Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (790 page)

   Not useful in screening the general population for undetected cancers

   Interpretation

Increased In

   Cancer. There is a wide overlap in values between benign and malignant disease. Increased concentrations are suggestive but not diagnostic of cancer.

   Seventy-five percent of patients with carcinoma of endodermal origin (colon, stomach, pancreas, lung) have CEA titers >2.5 ng/mL, and two thirds of these titers are >5 ng/mL. CEA is increased in about one third of patients with small cell carcinoma of the lung and in about two thirds with non–small cell carcinoma of the lung.

   Fifty percent of patients with carcinoma of nonentodermal origin (especially cancer of the breast, head and neck, ovary) have CEA titers >2.5 ng/ mL, and 50% of the titers are >5 ng/mL. Titers are increased in >50% of cases of breast cancer with metastases and 25% without metastases, but they are not associated with benign lesions.

   Forty percent of patients with noncarcinomatous malignant disease have increased CEA concentrations, usually 2.5–5.0 ng/mL.

   Increased in 90% of all patients with solid tissue tumors, especially with metastases to the liver or lung, but they are increased in only 50% of patients with local disease or only intra-abdominal metastases.

   May be increased in effusion fluid due to these cancers. Active nonmalignant inflammatory diseases (especially of the GI tract [e.g., ulcerative colitis, regional enteritis, diverticulitis, peptic ulcer, chronic pancreatitis]) frequently have elevated concentrations that decline when the disease is in remission.

   Liver disease (alcoholic, cirrhosis, chronic active hepatitis, obstructive jaundice) because metabolized by the liver.

   Other disorders:

   Renal failure

   Fibrocystic disease of the breast