with ovarian cancer; each patient had been followed-up at monthly intervals for at least 12 months. CEA was not detectable throughout the period of observation in 35% of the patients. In general. patterns showing a disappearance of CEA or persistently low levels were associated with a good prognosis, whereas those showing a reappearance or highly elevated and rising levels were associated with a poor prognosis. A transient reappearance of CEA was observed in 10 patients; this did not appear to be associated with tumor recurrence or progression. "False positive" results were obtained in 6 patients in whom no tumor has been clinically detectable to date. "False negative" results were obtained in 4 patients with obvious tumor progression. In terms of a good or poor prognosis, the use of CEA levels was highly accurate in patients with minimal or no residual disease (97% and 89%, respectively); the rate fell to 62% in patients with extensive disease. As the clinical significance and limitations become better known, serial CEA levels should contribute substantially to the monitoring of patients with ovarian cancer.

Carcinoembryonic antigen and beta 2-microglobulin as serum tumor markers in women with genital cancer

A comparative study of carcinoembryonic antigen (CEA) and beta 2-microglobulin (beta 2-MG) in serum was made by radioimmunoassay in 77 women with genital cancer. With a positive level defined as 5 ng of CEA/ml and 3.0 microgram of beta 2-MG/ml, CEA was positive in 31% of the women with cancer of the corpus, 36% of those with cancer of the cervix and 36% of those with cancer of the ovary the corresponding figures for beta 2-MG were 6%, 27% and 56%, respectively. The additional use of beta 2-MG provided an increase in positive results, especially in cases of cancer of the ovary. A direct relationship between the extent of tumor and serum marker level was more evident for beta 2-MG than CEA. There was no correlation between serial levels of CEA and beta 2-MG in most patients. CEA levels appeared to predict subsequent tumor behavior more accurately in patients with good prognoses (ie, complete or partial tumor response), whereas beta 2-MG levels gave the same prediction in those with bad prognoses (ie, nonresponsive or progressive tumor).

Ovarian teratoma with peritoneal gliomatosis

The case report describes the clinical and pathological features of a young girl with ovarian teratoma which showed a predominance of neural tissue. The peritoneal involvement by an admixture of mature and immature glial tissue resulted in the death of the patient despite surgery and cytotoxic chemotherapy. There was an association between this tumour and the presence of carcinoembryonic antigen and alphafetoprotein in the serum and ascitic fluid.

Carcinoembryonic antigen (CEA) in ovarian cancer: factors influencing its incidence and changes which occur in response to cytotoxic drugs

We report the serum levels of carcinoembryonic antigen (CEA) in 109 patients with ovarian cancer. Histology, degree of differentiation, and clinical stage influenced the incidence of positive CEA. Although CEA was significantly raised in patients with a variety of tumours, the highest incidence (77 per cent) was found in those with serious cystadenocarcinoma. Nearly all (94 per cent) of the poorly differentiated tumours were associated with a positive CEA result. Serial CEA levels provided a useful guide to management during cytotoxic chemotherapy, rapidly falling levels indicating a favourable tumour response which was reflected clinically. However, only two-thirds of tumours were associated with detectable CEA levels in serum, day-to-day variations in individual serum levels occurred, and CEA levels tended to fall paradoxically during terminal illness. The significance of persistently low levels in the apparent absence of disease was uncertain.

Carcinoembryonic antigen in colorectal practice: report of three cases

CEA, in combination with the time-honored barium enema, sigmoidoscopy, rectal examination with guaiac determinations, and thorough clinical history, is a useful tool for the colorectal surgeon in following the progression of disease in both colorectal carcinoma patients and patients who have certain premalignant conditions. In this high-risk group of patients, CEA determinations as well as colonoscopy are becoming increasingly useful. That tumors on the left side are associated with higher CEA levels than those on the right side, due to vascular invasion or the grades of the tumors, and that often CEA antigenicity and severity of symptoms in ulcerative colitis correlate well, are emphasized. Finally, following total colectomy in five cases of ulcerative colitis, all CEA titers decreased to the normal range and have remained there.

Carcinoembryonic antigen: clinical and historical aspects

To further define and determine the usefulness of CEA, 1100 CEA determinations have been made over the past two years at The Ohio State University Hospitals on patients with a variety of malignant and nonmalignant conditions. Correlation of CEA titers with history and clinical course has yielded interesting results not only in cancers of entodermally derived tissues, for which CEA has become an established adjunct in management, but also in certain other neoplasms and inflammatory states. The current total of 225 preoperative CEA determinations in colorectal carcinomas shows an 81% incidence of elevation, with postoperative titers remaining elevated in patients having only palliative surgery but falling to the negative zone after curative procedures. An excellent correlation exists between CEA levels and grade of tumor (more poorly differentiated tumors showing lower titers). Left-side colon lesions show significantly higher titers than right-side lesions. CEA values have been shown to be elevated in 90% of pancreatic carcinomas studied, in 60% of metastatic breast cancers, and in 35% of other tumors (ovary, head and neck, bladder, kidney, and prostate cancers). CEA levels in 35 ulcerative colitis patients show elevation during exacerbations (51%). During remissions titers fall toward normal, although in 31% still remaining greater than 2.5 ng/ml. In the six colectomies performed, CEA levels all fell into the negative zone postoperatively. Forty percent of adenomatous polyps showed elevated CEA titers (range 2.5-10.0) that dropped following polypectomy to the negative zone. Preoperative and postoperative CEA determinations are important in assessing the effectiveness of surgery. Serial CEA determinations are important in the follow-up period and in evaluation of the other modes of therapy (e.g., chemotherapy). These determinations of tumor antigenicity give the physician added prognostic insight into the behavior of the tumor growth. Rectal examination with guaiac determinations, sigmoidoscopy, cytology, barium enema, and a good clinical evaluation remain the primary tools for detecting colorectal disease. However, in the high-risk patient suspicious of developing cancer, CEA determinations as well as colonoscopy are now being used increasingly and provide additional highly valuable tools in the physician's armamentarium.