James D. Lewis, MD, MSCE
Last Modified: December 9, 2001
Dear OncoLink "Ask the Experts,"
I am a 45-year-old non-smoking male who at 41 was diagnosed with colorectal cancer. My CEA at diagnosis was 57. I had chemo and radiation therapy followed by surgery. Post-op, I had 5-F/U for 3 months. Ten months after surgery, a tumor was detected in my liver and was removed. CEA at the time of liver tumor detection was 8.2. Slowly over the last year my CEA has risen with the most recent number at 21, which jumped from 13. I have repeated CT's and nuclear studies which show nothing. I find it hard to believe nothing can be found. The last colonoscopy was 10 months ago. Any suggestions?
Thank you for your time.
James D. Lewis, MD, MSCE, Assistant Professor of Medicine, Senior Scholar at the Center for Clinical Epidemiology and Biostatistics, and Senior Fellow in the Leonard Davis Institute of Health Economics at the University of Pennsylvania, responds:
This is a difficult clinical scenario. As you know, we use CEA levels to point out that there could be recurrence of the cancer. It is certainly reassuring that your recent CT scans and nuclear studies have not identified a recurrence of your tumor. It would be important to ensure that there is no spread to your lungs, as isolated pulmonary metastases can be resected for cure. This is similar to your liver operation. I would encourage you to go ahead and seek a second opinion with an oncologist who specializes in this area.