Carcinoembryonic antigen (CEA) in plasma of patients with carcinoma of the bladder/urethra

Abstract

A modified CEA-Roche kit was used to determine plasma CEA levels in 191 patients with carcinoma of the bladder/urethra. Pretreatment values were determined in 48 patients and values after previous treatment in a total of 177 cases. Serial CEA determinations were done in 140 patients. Among the untreated patients, 32% had elevated CEA compared to 41% in the group of previously treated patients with transitional cell carcinoma (TCC). Significant elevations were seen in the T1 stage as well as in the more advanced stages. T1 patients with no detectable tumors had normal CEA values with few exceptions. In patients with T2-T4 disease little difference was found between cases with tumor and those who were regarded as tumor free. No significant correlation was seen between CEA level and the grade of tumor differentiation in patients with TCC. The previously treated TCC patients had CEA levels which did not show any significant correlation to the clinical stage when CEA was determined. Even most of the patients with widespread metastases had only moderate increase of CEA. In the untreated patients a tendency to increased elevation was seen in the advanced stages. Serial determination of CEA showed a majority of cases with local recurrences that had CEA values within the normal range and following treatment the CEA value did not show corresponding fluctuation. The best correlation to clinical course was seen when comparing the pretreatment CEA level with the level after primary treatment where 5 out of 34 patients had a decrease in CEA after removal of the tumor. The clinical value of CEA determinations seems to be limited mainly to patients with elevated CEA who are selected for radical treatment where persistance of CEA elevation may suggest incomplete removal of the tumor. Of special clinical interest was CEA determination in patients with adenocarcinoma and a small group (2–3%) of patients with tumors classified as TCC of the bladder/ urethra. In these patients plasma CEA increased to high levels with advancing tumor growth, and elevations were seen before metastases were clinically detected. CEA also showed marked decrease after cancer therapy in these patients. The plasma CEA level seems to reflect biological or histogenetic differences in bladder carcinoma.