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Japanese Journal of Clinical Oncology Advance Access published online on October 23, 2006
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyl110
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© 2006 Foundation for Promotion of Cancer Research
Received May 31, 2006
Accepted July 27, 2006

Case Report

Unusual Elevation of CEA in a Patient with History of Colon Cancer

Tzu-Chi Hsu 1 *

1 Division of Colon and Rectal Surgery, Taipei Mackay Memorial Hospital, Department of Surgery, Taipei Medical University, FACS, #92, Section 2, Chung-San North Road, Taipei, Taiwan

* To whom correspondence should be addressed.
Tzu-Chi Hsu, E-mail: tzuchi{at}ms2.mmh.org.tw


  Abstract

A 35-year-old female received right hemicolectomy for a poorly differentiated adenocarcinoma of the ascending colon with lymph node metastasis (1/28) in February 1997. CEA was 1.68 ng/µl prior to colectomy. Adjuvant chemotherapy with weekly 5-FU and leucovorin intravenously was started following surgery and discontinued after 17 doses in May 1997. She received bilateral salpingo-ophorecctomy for metastatic cancer in August 1999. Intravenous chemotherapy was resumed with weekly 5-FU and leucovorin intravenously in August 1999. CEA was 93.8 ng/µl in November 1999. Intravenous chemotherapy was discontinued after 20 doses and oral chemotherapy with futraful and leucovorin was started in January 2000. CEA was found to be 240.3 ng/µl in December 1999 and then elevated to 1521.3 ng/µl in June 2001, which was 10 months after resection of metastatic ovarian cancer. No metastatic lesions could be detected, however, with image studies. The CEA decreased to 396.6 ng/µl three months later. Futraful was switched to uracil-tegafur (UFUR) in September 2001. The CEA for the patient ranged from 68.5 to 298.9 ng/µl for the following 5 years without aggressive chemotherapy. No evidence of recurrence could be demonstrated by imaging studies. The patient is not a smoker and denied exposure to a smoking environment. She was also not known to have persistent infections, inflammatory bowel disease, pancreatitis, cirrhosis of the liver, or any benign tumors. The current case suggested that: (i) elevation of CEA is not necessarily well correlated with presence of metastatic colon cancer; (ii) some patients may live with elevated CEA for years without evidence of recurrence or metastasis; (iii) aggressive chemotherapy may not be necessary in patients with only elevated CEA.

Keywords: CEA; elevation; colon cancer; 5-FU; leucovorin.
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