Question aboout CEA levels and colon cancer

Thread view:

Enable EMail Alerts

Start New Thread

Thread rating:

J W - 20 Jan 2006 17:17 GMT

Hi and thanks in advance for your input. I had surgery on 12/23 for
colon cancer. They removed the tumor which was on right side of colon
and was said to be the size of 2 fists and resected a large amount
around it. It had also spread to my omentum which was removed as much as
was possible I suppose. They also removed 13 lymph nodes which all came
back positive for cancer. They also removed my appendix as well which
was somewhat diseased The doctor said he removed all visible cancer and
upon visual inspection only the liver and other nearby organs looked
clean. They said that the cancer had gotten through the colon or
intestinal wall into free space so they felt that even though they
removed all that was visible and all the other organs looked clear that
there was still some cancer loose in there that should be addressed with
chemo. Because it had spread to the omentum, lymph nodes and gotten
through into free space they are callng it stage 4 cancer which to my
understanding is the worst possible stage with very low or short
survival rates. In fact they told me 6 months or less without chemo and
24 months or less with chemo was the average survival rate with a one
percent or less chance of completely beating it.

My CEA level was approx. 92 before surgery and 42 when checked again
about 4-5 days after surgery. I have read that normal CEA levels are
about 2.5 percent for non smoker with no lung problems and about 4-5
percent for smokers or people with COPD or lung disease. I fall under
the smoker/COPD rate as I was a smoker prior to surgery and have COPD
asthma. Of course I no longer smoke but still have lung issues. On Jan.
11th my CEA was tested again and came back with a 6.8 number which is
hugely lower than I was expecting and if I uderstand this thing only a
few points above normal.

How much credence should one place on these CEA results? Are they
reliable? If so and the levels are this close to normal, should I risk
the damage chemo would cause and take it anyway or wait a bit and
monitor the CEA? My hemoglobin or red blood cell count is low and has
been low since surgery (10.8) and moving up very slowly (was between
high 8s and mid 9s while in hospital) and my iron level is very low,
below normal. I'm taking ferrous iron pills 325mg twice a day and eating
everything I can with iron in it short of eating bags of rusty nails but
it isn't moving up much at all. and now when the last blood test results
came back from Jan 11th which showed the 6.8 CEA level, they also showed
liver & kidney function numbers were very high where they had always
been normal before. The AST number was 57 with 0-40 being normal and the
ALT number was 163 with 0-55 being normal. Not sure what to make of all
this. Can anyone offer any insight or opinion?

Reply to this Message

J - 20 Jan 2006 20:01 GMT

> Hi and thanks in advance for your input. I had surgery on 12/23 for
> colon cancer. They removed the tumor which was on right side of colon
[quoted text clipped - 39 lines]
> ALT number was 163 with 0-55 being normal. Not sure what to make of all
> this. Can anyone offer any insight or opinion?

Hello J W and welcome.
We use "clear" here instead of "clean". Cancer's not dirty (dirty/clean -
see?).

I know from following someone, on another newsgroup, who had polyps removed
and was iron deficient, it took almost a year to recover from at least, some
of the chronic fatigue, even though his iron levels were eventually fine and
lousy breathing can cause fatigue as well. So I would think it prudent to
wait before starting chemo, especially given your asthma/COPD. Perhaps time
and proper treatment would put you in a place where you can take
postoperative chemo.

I've seen very, very high CEA's mentioned on this newsgroup, yet with
eventual treatment, years were gained. On the other hand, I think CEA's
measure gastointestinal cancers, which can be the liver. Steph?

I realize that under the circumstances, that you describe, a person would
normally immediately go on chemo, but you need to know that, as cancers
grow, they shed clones, and if on chemo, the clones eventually become
resistant to the chemo, so in fact, if you wait, you may be hitting them
when it counts most, when there's something to see and palliate at the same
time.

That would be my thinking if I were in your place. I'm not an expert. I
think a wait and finding an oncologist, whom you trust and whom you can ask
these same questions and whose answers make sense to you, may be what you
can do for the moment. Apparently the ratio between ALT and AST is more
important than the numbers, according to this web page.
http://www.gastromd.com/lft.html You'll also see that oxygen is involved.

That's also something I would speak with an oncologist and/or
gastroenterologist about so you know the full picture of what they think is
going on. So you're a difficult to manage patient (sorry for calling you a
name <g>), but I hope with proper treatment, perhaps a daily walking routine
to improve your lung function and circulation, and time to discuss these
issues, that the answers as to what and when to treat, will become obvious
to you.

If it was me, I'd wait and hope that when serial CEA's show more elevations,
by then I'd be able to tolerate the chemo.
Your decision after talking to the experts.
Keep in touch and let us know how it's going.
J
PS. Now watch, Steph'll give you a one-liner answer. :p

Reply to this Message

Steph - 20 Jan 2006 22:52 GMT

The standard treatment for you is surgical resection (which you've had) plus
adjuvant chemotherapy, and this combination is proven to give the best
chance of cure, though with a very advanced cancer like yours, the chance of
cure is small.
The liver enzyme tests could mean mets to the liver, but sometimes just
surgery and an anaesthetic can put them up temporarily.
The CEA result is what you would expect after all the gross cancer has been
removed.
The options are:
1) Go for the chemo
2) Accept that surgery is enough for you, and only consider chemo if/when
the cancer recurs and causes symptoms.
Nobody can make that decision for you - discuss with your oncologist.

Reply to this Message

46erjoe - 21 Jan 2006 02:37 GMT

My diagnosis was amost a clone to yours. A colonoscopy revealed an
orange-sized tumor in my large intestine. CEA at the time was 72. I
had a bowel resection, but they found metastes (small ones at the
time) to my liver, lymph system and a few to the lungs. After
resection and chemo began, my CEA level dropped to 4 or 5 and remained
that low. Over the past 2 years it has gradually gotten higher. Latest
was 45 I think. I've gone through several regiments. There is also a
trial should current chemo not work.

My onc told me that liver surgery is not an option for me, since there
are tumors elsewhere anyway. Besides there is danger in liver surgery
if the tumor is near feeder arteries.

Unfortunately as you were told, Stage IV has a low survival rate after
5 years. sh.t happens. But from the sounds of it, you have a lot of
living left. Make it quality time. Find the best hospital and
oncologist team within driving distance.

And hang out here. You'll learn a lot, and get steady support from
listening caring people.

--joe

>Hi and thanks in advance for your input. I had surgery on 12/23 for
>colon cancer. They removed the tumor which was on right side of colon
[quoted text clipped - 39 lines]
>ALT number was 163 with 0-55 being normal. Not sure what to make of all
>this. Can anyone offer any insight or opinion?

Reply to this Message