RAISED CARCINOEMBRYONIC ANTIGEN LEVEL AS AN INDICATOR OF RECURRENT DISEASE IN THE FOLLOW-UP OF PATIENTS WITH COLORECTAL-CANCER

Background. Serum carcinoembryonic antigen level is raised in 80% of p atients undergoing colonic resection for cancer. Subsequent elevation in the follow-up period may precede signs and symptoms as an indicator of recurrent disease. There is little evidence that 'classical' follo w up of patients in the general surgical outpatient clinic improves ei ther survival or quality of life. Regular carcinoembryonic antigen lev el estimation requested by the general practitioner, allied to day-cas e colonoscopic surveillance may be a more rational approach. Aim. A st udy was undertaken to investigate the relationship between raised carc inoembryonic antigen level and the recurrence of colorectal cancer in patients following a curative primary resection. Method. Retrospective analysis was carried out on the notes of 125 patients who had attende d a dedicated hospital colorectal follow-up clinic between 1988 and 19 92. Carcinoembryonic antigen level data were obtained by subsequent ex amination of the University of Edinburgh Department of Clinical Chemis try (immunoassay section) carcinoembryonic antigen database. Results. A single carcinoembryonic antigen level result of more than 100 ul(-1) (normal range less than 60 ul(-1)) was found to be a highly sensitive (87%), specific (89%) and accurate (88%) indicator of recurrent disea se. Raised carcinoembryonic antigen level preceded symptoms in 72% of patients with recurrence of colorectal cancer. Conclusion. Sequential laboratory estimation of carcinoembryonic antigen level organized by t he general practitioner may represent an accurate method of detecting recurrent colorectal disease. Hospital review could be limited to colo noscopic surveillance and restaging of patients referred with evidence of recurrent disease.