Abstract
Introduction: Measuring carcinoembryonic antigen (CEA) serum levels is frequently used as a biomarker for recurrent disease in follow-up after treatment of colorectal cancer. However, it is also elevated to a significant degree in a number of other malignant and non-malignant conditions. In this case, we present a patient with ongoing elevated CEA levels without a clear cause. Case Presentation: A 57-year-old female patient with adenocarcinoma of the rectum underwent neoadjuvant chemoradiation and a laparoscopic low anterior resection. During follow-up she presented without any clear symptoms but with an ongoing elevation of serum CEA levels, for which she underwent four sequential PET-CT scans within one year without any sign of malignancy. Other causes of elevated CEA levels were investigated and excluded by additional blood tests and imaging studies. Available literature was extensively reviewed but revealed no further possible explanations for the high CEA serum level. Conclusion: The manifestation of an exponential rise of CEA levels following the treatment of colorectal cancer in the absence of abnormalities is a rare presentation and remains a mystery. The cause of the elevated CEA is yet to be elucidated
Highlights
Measuring carcinoembryonic antigen (CEA) serum levels is frequently used as a biomarker for recurrent disease in follow-up after treatment of colorectal cancer
We present a patient with ongoing elevated CEA levels without a clear cause
CEA levels have been shown to be associated with tumour burden in patients with colorectal cancer and can be used as marker in follow up [1]
Summary
Serial measurements of carcinoembryonic antigen (CEA) serum levels can be indicative of recurrent disease after treatment of colorectal carcinoma and is frequently used as a biomarker in follow-up [1]. Benign causes contain cigarette smoking, mucinous cystadenoma of ovary/appendix, cholecystitis, liver cirrhosis, pancreatitis, inflammatory bowel disease and several medications [4]. In this case, we present a patient with ongoing elevating CEA levels without a clear cause. Radiotherapy was continued and 6 weeks after final treatment, a re-staging MRI was performed. This showed a partial response (ycT2N1) and a laparoscopic low anterior resection with an end-to-end stapled anastomosis was performed. Recovery looked promising until patient developed a pre-sacral abscess for which she received an Endo-sponge® for drainage. Patient underwent regular follow-up according to the Dutch National Oncological Guidelines and the ileostomy was closed 3,5 months after the initial surgery [5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
