CARCINOEMBRYONIC ANTIGEN

C 1ini cal Ajip 1i cat i o n

I'AYLIANC
W. Go, M D

Carcinoembryionic antigen (CEA) a glycoprotein extracted from colonic cancer

tissue (P-globulin electrophoretic mobility, sedimentation coefficient 7 to 8S, and
mol wt -200,000) can be detected and measured by radioimmunoassay. Clinical
evaluations of CEA determination have given the following results: In health:
(1) Serum CEA level is not influenced by sex, age, blood type, time of blood
sampling, or family history of cancer; (2) serum CEA level is influenced by a his-
tory of smoking or inflammatory disease of the bowel, lung, pancreas, and other
organs (occasionally, a CEA level as high as 10 ng/ml is noted); and (3) currently,
CEA positivity is defined as >2.5 ngiml, however, 5 ng/ml may be more realistic.
I n cancer: (1) CEA level may be increased in primary cancer of the gastroin-
testinal (GI) tract as well as in non-GI neoplasia; (2) the CEA test is not recom-
mended for screening to detect early cancer; (3) serum CEA level depends on
the stage of the neoplasia and usually is not influenced by the grade of differen-
tiation; and (4) markedly increased (>25 ng/ml) serum CEA values are highly
suggestive of metastatic cancer, particularly hepatic metastasis. I n biological
fluid: The CEA or CEA-like activity can be measured in gastrointestinal secre-
tions. Quantitative studies of CEA levels in such fluids may yield more informa-
tion than is obtainable from studies of serum. However, this possibility needs
more study at present. Therefore, the currently available CEA tests cannot re-
place any of the now standard diagnostic methods for cancer detection. This
use for assessment of therapy in selected patients or for following those known
to be at high risk for cancer appears promising in preliminary studies, but
clinical value, if any, remains to be determined.
Cancer 37:562-566, 1976.

I N1965, GOLDA N D FREEDMAN REPORTED THAT

carcinomas of the colon contained an anti-
gen that was absent from normal adult intesti-
nal mucosa but was present in primitive ento-
derm.1g.2" T h e authors named this material
carcinoembryonic antigen (CEA) of the diges-
tive system. In 1969, Thomson et al. described
a radioimmunoassay for CEA in serumBoand
nosis of colonic cancer. Subsequently, immu-
nochemicnl tests showed that this material
could be detected in the serum of patients
with gastrointestinal or nongastrointestinal
malignancy, in extracts from gastrointestinal
a n d nongastrointestinal tumors, and in tissue
extract? of the fetal gastrointestinal t r a ~ t . ~ J ~ $
~ 1 4 4 Recently several laboratories have re-

reported positive findings in 97yo of a series ported CEA immunoreactivity in urine,7,13.21

of patients with cancer of the colon. So CEA
was acclaimed in the medical and lay litera-
ture as a tumor-specific antigen whose detec-
tion in the serum may be helpful in the diag-
Presented at the meeting of the ACS-NCI National
Conference on Advances in Cancel Management, Part
11: Detection and Diagnosis, Denver, CO, May 1-3,
1975.
From the Gastroenteiology Unit, Mayo Clinic and
Mayo Foundation, Rochester, Minnesota.
Supported by research giant CB 23854 from the
National Cancer Institute, National Institutes of
Health.
Address for reprints: V. L. MI. Go, MD, Mayo Clinic,
Rochester, M N 55901.
562
stool,l2 14 and intestinal secretionsl~l"~'~3"45of
cancer patients and of normals.
T w o coopeiative trials of the CEA test in
blood have been carried out in a number of
centers in the United States and Canada. T h e
National Cancer Institute of Canada and the
American Cancer Society sponsored a col-
laborative study of CEA tests employinq the
Thomson technique,25 while the Hoffmann-
LaRoche Company organized a trial utilizing
tlie Hansen technique.22 Through a contract
awarded by the National Cancer Institute, we
have carried out a prospective evaluation of
CEA test5 in a clinical setting, using reagents

No. 1 CARCINOEMBRYONIC
ANTIGEN
kindly supplied by Dr. Hans Hansen, Hoff-
mann-LaRoche Company. Over the last 30
months, 6,700 patients have been entered into
the study. From our experience and that of
others in such studies and in applying the
CEA test to b10od3.2"30.31,~~.*3,~~and to gastro-
iritestinal1,15,17.",4~and urinary secretions,13.21
I shall review the present status of this test.
