A 78-year-old man with no significant medical or family history of cancer presented with 2 weeks of worsening abdominal pain and was found to have a cecal mass on computed tomography (CT) scan. Colonoscopy and biopsy revealed a partially obstructing cecal adenocarcinoma; colonoscope could not be passed beyond the mass. On further workup, his carcinoembryonic antigen (CEA) level was 11.0 ng/mL. CT scan of chest showed no evidence of metastatic disease. The patient underwent a right hemicolectomy with surgical pathology showing a 5.5-cm adenocarcinoma with 0 of 19 lymph nodes positive for cancer. A colonoscopy, which was performed 3 months after surgery because of an incomplete preoperative examination, did not show any remaining mass or synchronous lesions. Given stage IIA disease, the patient did not receive adjuvant chemotherapy and was scheduled for postoperative surveillance with CEA testing every 6 months and a CT scan and colonoscopy in 1 year. One year after surgery, testing showed the patient’s CEA level to be 5.1 ng/mL, then 6.1 ng/mL on repeat testing. The patient did not have any new symptoms and his physical examination was unremarkable. His serial CEA levels are shown in the Table.
Kim SS, Donahue TR, Girgis MD. Carcinoembryonic Antigen for Diagnosis of Colorectal Cancer Recurrence. JAMA. 2018;320(3):298–299. doi:10.1001/jama.2018.8424
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