Can necrosis cause tumor markers to rise?

[Unregistered]

Hi there. A quick question. My mother had gamma knife on 6 brain lesions a year ago. All have shrunk a bit since, except for one which started getting larger since Jan. Mother had another MRI today which showed it again got a bit larger. Neurosurgeon thinks it's most likely necrosis but wants to keep a vigilant eye on it. I know this has happened to many of you. What concerns me is that my mother's CEA rose dramatically (like Steph's) with the brain mets. From 1's to the 9's. Since June it's been between .6 and .9 . Now it's gone from .8 to 1.0. Should this trouble me? Is that change significant? or can necrosis cause CEA to rise a bit? Anyone's experience is truly appreciated.

[StephN]

Hello -

All I can tell you is from my own experience. Your Mom is lucky to have someone like you looking out for her.

Keep in mind that the CEA marker is normal at BELOW 5. You Mom's result is BELOW ONE - so I do not see this as an indication that anything is wrong. If her number is now around ONE, it is nowhere near the highs of 9 when her brain mets were all active. As they keep an eye on the size of the area of mets, they should keep watching the CEA. If it creeps up again consistently, there may be more tumor activity.

In my case just this month - my CEA marker has been steady at .9 and what was increasing in size in the old brain tumor bed WAS necrosis.

Know also that it very difficult to sort out the changes in an area of old tumor. The scans we have just are not precise enough. If your Mom can avoid an "exploratory" surgery, she would. Our docs do not like to take chances with us stage IV patients.

[JohnL]

I found this, which basically says that necrosis - and other treatment related effects - can raise CEA levels.

CEA results should not be interpreted as absolute evidence for the presence or absence of malignant disease but should be used in conjunction with information from other test procedures and from clinical evaluations of the patient tested. CEA levels are elevated in smokers; patients with inflammation including infections, inflammatory bowel disease, and pancreatitis; some patients with hypothyroidism; cirrhosis; and in some patients with noncolorectal neoplasms especially gastric, pancreatic, breast, and ovarian. CEA is not a screening test for occult cancer. Many negatives occur iCEA results should not be interpreted as absolute evidence for the presence or absence of malignant disease but should be used in conjunction with information from other test procedures and from clinical evaluations of the patient tested. CEA levels are elevated in smokers; patients with inflammation including infections, inflammatory bowel disease, and pancreatitis; some patients with hypothyroidism; cirrhosis; and in some patients with noncolorectal neoplasms especially gastric, pancreatic, breast, and ovarian. CEA is not a screening test for occult cancer. Many negatives occur in patients with early carcinoma. Negative in some patients with even metastatic colorectal and other neoplasms: a minority of such patients do not have high CEA levels. Hepatotoxicity of antineoplastic drugs, as well as tumor cell necrosis or membrane damage may permit escape of CEA into the circulation and cause CEA increase; simultaneous evaluation of liver-related tests has been advocated for the former. Radiation therapy may also induce a transient rise in CEA. Benign diseases usually do not cause CEA levels >5-10 ng/mL.tients with early carcinoma. Negative in some patients with even metastatic colorectal and other neoplasms: a minority of such patients do not have high CEA levels. Hepatotoxicity of antineoplastic drugs, as well as tumor cell necrosis or membrane damage may permit escape of CEA into the circulation and cause CEA increase; simultaneous evaluation of liver-related tests has been advocated for the former. Radiation therapy may also induce a transient rise in CEA. Benign diseases usually do not cause CEA levels >5-10 ng/mL.