PHYSICOCHEMICAL
PROPERTIES
OF CEA
Recent progress in elucidation of the physi-
cal and chemical properties of purified CEA
has been reviewed extensively by Terry et al.38
CEA is a glycoprotein, extracted, and purified
from primary adenocarcinoma of the colon o r
from colonic carcinoma metastasized to the
liver. Purified CEA has a molecular weight of
about 200,000, sedimentation coefficient of 7.0
to 8.OS, and beta-globulin electrophoretic mo-
hili ty. Electron microscopy has shown the
molecule to be of uniform size with a complex
secondary structure.6 It is soluble in I hl
perchloric acid and in half-saturated ammo-
nium sulfate.
Chemical analysis of purified CEA shows
approximately 50 to 65y0 carbohydrate, the
remainder being protein. T h e carbohydrate
portion of CEA contained fucose, mannose,
galactose, N-acetyl-glucosamine, sialic acid, and
tracer of N-acetyl-galactosamine. T h e charge
heterogeneity of various CEA preparations
have been attributed, in part, to variations in
sialic acid content of the molecule. Amino
acid sequencing of the protein backbone of
CEA is not yet complete. However, the first 24
residues from the N-terminal of purified CEA,
obtained from liver metastasis or isolated
from serum of patients with advanced meta-
static colonic cancer, are identical.*'
CE,\ RADIOIMMLINOASSAY METHOD
Several techniques for radioimmunoassay
to measure CEA have been described. The
m a y measures inhibition of the binding of
known amounts of radiolabeled purified CEA
to the specific antibody. T h e techniques used
most often are those originally described by
Thornson et al.,5O by Hansen,31 and by Egan.11
Several modifications of these methods have
been validated.30e34~42 To date, the CEA-Roche
test is the only one approved by the FDA for
clinical use. T h e assay techniques differ mostly
in their ways of extracting CEA from plasma
10970142, 1976, S1, Downloaded from https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/1097-0142(197601)37:1+<562::AID-CNCR2820370721>3.0.CO;2-0 by Nat Prov Indonesia, Wiley Online Library on [04/11/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
- Go 563
or serum and their ways of separating free
from antibody-bound antigen. Some tech-
niques use either serum or plasma and some
use inta.ct serum o r plasma (direct assay),
whereas for others the test serum must be ex-
tracted first with perchloric acid (indirect as-
say). T h e reliability and comparability of the
various methodologies were demonstrated in
a study organized by the National Cancer In-
stitute in which CEA levels of 94 blood speci-
mens ohtained from different patients were
tested simultaneously by different 1a.borato-
ries, including those of Das, Go, Gold, Han-
sen, LoCerfo, Mach, Martin, Reynoso, Todd,
and Zarncheck:"4 Correlations of 82 to 907;
were obtained.
CEA LEVELI N HEALTH
CIRCULATING AND
BENIGNDISORDERS
T h e normal values for the different assays
vary among laboratories. T h e Thomson assay
and the CEA-Roche assay used the cut-off
point of 2.5 ng/ml; the Egan-Todd assay is
approximately 12.5 ng/ml; and other labora-
tories, including Mach and our laboratory,
use a cut-off point of 5 ng/ml. Therefore, the
CEA result obtained by each laboratory
should always be interpreted in comparison
with tlie value obtained from normal controls
using the same assay procedure.
T h e serum or plasma CEA level is influ-
enced by the history of cigarette smoking,
tending to he higher in heavy smokers than in
nonsmokers.2') Elevated 'CEA levels between
2.6 and 10 ng/ml and occasionally as high as
10 ng/ml occur in many patients with a va-
riety of benign conditions including bron-
chitis, inflammatory bowel disease, pancrea-
titis, cirrhosis, and pulmonary empliysetna.2~~~
x,21.2*.33.37 CEA positivity defined as greater
than 2.5 ng/ml is not helpful in the diagnosis
of cancer, particularly if there is a history of
heavy smoking or any of the listed underlying
henign diseases.
