Carcinoembryonic antigen in malignant and nonmalignant gynecologic tumors.Circulating levels and tissue localization

Abstract

Carcinoembryonic antigen (CEA) was determined in the serum and tissues of patients with gynecologic tumors utilizing radioimmunoassay and immunoperoxidase techniques. Among 328 patients with gynecologic cancer the serum CEA concentration was elevated over the normal background level of 5 ng/ml in 32 cases (9.8%), and the frequency of elevated CEA levels increased with advancing clinical stage. Among 84 patients with benign tumors CEA was elevated in 5 cases (6%). Elevated levels were most commonly seen in patients with ovarian cancer (20%). In squamous cell carcinoma of the uterine cervix elevated levels occurred in 10%, and in cervical adenocarcinoma CEA elevation took place in 19% of the cases. In endometrial cancer CEA became less frequently elevated (7%). After radical surgery the CEA concentration decreased and remained low in 20 of 24 cancer patients (83%). Fifteen of these remained clinically tumor free during the follow-up period of 4–24 months. Three of four patients whose CEA concentration did not significantly decrease after operation were found to have residual tumor. Radiotherapy resulted in an increased CEA concentration in 3 of 5 patients with advanced cancer. Immunoperoxidase staining of CEA was carried out in formalin-fixed paraffin-embedded sections of 64 tumors and 33 specimens from normal genital tract. Tissue CEA was demonstrable in early as well as in advanced stages of malignant tumors. All normal tissue specimens from the genital tract were CEA-negative, but the brushborder of normal colon was CEA-positive. CEA activity in tissue was found in 11 of 14 squamous cell carcinomas of the cervix (79%) and in 7 of 9 cervical adenocarcinomas (78%). By contrast, endometrial adenocarcinoma showed CEA staining in one of 11 tumors only, and in ovarian adenocarcinoma positive CEA staining was never seen. CEA reactions were sometimes found in benign mucinous cystadenomas of the ovary, but not in serous cysts. The serum CEA concentration was normal or sometimes slightly elevated in cases where the tumor was CEA-negative, whereas normal or even highly elevated serum CEA concentrations were seen in CEA-positive tumors. On the basis of these results the following conclusions can be made: 1) Serum CEA measurement is likely to be more effective in cervical and ovarian than in endometrial cancer for the detection of recurrent CEA-positive tumors. 2) It is possible by immunoperoxidase technique to identify certain CEA-positive cervical carcinomas before the serum CEA concentration becomes elevated. 3) Some benign ovarian tumors apparently produce high amounts of CEA without any clinical evidence of malignancy.