The value of CEA in the management of colorectal cancer

A personal series of 544 cases of colorectal cancer was reviewed to evaluate the values of preoperative and postoperative CEA in the management of colorectal cancer. Based on the data, a trend of increasing incidence of abnormal preoperative CEA values in association with advancing Dukes' stage was observed. It was also noted that patients with a preoperative CEA value higher than 20 ng/ml had a higher incidence of advanced stage disease. These results are consistent with others' findings that elevated preoperative CEA values are associated with a poorer prognosis (higher recurrence rate and shorter survival rate) independent of the stage of the disease. Postoperative CEA values in monitoring recurrence or metastasis during the follow-up period were analysed in the preoperative normal or abnormal CEA subgroups respectively. A higher sensitivity rate for CEA rise as an indicator of recurrence was observed in the preoperative abnormal CEA subgroup than in the normal subgroup. Temporary elevations of CEA value during the follow-up did not always indicate recurrence, while persistent CEA values within normal range but with a trend to slowly elevate usually predicted recurrence. Therefore, serial assays of CEA are needed for the early detection of recurrence. For clinical practice, we recommended a more aggressive attitude is recommended toward the abnormal preoperative CEA subgroup than for the normal subgroup because of the former's higher sensitivity rate.