Skip to main content


Log in

Role of carcinoembryonic antigen and liver function tests in the detection of recurrent colorectal carcinoma

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum


The optimal laboratory evaluation for the early detection of liver metastases from colorectal cancer is controversial. This investigation was undertaken to compare the efficacy of liver function tests (LFTs) with that of carcinoembryonic antigen (CEA) levels for the early detection of liver metastases. Patients who developed liver metastases after potentially curative resections of adenocarcinoma of the colorectum between 1974 and 1988 were reviewed. The following laboratory tests were serially evaluated during the follow-up period: CEA., alkaline phosphatase (AP), serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), and lactic dehydrogenase (LDH). These values were retrospectively assessed from the time of documented liver metastases to identify which lab value (s) were elevated initially. Ninety-two patients were available for study. Average time for the occurrence of liver metastases was 20 months (range, 3–72 months). The incidence of elevation of individual tests at the time of suspicion of liver metastasis was: CEA, 94.6 percent (P <0.25, chisquared); AP, 18.5 percent; SGOT, 12.0 percent; SGPT, 5.4 percent; and LDH, 29.3 percent. When comparing CEA with a battery of LFTs at the time of suspicion of liver metastasis, CEA was elevated with normal LFTs in 64.1 percent (P <0.05, chi-squared), the most frequent occurrence. At least one LFT was elevated with a normal CEA in only 2.2 percent; CEA and at least one LFT were increased in 30.4 percent; and both tests were normal in only 3.3 percent. These results indicate that, of the individual laboratory tests performed, CEA elevation heralds liver metastases significantly more frequently. LDH is the liver function test most frequently elevated when liver metastases are first suspected. When CEA is directly compared with a battery of LFTs, CEA is statistically significantly more frequently elevated. In fact, suspicion of liver metastases would have been delayed by the omission of LFTs in only 2.2 percent of patients. Therefore, we conclude that LFTs should be deleted from the follow-up of colorectal cancer patients, decreasing costs without significantly decreasing accuracy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Holleb A. Cancer statistics, 1990. CA 1990;40:9–26.

    PubMed  Google Scholar 

  2. Abrams HL, Spiro R, Goldstein N. Metastases in carcinoma, analysis of 1000 autopsied cases. Cancer 1950;3:74–85.

    PubMed  Google Scholar 

  3. Martin EW Jr, Cooperman M, Carey LC, Minton JP. Sixty second-look procedures indicated primarily by rise in serial carcinoembryonic antigen. J Surg Res 1980;28:389–94.

    PubMed  Google Scholar 

  4. Dukes CE. Cancer of the rectum: an analysis of 1000 cases. J Pathol Bacteriol 1940;50:527–39.

    Google Scholar 

  5. Ekberg H, Tranberg K-G, Andersson R,et al. Determinants of survival in liver resection for colorectal secondaries. Br J Surg 1986;73:727–31.

    PubMed  Google Scholar 

  6. Steele G Jr, Ravikumar TS. Resection of hepatic metastases from colorectal cancer. Ann Surg 1989;210:127–38.

    PubMed  Google Scholar 

  7. Castagna J, Benfield JR, Yamada H, Johnson DE. The reliability of liver scan and function tests in detecting metastases. Surg Gynecol Obstet 1972;134:463–6.

    PubMed  Google Scholar 

  8. Yesner R, Conn HO. Liver function tests and needle biopsy in the diagnosis of metastatic cancer of the liver. Ann Intern Med 1963;59:62–73.

    PubMed  Google Scholar 

  9. Kemeny MM, Sugarbaker PH, Smith TJ,et al. A prospective analysis of laboratory tests and imaging studies to detect hepatic lesions. Ann Surg 1982;195:163–7.

    PubMed  Google Scholar 

  10. Ranson JH, Adams PX, Localio SA. Preoperative assessment for hepatic metastases in carcinoma of the colon and rectum. Surg Gynecol Obstet 1973;137:435–8.

    PubMed  Google Scholar 

  11. Tempero MA, Petersen RJ, Zetterman RK, Lemon HM, Gurney J. Detection of metastatic liver disease: use of liver scans and biochemical liver tests. JAMA 1982;248:1329–32.

    PubMed  Google Scholar 

  12. Cooper EH, Turner R, Steele L, Neville AM, MacKay AM. The contribution of serum enzymes and carcinoembryonic antigen to the early diagnosis of metastatic colorectal cancer. Br J Cancer 1975;31:111–7.

    PubMed  Google Scholar 

  13. Tartter PI, Slater G, Gelernt I, Aufses A Jr. Screening for liver metastases from colorectal cancer with carcinoembryonic antigen and alkaline phosphatase. Ann Surg 1981;193:357–60.

    PubMed  Google Scholar 

  14. Deveney KE, Way LW. Follow-up of patients with colorectal cancer. Am J Surg 1984;148:717–22.

    PubMed  Google Scholar 

  15. Rocklin MS, Slomski CA, Watne AL. Postoperative surveillance of patients with carcinoma of the colon and rectum. Am Surg 1990;56:22–7.

    PubMed  Google Scholar 

  16. Carlsson U, Stewénius J, Ekelund G, Leandoer L, Nosslin B. Is CEA analysis of value in screening for recurrences after surgery for colorectal carcinoma? Dis Colon Rectum 1983;26:369–73.

    PubMed  Google Scholar 

  17. Wanebo HJ, Llaneras M, Martin T, Kaiser D. Prospective monitoring trial for carcinoma of colon and rectum after surgical resection. Surg Gynecol Obstet 1989;169:479–87.

    PubMed  Google Scholar 

  18. Graffner H, Hultberg B, Johansson B, Möller T, Petersson BG. Detection of recurrent cancer of the colon and rectum. J Surg Oncol 1985;28:156–9.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


About this article

Cite this article

Rocklin, M.S., Senagore, A.J. & Talbott, T.M. Role of carcinoembryonic antigen and liver function tests in the detection of recurrent colorectal carcinoma. Dis Colon Rectum 34, 794–797 (1991).

Download citation

  • Issue Date:

  • DOI:

Key words