What Does Duke's Stage C1 Indicate?

Posted on Fri, 28 Nov 2014

Question: What can the following results suggest following colon cancer surgery in march and confirmed a dukes c1:

May -3 XXXXXXX -4
July -6
Sept-9.8
October - 8

I note that October is a little
Drop , can this mean anything ?

Answered by Dr. Noble Zachariah (37 minutes later)

Brief Answer:
CEA estimation in November important.

Detailed Answer:
Hello,

Welcome to HCM and thank you for the query.
I understand your concern.
Duke's Stage C1 means that the tumor was extending into muscularis propria but had not penetrated through it. Nodes were involved.
I presume the values you have shown are for the Carcinoembryonic antigen levels ( CEA) post surgery. This is done to detect any recurrence of the cancer. Different centers may follow different protocols and you can get the details from your surgeon.
Using a CEA cut off of 10 IU/L, the sensitivity and specificity for detecting any recurrence were 44% and 90%, respectively. An elevated serum CEA calls for a complete evaluation for recurrent disease, including chest, abdominal, and pelvic imaging and colonoscopy. Sometimes PET scan also is required.
The false-positive rate for CEA elevation during follow-up may be as high as 16%. So let us hope that 8 is the correct level and 9.8 was the falsely elevated level. The next estimation in November is important.
Best wishes,
Dr Noble Zachariah

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Noble Zachariah (27 minutes later)

The ones I have were all after surgery . However a pet scan has detected a liver met and 1 node .

So sept was 9.8 . Chemo
Has stopped since sept due to scans taking place and I was surprised y cea dropped to 8 despite no chemo for 8 weeks .

Answered by Dr. Noble Zachariah (18 minutes later)

Brief Answer:
Unexpected but welcome result

Detailed Answer:
Probably the prior chemotherapy had helped.
In such situations, the immune response of the body is very important.
Time and again, we see responses different from our expectations.
You should follow the advice of your treating team.
Keep up the good spirits and optimism, eat wholesome food , exercise and follow a healthy life style to boost your immunity.
Let us hope the November value would be good.
Take Care

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Noble Zachariah (11 minutes later)

But there is still 1 met that has appeared in liver of 16 mm
And I aortocaval lymph node . There is another lesion in liver of 16mm also but that has no uptake so can that be one killed by the chemo ?

Answered by Dr. Noble Zachariah (12 minutes later)

Brief Answer:
Follow the advice of the treating team

Detailed Answer:
It is good news that one lesion is inactive, probably due to the effect of chemotherapy. So if your treating team advise you regarding further chemo, you should go for it, in my opinion, along with the healthy life style and positive outlook. Let us hope that the next chemo would knock out the remaining one also.
I sometimes tell my patients that there is a difference between mathematics and medicine. In mathematics 2+2 is always 4. In the practice of medicine over so many years, one learns that 2+2 is not always 4. Sometimes it is 3 and other times it is 5.
So let us be optimistic but do what we have to as per the advice of the treating team.
Best wishes for the best outcome.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Noble Zachariah (1 hour later)

The 1 node that has a met also , us chemo
Best treatment for this?

Without chemo can a cea drop from
9.8 to 8?

Answered by Dr. Noble Zachariah (2 hours later)

Brief Answer:
Chemo would have helped

Detailed Answer:
My impression is that the chemo has helped in decreasing the CEA.
As regards to further chemo, please follow the advice of the treating doctor and team.

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Above answer was peer-reviewed by : Dr. Vinay Bhardwaj