We have found that other factors-sex, age,
time of the clay when tlie blood sample was
drawn, and the presence or absence of family
history of cancer-do not influence the CEA
level.";
CEA IN MALIGNANT
DISEASES
CEA tests have limited sensitivity and speci-
ficity for cancer. T h e initial studies utilized
cases of frank gastrointestinal cancer, many

564 Janirory Supplement 197G
CANCER
with metastasis; the CEA levels were higher
than 2.5 ng/ml in more than 75% of them.
Subsequent prospective evaluations of CEA
tests in gastrointestinal malignancy, particu-
larly in cancer of the colon, have shown that
the CEA level varies with the stage of the can-
cer. Large proportions of patients with early
surgical and resectable colonic cancer have
normal concentrations of circulating CEA. As
the cancer spreads to adjacent organs or me-
tastasi7es distantly, the amount of circulating
CEA and the incidence of CEA positivity in-
crease. Greatly increased serum CEA values
(> 25 ng/ml) are highly suggestive of meta-
static cancer, and particularly hepatic metas-
tasis. Similar patterns have been observed in
cancer of the pancreas, stomach, lung, breast,
prostate, and other solid tumors. Therefore,
the use of CEA test alone for screening pur-
poses is not recommended. At present, CEA
tests are useful as a diagnostic adjunct when
cancer is suspected, but they cannot replace
any of the currently standard methods for can-
cer detection. A normal CEA level does not
preclude the presence of primary, metastatic,
or recurrent cancer.
Comparison of concentrations of circulating
CEA and other enzymes such as serum alkaline
phosphatase, gamma-glutamyl transpeptidase,
lactate dehydrogenase, and other serum en-
zymes suggest that measurements of CEA and
enzyme concentrations were complementary to
each other in patients with primary and meta-
static m a l i g n a n ~ i e s . l 8 . ~Similar
0 ~ ~ ~ findings were
obtained from simultaneous measurements of
CEA and other tumor-associated antigens such
as alpha-fetoprotein. I n our experience, when
alpha-fetoprotein and CEA were measured si-
multaneously, 54y0 of patients with gastric
carcinoma had elevations of one or both,
whereas only 27% had elevated alplia-fetopro-
tein alone and 2 2 7 , had elevated CEA al0ne.3~
This suggests the possibility that measure-
ments of CEA and other tumor-associated an-
tigens such as alpha-fetoprotein, human cho-
rionic gonadotropin, or Regan isoenzymes
and other enzymes might increase significantly
our ability to detect advanced gastrointestinal
cancer.
CEA AS MARKERFOR CANCER
BIOLOGIC
THERAPY
Thomson, Gold et al. first reported five
cases of colonic cancer with elevated CEA
levels that declined to normal in three cases
after complete resection of the cancer. Such
a response was confirmed by Dhar et al.,'" L o
10970142, 1976, S1, Downloaded from https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/1097-0142(197601)37:1+<562::AID-CNCR2820370721>3.0.CO;2-0 by Nat Prov Indonesia, Wiley Online Library on [04/11/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
1'01. 97
Gerfo et al.,31J2 Reynoso et al.,23s43 Laurence
et > I I . , ~ O Mach et al.,3-' and Khoo and Macky.41
However, a drop of the CEA level to normal
after surgery does not always provide a good
index of completeness of surgical excision, for
in some cases the cancer recurs. I n a small
number of cases the CEA level has fallen to
normal after surgical therapy but risen again
during recurrence, perhaps before there was
clinical evidence of recurrence. O u r experi-
ence showed that during recurrence after 110-
tentially curative resection the level of CEA
depends o n the stage of the recurrent disease.
T h e CEA level is normal in localized recur-
rent disease, and a n elevated CEA level sug-
gests regional and distant metastasis. Our data
suggest that serial determinations of serum
CEA could indicate advances of recurrent can-
cer in long-term follow-up of patients who had
undergone curative surgery and who have a
normal postoperative CEA. However, i t must
be made clear that i n those cases where CEA
increased, the tumor recurrence was readily
detectable by other means.42
Serial CEA assays have been used for moni-
toring cancer chemotherapy in patients with
cancer of the colon, pancreas, stomach, biliary
tract,*4-.J"4G breast,5?48 cervix, body of the
uterus, ovary,"fi.2' and lung,51 and in patients
with neuroblastoma.4~ These studies have
shown a fair correlation between effectiveness
of cancer chemotherapy and serum CEA con-
centration, and our findings seem to confirm
these general results. However, serial determi-
nations of serum CEA must be interpreted in
the clinical context, for we have noted that
preterminally the CEA concentration may fall
rather than rise and that patients whose orig-
inal cancer produced no CEA may deteriorate
without producing any. Furthermore, various
cancer chemotherapy agents may alter the syn-
thesis and secretion of CEA without affecting
the progression of the neoplasia. It is in this
area of research that CEA assay as a biologic
marker for following cancer chemotherapy
may prove fruitful.
