Biliary Carcinoembryonic Antigen (CEA) Levels: The Role in Detection of Occult Hepatic Metastases in Colorectal Carcinoma Biliary Carcinoembryonic Antigen (CEA) in Occult Hepatic Metastases in Colorectal Carcinoma

Main Article Content

Sunay Şengezer
Fikret Aksoy


Objective: Colorectal carcinoma (CRC) is a major public health concern, often complicated by hepatic metastasis. Despite the widespread use of serum Carcinoembryonic Antigen (CEA) for postoperative monitoring, early detection of hepatic metastasis remains elusive. This study aims to evaluate the prognostic significance of CEA levels in both peripheral blood and gallbladder bile for predicting hepatic metastasis in CRC patients, and to explore its potential utility for personalized treatment regimens.

Materials and Methods: A prospective randomized study was conducted over three years, enrolling 31 participants, 21 of whom underwent curative operations for CRC. Preoperative and postoperative CEA levels were assessed with rigorous diagnostic imaging and histological examinations. Patients were stratified into groups based on liver metastasis, postoperative chemotherapy, and CEA levels in both blood and bile.

Results: A statistically significant difference was found in biliary CEA levels between patients with (mean = 129.22 ng/ml) and without intraoperative liver metastasis (mean = 33.16 ng/ml), p-value = 0.01. Serum and biliary CEA levels were robustly correlated, p > 0.05. Biliary CEA values differed significantly across Duke's stages, with particular significance between the control group and Duke's stage D (p < 0.001). Among patients without intraoperative liver metastasis but with biliary CEA >10 ng/ml, 80% developed liver metastasis postoperatively despite undergoing chemotherapy.

Conclusion: This research highlights the pivotal role of biliary CEA levels in diagnosing latent hepatic metastases in colorectal cancer. Demonstrating superior sensitivity compared to traditional serum tests, biliary CEA presents a potential shift in early detection. Elevated levels suggest expanded therapeutic options, from timely hepatectomies to adopting radiofrequency ablation and anti-CEA monoclonal antibodies, enhancing the likelihood of better patient outcomes. Essentially, these findings enhance our understanding of colorectal cancer, emphasizing the importance of personalized care, early diagnosis, and customized treatments, thereby directing us toward better patient outcomes.


Download data is not yet available.

Article Details

How to Cite
Şengezer, S., & Aksoy, F. (2023). Biliary Carcinoembryonic Antigen (CEA) Levels: The Role in Detection of Occult Hepatic Metastases in Colorectal Carcinoma: Biliary Carcinoembryonic Antigen (CEA) in Occult Hepatic Metastases in Colorectal Carcinoma. Medical Science and Discovery, 10(10), 772–778.
Research Article
Received 2023-09-20
Accepted 2023-10-02
Published 2023-10-06


Cao Y, Deng S, Yan L, Gu J, Yang J, Yang M, et al. A nomogram based on pretreatment levels of serum bilirubin and total bile acid levels predicts survival in colorectal cancer patients. BMC cancer. 2021;21:1-13. DOI:

Waisberg J, Palma RT, Neto LC, Martins LC, Oliveira MS, Nagashima CA, et al. Biliary carcinoembryonic antigen levels in diagnosis of occult hepatic metastases from colorectal carcinoma. World Journal of Gastroenterology: WJG. 2003;9(7):1589. DOI:

Li Destri G, Curreri R, Lanteri R, Gagliano G, Rodolico M, Di Cataldo A, et al. Biliary carcinoembryonic antigen in the diagnosis of occult hepatic metastases from colorectal cancer. Journal of surgical oncology. 2002;81(1):8-11. DOI:

Kutun S, Celik A, Hatiboglu C, Ulucanlar H, Cetin A. Carcinoembryonic antigen to detect hepatic metastases of colorectal cancers. Surgery today. 2003;33:590-4. DOI:

Takeda Y, Nakano T, Yanagaki M, Takada N, Kumamoto T, Furukawa K, et al. The time-dependent changes in serum carcinoembryonic antigen impact on posthepatectomy outcomes of colorectal liver metastasis. Surgery. 2022;172(2):625-32. DOI:

Ramphal W, Boeding JR, van Iwaarden M, Schreinemakers JM, Rutten HJ, Crolla RM, et al. Serum carcinoembryonic antigen to predict recurrence in the follow-up of patients with colorectal cancer. The International journal of biological markers. 2019;34(1):60-8. DOI:

Yoshino K, Osumi H, Ito H, Kamiimabeppu D, Ooki A, Wakatsuki T, et al. Clinical usefulness of postoperative serum carcinoembryonic antigen in patients with colorectal cancer with liver metastases. Annals of Surgical Oncology. 2022;29(13):8385-93. DOI:

Malati T. Tumour markers: An overview. Indian Journal of Clinical Biochemistry. 2007;22:17-31. DOI:

Tuech JJ, Pessaux P, Regenet N, Daver A, Lorimier G, Bergamaschi R, et al. Detection of occult liver metastases in colorectal cancer by measurement of biliary carcinoembryonic antigen concentration: a prospective study. Journal of surgical oncology. 2004;88(1):27-31. DOI:

Manfredi S, Lepage C, Hatem C, Coatmeur O, Faivre J, Bouvier A-M. Epidemiology and management of liver metastases from colorectal cancer. Annals of surgery. 2006;244(2):254. DOI:

Cost-Effectiveness C. CEA Monitoring in Colorectal Cancer (2023).

Thomas P, Forse RA, Bajenova O. Carcinoembryonic antigen (CEA) and its receptor hnRNP M are mediators of metastasis and the inflammatory response in the liver. Clinical & experimental metastasis. 2011;28:923-32. DOI:

Zhou J-M, Wang L, Mao A-R. Value and prognostic factors of repeat hepatectomy for recurrent colorectal liver metastasis. Hepatobiliary & Pancreatic Diseases International. 2023. DOI:

Takeda K, Kikuchi Y, Sawada Y, Kumamoto T, Watanabe J, Kuniski C, et al. Efficacy of Adjuvant Chemotherapy Following Curative Resection of Colorectal Cancer Liver Metastases. Anticancer Research. 2022;42(11):5497-505. DOI:

Chen L, Ma X, Dong H, Qu B, Yang T, Xu M, et al. Construction and assessment of a joint prediction model and nomogram for colorectal cancer. Journal of Gastrointestinal Oncology. 2022;13(5):2406. DOI:

Yaghoubi N, Avval FZ, Khazaei M, Sahebkar A, Aghaee-Bakhtiari SH. High diagnostic and prognostic value of miRNAs compared with the carcinoembryonic antigen as a traditional tumor marker. Anti-Cancer Agents in Medicinal Chemistry (Formerly Current Medicinal Chemistry-Anti-Cancer Agents). 2022;22(2):206-14. DOI:

Mocan LP, Rusu I, Melincovici CS, Boșca BA, Mocan T, Crăciun R, et al. The Role of Immunohistochemistry in the Differential Diagnosis between Intrahepatic Cholangiocarcinoma, Hepatocellular Carcinoma and Liver Metastasis, as Well as Its Prognostic Value. Diagnostics. 2023;13(9):1542. DOI:

Soma S, Gurnule S. Role of Serum Carcinoembryonic Antigen in Predicting Recurrent Disease following Curative Resection of Rectal Cancer. South Asian Journal of Cancer. 2022;11(02):118-20. DOI: