Role of carcinoembryonic antigen in detection of asymptomatic disseminated disease in colorectal carcinoma.

Fifty one patients were studied prospectively to evaluate the role of sequential determinations of the carcino-embryonic antigen concentration in the detection of asymptomatic disseminated disease after curative resection for colorectal carcinoma. Computed tomography of the liver was performed during the immediate postoperative period in all patients. Serum concentrations of the antigen were estimated at three month intervals for a minimum of two years. Computed tomography at the time of operation detected occult hepatic metastases in 12 patients. Of the remaining 39 patients, six developed local recurrence alone, two developed disseminated disease in the absence of hepatic metastases, and one developed hepatic disease at 10 months, as detected by sequential computed tomography. Of all 13 patients with asymptomatic hepatic metastases, only eight developed an increase in serum carcinoembryonic antigen concentrations before death. The median interval between detection by computed tomography and rise in antigen concentrations was 7.5 months. The corresponding median interval from increase in concentration to death was only 5.5 months. Of the six patients who developed local recurrence alone, only two had raised concentrations of the antigen. These results suggest that increase in the serum carcinoembryonic antigen concentration occurs late in colorectal carcinoma.