CEA-LIKEACTIVITY
I N SECRETIONS
CEA or CEA-like activities have been de-
tected by various immunologic tests in saliva,
gastrointestinal secretion, feces, urine, bron-
chial washings, and other biologic fluids and
secretions of different organ sy~tems.l,7.1"1~,~~.
1 5 ~ 7 . 2 1 . 3 5 . 3 6 ~ 4With
5 use of several intestinal per-
fusion techniques, we recently have quantified
the secretion of CEA-like activity in the gastro-
intestinal tract of healthy human subjects.

No. 1 CARCINOEMBRYONIC
ANTIGEN
T h e secretory rate was highest in colonic se-
cretion, arid next highest in pancreatico-biliary
secretion.17 T h e CEA-like material extracted
from normal human saliva, normal gastroin-
testinal secretion, and feces has chromato-
graphic and immunologic properties similar
to those of purified CEA extracted from liver
tissue containing metastatic cancer of the
colon. Whether this immunoreactive CEA ma-
terial is chemically the same as purified CEA
needs further study.
It has been suggested that studies of CEA-
like activity in fluid secreted by hollow vis-
cera such as the gastrointestinal tract, lung,
and urinary bladder might lead to improve-
ment in early detection of cancer. Winawer
found that the CEA concentration in colonic
lavage specimens from 38 patients ranged
from 0 to 4450 ng/mg protein.5' Patients with
cancer and polyps were at the higher end of
the range, patients with ulcerative colitis in-
termediate, and normal subjects at the lower
REFERENCES
1. Bhargava, .4. K., Chen, J. F.,Vincent, R. G., and
Chu, T. M.: Characterization of a glycoprotein from
ascites of pancreatic carcinoma and its comparisons
with colonic carcinoembryonic antigen (CFA). Pro-
ceedings of the American Association for Cancer R e -
search of the American Society of Clinical Oncology
16: 131(#521), 1975.
2. Booth, S. N., King, J. P. G., Leonard, J. C., and
Dykes, P. W.: Serum carcinoembryonic antigen in
clinical disorders. G u t 14:794-799, 1973.
3. Booth, S. N., King, J. P. G., Leonard, J. C., and
Dykes, P. W.: T h e significance of elevation of serum
carcinoembryonic antigen (CEA) levels in inflamma-
tory disease of the intestine. Scand. J. Gastroenterol. A. J.. and Moertel, C. G.: Prospective evaluation of
9 :651-656, 1974.
4. Burtin, P., Sahine, M. C., and Chavanel, G.:
Presence of carcinoemhryonic antigen in children's
colonic mucosa. Znt. J. Cancer 1072, 1972.
5 . Chu, T. M., and Nemoto, T.: Evaluation of
carcinoembryonic antigen in human mammary car-
cinoma. ./. Notl. Cancer Inst. 51:1119-1122, 1973.
6. Coligan, J. E., and Todd, C. W.: Structural studies man gastrointestinal secretions. Clin. Res. 22:489A,
on carcinoemhryonic antigen periodate oxidation. Bio-
rhemology 14:805-810, 1975.
7. Coombes, G . B., Hall, R. R., Laurence, D. J. R.,
and Neville, A. M.: Urinary carcinoemhryonic antigen
(CE.A)-like molecules and urothelial malignancy--i\
clinical appraisal. B r . J. Cancer 31:135-142, 19175.
8. Delwiche, R., Zamcheck, N., and Marcon, N.:
Positive serum carcinoembryonic antigen (CEA) in
alcoholic pancreatitis. Cancer 31:328-330, 1973.
