Health Screening – Raised Cancer Markers CEA, Ca 19-9 and aFP

25th April 2022

Singapore is an affluent society.  Many people who live in this country undergo annual health screening.  Many of these health screening packages include numerous tumour markers.  Carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (Ca 19.9) and alpha fetoprotein (afp) are some of the tumour markers which I often come across.  In this passage, I will only discuss the most common cancer associated with these tumour markers.  Please keep in mind that the above tumour markers can also be elevated in other types of cancers.

CEA – This is a common test used for colon cancer screening.  One thing to keep in mind is that this tumour marker is elevated in less then 50% of patients with colon cancer.  Colorectal cancer patients with a high CEA tend to have advanced disease or metastatic disease. Meaning the colon cancer has spread to other organs such as the liver.  In simple terms, a normal CEA level does not necessarily mean that you do not have colon cancer.

Ca 19-9 – Pancreatic cancer is a rare cancer.  Approximately 80% of pancreatic cancers will cause a rise in  ca 19-9 levels.  Therefore, Ca 19-9 is a useful marker for managing pancreatic cancers. After surgery or chemotherapy, the Ca 19-9 level may drop which indicates a response to treatment.

The role of using Ca 19-9 for screening is less clear.  In Australia where I previously worked and trained in, Ca 19-9 is not routinely ordered in health screening.  I will request for a Ca 19-9 level only after the diagnosis of pancreatic cancer.  This is to monitor the response to treatment.

aFP – alpha fetoprotein is associated with primary liver cancer.  Approximately 60% of patients with liver cancer will have an elevated aFP.  Common risk factors for liver cancer is hepatitis B, hepatitis C and various causes of liver cirrhosis.

Hepatitis B is prevalent in South East Asia.  However, with the introduction of hepatitis vaccination, the number of people with hepatitis B is starting to diminish.  A simple blood test can check for hepatitis B and C status.

People with hepatitis B can be controlled with medications.  Regular screening with aFP and liver ultrasound can detect early liver cancers.  Early detection improves survival.

Hepatitis C can be cured with medications.  So this risk factor for liver cancer can be eliminated completely.

This blog will not be able to cover every aspect of raised tumour markers. If you have any concerns regarding a raised tumour marker, please feel free to contact us.

Stay safe.

Tail of pancreas tumour.  Laparoscopic excision.

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