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1 Department of Nuclear Medicine, St Vincent’s University Hospital, Dublin 4, and Department of Surgery and Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin 4, Ireland.
Background: Carcinoembryonic antigen (CEA) is one of the most widely used tumor markers worldwide. Its main application is mostly in gastrointestinal cancers, especially in colorectal malignancy. Although in use for almost 30 years, the clinical value of CEA in colorectal cancer is still not clear.
Methods: The literature relevant to the clinical value of CEA in colorectal cancer was reviewed. Particular attention was paid to studies involving metaanalyses and guidelines issued by Expert Panels.
Results: Although of little use in detecting early colorectal
cancer, high preoperative concentrations of CEA correlate with adverse
prognosis. Serial CEA measurements can detect recurrent colorectal
cancer with a sensitivity of 
80%, a specificity of 70%, and can
provide a lead time of 5 months. CEA is the most frequent indicator
of recurrence in asymptomatic patients and currently is the most
cost-effective test for the preclinical detection of resectable
disease. CEA is most useful for the early detection of liver metastasis
in patients with diagnosed colorectal cancer. Overall, however, little
evidence is available that monitoring of all patients with diagnosed
colorectal cancer leads to enhanced patient outcome or quality of life.
Conclusions: Currently, the most useful application of CEA is in the detection of liver metastasis from colorectal cancers. Because of the relative success of surgery in resecting hepatic metastases, serial determinations of the marker are recommended for detecting cancer spread to the liver. In the future, preoperative concentrations of CEA may be included with the standard staging procedures for assessing prognosis.
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