9. DiMagno, E. P., Moertel, C. G.. and Go, V. L. W.:
Pancreatic CEA-like activity and serum CEA in health
and pancreatic disease. C l i n . Res. 23:248A3, 1975.
10. Dhar, P., Moore, T. I>,, Zamcheck, N., and Kup-
chik, H. Z.:Carcinoemhryonic antigen (CEA) in colonic
cancer: Use in pre- and postoperative diagnosis and
prognosis. J A M A 221:31-35, 1972.
11. Egan, M. I., Lautenschleger, J. T., Coligan.
J . E., and Todd, C. W.: Radioimmunoassay of car-
cinoemhryonic antigen. Zmn~u?zochemistry9:289-299,
1972.
10970142, 1976, S1, Downloaded from https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/1097-0142(197601)37:1+<562::AID-CNCR2820370721>3.0.CO;2-0 by Nat Prov Indonesia, Wiley Online Library on [04/11/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
- Go 565
end.5' I n pancreatic secretion, we found that
CEA output does not differentiate patients
with pancreatic disease from healthy persons;
yet one-third of patients with pancreatic can-
cer and 20% of those with chronic pancreatitis
had increased outputs of CEA in response to
cholecystokinin stimulation.9 Hall and co-
workers found abnormal urinary CEA values
in two-thirds of their patients with active
bladder cancer.tl We have confirmed their ob-
servations and further noted that the fre-
quency of abnormal CEA values correlated
with the extent and grade of the tumor. How-
ever, urinary tract infection can produce ab-
normal CEA values in patients without can-
cer.
These and 0therf5-36,~gvarious preliminary
results suggest that measurement of CEA-like
activities may have some diagnostic value.
However, its ultimate clinical application re-
mains to be determined.
12. Elias, E. G., Holyoke, E. D., and Chu, T. M.:
Carcinoemhryonic antigen (CEA) in feces and plasma
of normal subjects and patients with colorectal car-
cinoma. Dis. Colon Rectum 17:38:41, 1974.
13. Fraser, R. A., Ravry, M. J., Segura, J. W., and
Go, V. L. W.: Clinical evaluation of urine and serum
urinary bladder cancer. J. Urol., in press, 1975.
14. Freed, D. L. J., and Taylor, G.: Carcinoemhry-
onic antigen in faeces. Br. M e d . J. 85-87, 1972.
15. Kawanishi, H., Sell, J. E., and Pollard, H. M.:
Carcinoembryonic antigen and cytology of pancreatic
fluid. Gastroenterology 68: A-66/923, 1975.
16. Go, V. L. W., Ravry, M., Taylor, W. IF., Schutt,
carcinoembryonic antigen (CEA) in clinical setting.
Proceedings of the American Association for Cancer
Research of the American Society of Clinical On-
cology 15:194(#842), 1974.
17. Go, V. L. W., Ammon, H. K., Holtermuller,
K. H., Krag, E., and Phillips, S. F.: Quantification of
carcinoembryonic antigen-likc activities in normal hu-
1974.
18. Go, V. L. W.: Unpublished data.
19. Gold, P., and Freedman, S. 0.:Demonstration
of tumor-specific antigens in human colonic carcino-
mata by immunological tolerance and absorption
techniques. . J . E x p . M e d . 121:439-462, 1965.
20. Gold, P., and Freedman, S. 0.: Specific carcino-
embryonic antigens of the human digestivc system.
J . E x p . M e d . 122:467-481, 1965.
21. Hall, R. R., Laurence, D. J. R., Darcy, D.,
Stevens, U., James, R., Roberts, S., and Munro
Neville, A.: Carcinoemhryonic antigen in the urine
OE patients with urothelial carcinoma. Rr. M e d . J.
3:G09-611, 1972.
22. Hansen, H. J.. Snyder, J. J., Miller, E., Vande-
voorde, J. P., Milelr, 0. N.. Hines, L. R., and Burns,
J. J.: Carcinoemhryonic antigen (CEA) assay. A lahora-
tory adjunct in the diagnosis and management of
cancer. J . Hum. Pathol. 5:139-147, 1974.
23. Holyoke, D., Reynosa, G., and Chu, T. M.:

566 CANCER
Jnnzinry Supplement 1976
Carcinoemhryonic antigen (CEA) in patients with
carcinoma of the digestive tract. A n n . Szirg. 175:559-
563, 1972.
