CARCINOEMBRYONIC ANTIGEN

• CEA is a glycoprotein normally found in embryonic entodermal epithelium

• Exhibits heterogeniety  carbohydrate side chains
• Liver  primary site for metabolism of CEA
• It is suggested that it might act as an adhesion molecule
– Number of liver metastases increased from 2% to
48% after injection of nude mice with CEA
– Localized in the apical surface of mature
enterocytes & bind certain E. coli strains
• Present in other neoplastic and non neoplastic
conditions
 Capture
antibody
PRINCIPLE

• Specimen: Clotted blood (Serum) Antigen

• Circulatory half-life: ~7 days
• Two-site sandwich immunoassay
using two antibodies
– Capture antibody: Monoclonal mouse
anti-CEA antibody covalently coupled to
paramagnetic particles
– Antigen: Serum containing CEA
– Detection antibody: Purified polyclonal Detection
rabbit anti-CEA antibody labeled with antibody
acridinium ester
• Colorimetric response:
Spectrophotometer

Normal values: <2.5 ng/ml and for a smoker <5.0 ng/ml

 FACTORS AFFECTING SERUM CEA
CONCENTRATIONS IN PATIENTS WITH
COLORECTAL CANCER
Tumor stage Increased values with increasing disease stage

Tumor grade Increased with well-differentiated tumors than

Liver status
Tumor site within the colon
Presence or absence of bowel
obstruction
Smoking
Ploidy status of tumor
poorly differentiated tumors
Certain benign liver diseases can impair
clearance of CEA
Left sided tumors have higher incidence of
increased CEA than right sided tumors
Bowel obstruction per se can cause increase in
CEA & decompression can reduce CEA
Approximately doubles serum CEA
concentration
Aneuploid CRC produce higher CEA
concentrations than those with a near diploid
pattern
 CEA as a marker for colorectal cancer
• SCREENING
– For Dukes A and B
– Upper limit of normal 2.5 ug/L
– Sensitivity: 36%
– Specificity: 87%
– vs HSFBT: Sen > 70%;
Spec: >90%
• DIAGNOSIS
– Benign diseases rarely give rise to
> 10ug/L
– > 5x upper limit of normal –
strongly suggestive of cancer
– Sensitivity at 5ng/ml: 52%;
at 2.5ng/ml: 68.7%
– Specificity at 5ng/ml:
76.98%; at 10ng/ml: 86%
• PROGNOSIS
– College of American Pathologists
Expert Groups: preoperative serum
CEA concentration – Category I
prognostic marker for CRC
– High concentration 1-3 months
after hepatectomy = adverse
prognosis
 CEA as a marker for colorectal cancer
• SURVEILLANCE
– Longitudinal CEA measurements
for recurrent ds
• Sensitivity: ~80%
• Specificity: ~70%
– Serial CEA measurement for liver
metastasis
• Sensitivity: 94%,
• Specificity: 96%
– Can detect recurrent CRC with an
average lead time of 5 months
• MONITORING CHEMOTX IN
PATIENTS WITH ADVANCED
DISEASE
– American Society of Clinical
Oncology Panel:
• Baseline CEA value before
treatment
• Serial monitoring every 2-3
months
update