Carcinoembryonic antigen

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Carcinoembryonic antigen (CEA) describes a set of highly related glycoproteins involved in cell adhesion. CEA is normally produced in gastrointestinal tissue during fetal development, but the production stops before birth. Therefore, CEA is usually present only at very low levels in the blood of healthy adults. However, the serum levels are raised in some types of cancer, which means that it can be used as a tumor marker in clinical tests. Serum levels can also be elevated in heavy smokers. CEA are glycosyl phosphatidyl inositol (GPI) cell surface anchored glycoproteins whose specialized sialofucosylated glycoforms serve as functional colon carcinoma L-selectin and E-selectin ligands, which may be critical to the metastatic dissemination of colon carcinoma cells.[2][3][4] Immunologically they are characterized as members of the CD66 cluster of differentiation.

History

CEA was first identified in 1965 by Phil Gold and Samuel O. Freedman in human colon cancer tissue extracts.[5]

Diagnostic significance

Serum from individuals with colorectal carcinoma often has higher levels of CEA than healthy individuals (above approximately 2.5 µg/L).[6] CEA measurement is mainly used as a tumor marker to monitor colorectal carcinoma treatment, to identify recurrences after surgical resection, for staging or to localize cancer spread through measurement of biological fluids.[7] CEA levels may also be raised in gastric carcinoma, pancreatic carcinoma, lung carcinoma, breast carcinoma, and medullary thyroid carcinoma, as well as some non-neoplastic conditions like ulcerative colitis, pancreatitis, cirrhosis,[8] COPD, Crohn's disease, hypothyroidism [9] as well as in smokers.[citation needed] The CEA blood test is not reliable for diagnosing cancer or as a screening test for early detection of cancer.[10] Most types of cancer do not result in a high CEA level. Elevated CEA levels should return to normal after successful surgical resection or treatment .[citation needed]

CEA elevation is known to be affected by multiple factors. It varies inversely with tumor grade (well-differentiated tumors secrete more CEA). CEA is elevated more in tumors with lymph node and distant metastasis than in organ-confined tumors (varies directly with tumor stage). Left-sided tumors tend to have higher CEA levels than right-sided tumors.[citation needed] Tumors causing obstruction produce higher CEA levels. Aneuploid tumors produce more CEA than diploid tumors. Liver dysfunction increases CEA levels as the liver is the primary site of CEA metabolism.

Regions of high CEA levels in the body can be detected with the monoclonal antibody arcitumomab.[clarification needed]

Antibodies to CEA are also commonly used in immunohistochemistry to identify cells expressing the glycoprotein in tissue samples. In adults, CEA is expressed only in cancer cells,[citation needed] especially adenocarcinomas, such as those arising in the colon, lung, breast, stomach, or pancreas. It can therefore be used to distinguish between these and other similar cancers. For example, it can help to distinguish between adenocarcinoma of the lung and mesothelioma, a different type of lung cancer which is not normally CEA positive. Because even monoclonal antibodies to CEA tend to have some degree of cross-reactivity, occasionally giving false positive results, it is commonly employed in combination with other immunohistochemistry tests, such as those for BerEp4, WT1, and calretinin.[11]

Genetics

CEA and related genes make up the CEA family belonging to the immunoglobulin superfamily.

In humans, the carcinoembryonic antigen family consists of 29 genes, 18 of which are normally expressed.[12] The following is a list of human genes which encode carcinoembryonic antigen-related cell adhesion proteins: CEACAM1, CEACAM3, CEACAM4, CEACAM5, CEACAM6, CEACAM7, CEACAM8, CEACAM16, CEACAM18, CEACAM19, CEACAM20, CEACAM21

See also

References

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  8. ↑ Lua error in package.lua at line 80: module 'strict' not found.
  9. ↑ De Mais, Daniel. ASCP Quick Compendium of Clinical Pathology, 2nd Ed. ASCP Press 2009.
  10. ↑ Lua error in package.lua at line 80: module 'strict' not found.
  11. ↑ Lua error in package.lua at line 80: module 'strict' not found.
  12. ↑ Lua error in package.lua at line 80: module 'strict' not found.

External links

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