24. Holyoke, E. D., Reynoso, G., and Chu, T. M.:
Carcinoemhryonic antigen in patients with carcinoma
of the digestive tract. I n Embryonic and Fetal Antigens
in Cancer, vol. 2, IJSAEC Report CONF-72020R. Spring-
field, VA, 1J.S. Dept. of Commerce, 1972; pp. 215-219.
25. Joint National Cancer Institute of Canada/
American Cancer Society Investigation. A Collahora-
tive Study of a Test for Carcinoenihryonic Antigen
(CEA) in the Sera of Patients with Carcinoma of the
Colon and Rectum. Con. hled. Assor. J . 107:25-33,
1972.
26. Khoo, S. K.. and Mackay, E. V.: Carcinoemhry-
onic antigen by radioimmunoassay in the detection
of recurrence during long-tcrm follow-up of female
genital cancer. Cnnrer 34:542-548, 1974.
27. Khoo, S. K., and Mackay, E. V.: Carcinoembry-
onic antigen in cancer of the female reproductive
system: Sequential levels and effects of treatment.
Aust. N.Z. J. Ohstet. Gynnecol. 13:l-7, 1973.
28. Khoo, S. K.. Warner, N. L., Lie, J. T., Mackay.
I. R.: Carcinoembryonic antigenic activity of tissue
extracts: A quantitative study of malignant and benign
neoplasms. Cirrhotic liver, normal adult and fetal
organs. I n t . .J. Cancer 11:681-687, 1973.
29. Kupchik. H. Z., and Zamcheck. N.: Carcino-
embryonic antigens(s) in liver disease. 11. Isolation
from human cirrhotic liver and serum and from nor-
mal liver. Gnstroenterology 63:95-101, 1972.
30. Laurence, D. J. R., Stevens, U., Bettelheim. R.,
et al.: Evaluation of the role of plasma rarcinoemhry-
onic antigen (CEA) in the diagnosis of gastrointestinal,
mammary and bronchial carcinoma. Br. M e d . J. 3:605-
609. 1972.
31. LoGerfo, P., Krupey, J.. and Hansen, H. J.:
Demonstration of an antigen common to several varie-
ties of neoplasia. Assay using zirconyl phosphate gel.
N . En@. J. Aled. 285:138-141, 1971.
32. LoGcrfo, P., Krupey. J . . Herter. F., Barker,
H. G . , and Hansen, H. J.: Tumor-associatcd antigen
in patients with carcinoma of the colon. A m . J . Sitrg.
123:127-131, 1972.
33. Lurie. R. R., Loewenstcin. M. S., antl Zam-
check. N.: Elevated carcinoemhryonic antigen (CEA)
in benign biliary ohstrnction. C l i n . Reg. 22:363A.
1974.
34. Mach, J. P., Jaeger, P. H.. Bertholet, M. M.,
Ruegsegger, C. H., Loosli, R. M., and Pettavel, J.:
Detection of recurrence of large-bowel carcinoma hy
radioimmunoassay of circulating carcinoemhryonic
antigen (CEA). Lnncrt 2:535-540, 1974.
35. Martin, F., and Devant, J.: Carcinoembryonic
antigen in normal human saliva. J. N n t l . Cancer Inst.
50:1375-1371), 1973.
36. McCabe. R. P.. Knpchik, H . Z., and Zam-
check, H.: Identification of carcinoemhryonic (CEA)
activity in the pancreatic juice of patients with car-
cinoma of the pancrras. Fed. Proc. 33:637, 1974.
37. Moore, T. L., Dhar, P., Zamcheck. N.. Keeley, A..
Gottlieh. L.. and Kupchik, H. 2.: Carcinoemhryonic an-
tigen(s) in liver disease. Gastroenterology 63:88-94,
1972.
38. Moore, 1’. L., Kupchik, H. Z.,Marcon, N., and
%amcheck,N.: Carcinoemhryonic antigen assay in can-
cer of the colon and pancreas and other digestive tract
10970142, 1976, S1, Downloaded from https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/1097-0142(197601)37:1+<562::AID-CNCR2820370721>3.0.CO;2-0 by Nat Prov Indonesia, Wiley Online Library on [04/11/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Vol. 37
disorders. A m . f . Dig. Dis. 16:l-7, 1971.
