Background

CEA measurement is used in monitoring and surveillance of patients with known colorectal cancer. CEA is raised in many benign conditions such as hepatitis, cirrhosis, pancreatitis and renal disease and can also be raised in almost any advanced adenocarcinoma. CEA within the reference range does not exclude colorectal cancer. Therefore, CEA should not be requested in primary care. A recent study in NHS GG&C found that 93% of CEA requesting in primary care was inappropriate. 

When to test

CEA should not be requested by primary care for diagnosis of colorectal cancer. 

Symptomatic patients should always be referred for appropriate investigations; a CEA within the reference interval may potentially delay this referral.

When not to test

CEA should only be measured if requested by secondary care. 

CEA should not be used as part of a tumour marker screen:

  • CEA within the reference range does not exclude colorectal cancer
  • CEA may be raised in other malignancies in addition to other non-malignant pathologies.

When to repeat a test

CEA should be repeated if: 

  • Directed by secondary care.

Reference and further reading

Scottish Referral Guidelines for Suspected Cancer [Internet]. NHSScotland; 2019. Lower Gastrointestinal Cancer; 2022 Jul 18 [cited 2022 Oct 04]. Available from: https://www.cancerreferral.scot.nhs.uk/lower-gastrointestinal-cancer/?alttemplate=Guideline

Quiz

Editorial Information

Last reviewed: 01/04/2023

Next review date: 01/04/2024

Author(s): Helen Falconer.

Version: 1

Approved By: National Demand Optimisation Group – Education Short Life Working Group and the Scottish Clinical Biochemistry Network (SCBN) Cancer Subgroup