Carcinoembryonic Antigen as a Marker for Colorectal Cancer
2006 recommendation for carcinoembryonic antigen as a screening test. Carcinoembryonic antigen (CEA) is not recommended for use as a screening test for colorectal cancer.
2006 recommendation for preoperative carcinoembryonic antigen (CEA) testing. CEA may be ordered preoperatively in patients with colorectal carcinoma if it would assist in staging and surgical treatment planning. Although elevated preoperative CEA (>5 mg/mL) may correlate with poorer prognosis, data are insufficient to support the use of CEA to determine whether to treat a patient with adjuvant therapy.
2006 recommendation for postoperative CEA testing. Postoperative serum CEA testing should be performed every 3 months in patients with stage II or III disease for at least 3 years after diagnosis if the patient is a candidate for surgery or systemic therapy. An elevated CEA, if confirmed by retesting, warrants further evaluation for metastatic disease, but does not justify the institution of adjuvant therapy or systemic therapy for presumed metastatic disease (Ueno et. al, 2000). CEA elevations within a week or two following chemotherapy should be interpreted with caution (Sorbye & Dahl, 2003).
2006 recommendation for CEA testing to monitor metastatic colorectal cancer. CEA is the marker of choice for monitoring metastatic colorectal cancer during systemic therapy. CEA should be measured at the start of treatment for metastatic disease and every 1 to 3 months during active treatment. Persistently rising values above baseline should prompt restaging, but suggest progressive disease even in the absence of corroborating radiographs. Caution should be used when interpreting a rising CEA level during the first 4 to 6 weeks of a new therapy, since spurious early rises may occur especially after oxaliplatin use (Sorbye & Dahl, 2003; Sorbye & Dahl, 2004).
CA 19-9 As a Marker for Colon Cancer
2006 recommendation for use of CA 19-9 in colon cancer. Present data are insufficient to recommend CA 19-9 for screening, diagnosis, staging, surveillance, or monitoring treatment of patients with colorectal cancer.
DNA Ploidy or Flow Cytometric Proliferation Analysis As a Marker for Colon Cancer
2006 recommendation for DNA ploidy or DNA flow cytometric proliferation analysis to determine prognosis. Neither flow-cytometrically derived DNA ploidy (DNA index) nor DNA flow cytometric proliferation analysis (%S phase) should be used to determine prognosis of early-stage colorectal cancer.
p53 As a Marker for Colorectal Cancer
2006 recommendations for p53 testing. Present data are insufficient to recommend the use of p53 expression or mutation for screening, diagnosis, staging, surveillance, or monitoring treatment of patients with colorectal cancer.
ras As a Marker for Colorectal Cancer
2006 recommendation for ras testing. Present data are insufficient to recommend the use of the ras oncogene for screening, diagnosis, staging, surveillance, or monitoring treatment of patients with colorectal cancer.
Thymidine Synthase, Dihydropyrimidine Dehydrogenase, and Thymidine Phosphorylase As Markers in Colorectal Cancer
Note: These topics are new to the guideline.
2006 recommendation for thymidine synthase, dihydropyrimidine dehydrogenase, and thymidine phosphorylase as screening tests. Thymidine synthase (TS), dihydropyrimidine dehydrogenase (DPD), and thymidine phosphorylase (TP) are tissue markers that have been used to predict response to treatment of established carcinomas and thus are not useful for screening.
2006 recommendation for use of TS, DPD, or TP for prognosis. None of the three markers—TS, DPD, or TP—are recommended for use to determine the prognosis of colorectal carcinoma.
2006 recommendation for use of TS, DPD, or TP in predicting response to therapy. There is insufficient evidence to recommend use of TS, DPD, or TP as predictors of response to therapy.
2006 recommendation for use of TS, DPD, or TP in monitoring response to therapy. There is insufficient evidence to recommend use of TS, DPD, or TP for monitoring response to therapy.
Microsatellite Instability/hMSH2 or hMLH1 As Markers in Colorectal Cancer
Note: This topic is new to the guideline.
2006 recommendation for use of microsatellite instability to determine prognosis. Microsatellite instability (MSI) ascertained by polymerase chain reaction (PCR) is not recommended at this time to determine the prognosis of operable colorectal cancer nor to predict the effectiveness of FU adjuvant chemotherapy.
1 8q-LOH/DCC As Markers for Colorectal Cancer
Note: This topic is new to the guideline.
2006 recommendation for use of 18q-LOH/DCC to determine prognosis or to predict response to therapy. Assaying for loss of heterozygosity (LOH) on the long arm of chromosome 18 (18q) or deleted in colon cancer (DCC) protein determination by IHC should not be used to determine the prognosis of operable colorectal cancer, nor to predict response to therapy.
CA 19-9 as a Marker for Pancreatic Cancer
Note: This topic is new to the guideline.
2006 recommendation for use of CA 19-9 as a screening test. CA 19-9 is not recommended for use as a screening test for pancreatic cancer.
2006 recommendation for use of CA 19-9 to determine operability. The use of CA19- 9 testing alone is not recommended for use in determining operability or the results of operability in pancreatic cancer.
2006 recommendation for use of CA 19-9 to provide evidence of recurrence. CA 19-9 determinations by themselves cannot provide definitive evidence of disease recurrence without seeking confirmation with imaging studies for clinical findings and/or biopsy.
2006 recommendation for use of CA19-9 for monitoring response to therapy. Present data are insufficient to recommend the routine use of serum CA 19-9 rules alone for monitoring response to treatment. However, CA19-9 can be measured at the start of treatment for locally advanced metastatic disease and every 1 to 3 months during active treatment. If there is an elevation in serial CA19-9 determinations, this may be an indication of progressive disease, and confirmation with other studies should be sought.