39. Mulcarr, R., and LoGerfo, P.: Tumor-associated
antigen in the chemotherapy of solid tumors. 1. S w g .
O n d . 4:407-417, 1972.
40. Mnnjal, D., Chawla, P. I-.. I.okich, J . J., and
Zamcheck, N.: Circulating antl tissue levels of car-
cinoernhryonic antigen (CEA), phosphohexose isomcrase
(PHI), gamma-gliitamyl transpeptidase (y-GTP) and
lactatr dehytlrogenasc (LDH) in cancer patients. C l i n ,
Res. 23:341A, 1975.
41. Ravry, M., McIntire, K. R., Moertel, C. G , ,
Waldmann, T . .4., Schutt. A. J., and Go, V. L. W.:
Brief communication-Carcinoenihryonic antigen (CE.4)
and alpha-fetoprotein (aFP) in the diagnosis of gastric
and colonic cancer. A comparative clinical evaluation.
J. N n f l . Cnncer I n s t i t . 52:1019-1021, 1974.
42. Ravry. M., Moertel, C. G., Schutt. A. J., antl Go,
V. 1.. W.: Usefulness of serial serum carcinoemhryonic
antigen (CEA) determinations during anticancer ther-
apy or long-term followup of gastrointestinal car-
cinoma. Cnncer 34: 1230-1234, 1974.
43. Reynow, G., Chu, T. M., Holyoke, D., et al.:
Carcinoemhryonic antigen in patients with different
cancers. , J A M A 220:361-365, 1972.
44. Rosai. J., Tillack, T. W.. and Marchesi. V. T.:
Membrane antigens of human colonic carcinoma antl
non-tumoral colonic mucosa-Results obtained with
a new isolation method. I t i t . J . C m r e r 10357-367,
1972.
45. Sharma, M. P., Grcgg, J . A,, McCahe. R. P.,
Locwenstein, M. S., Lurie, R . B., and Zamcheck, N.:
Carcinoembryonic antigen, (CEA)-like activity in pan-
creatic juice of patients with pancreatic cancer antl
pancreatitis. Gnstroenterology 66:A-122/776. 1974.
46. Skarin, A. T.. Delwiche. R.. Zamcheck, N.,
Lokich, J. I., and Frei, E.. 111. Carcinoembryonic an-
tigen-Clinical correlaion with chemotherapy for
metastatic gastrointestinal cancer. Cnncer 33: 1239-
1245, 1974.
47. Steele. I,.. Cooper, E. H., Mackay, A. M., Losow-
sky, M. S., and Golighyr, J . C.: Comhination of
carcinoemhryonic antigen and gamma glntamyl trans-
peptidasc in the study of the cvolution of colorectal
cancer. Br. J . Cnncer 30:319-324, 1974.
48. Steward, A . M., Nixon, D. W., Zamcheck, N.,
and Airenherg, A,: Carcinoemhryonic antigen in breast
cancer patients-Serum levels and disease progress.
Cnnrer 33:1246-1252, 1974.
49. Terry. W. D., Henkart, P. A.. Coligan, J. E.,
and Todd, C. W.: Carcinocmhryonic antigen-Char-
acterirstion and clinical application. Transplant. R e v .
20:100-129, 1974.
50. Thomson, D. M. P., Krupey, J., Freedman, S. O.,
antl Gold, P.: T h e radioimmunoassay of circulating
carcinoemhryonic antigen of the human digestive sys-
tem. Proc. N a f l . A m d . Sri. IJSA 64:161-167, 1969.
51. Vincent, R. G., and Chu. T. M.: Carcinoemhry-
onic antigen in patients with carcinoma of the lung.
J. Thornc. Cordiovnsc. S w g . 66:320-328, 1973.
52. Winawer, S. J.: Detection of early colon cancer.
Nationnl 1.arge Bowel Cancer Project Newsletter 3:7-9,
1975.
53. Zamcheck, N.: Carcinocmhryonic antigen-@an-
titative variations in circulating levels in benign and
malignant digestive tract diseases. I n Advances in In-
ternal Medicine, vol. 19. Chicago, Year Rook Medical,
1974; pp. 413--433.