Carcinoembryonic antigen (CEA) is a glycoprotein involved in cell adhesion. It is normally produced in gastrointestinal tissue during fetal development, but the production of CEA stops before birth. Therefore, it is usually present only at very low levels in the blood of healthy adults. However, the serum levels are raised in some types of cancer, which means that it can be used as a tumor marker in clinical tests. Serum levels can also be elevated in heavy smokers. CEA is a glycosyl phosphatidyl inositol (GPI) cell surface anchored glycoprotein whose specialized sialofucosylated glycoforms serve as functional colon carcinomaL-selectin and E-selectin ligands, which may be critical to the metastatic dissemination of colon carcinoma cells.
CEA elevation is known to be affected by multiple factors. It varies inversely with tumor grade (well-differentiated tumors secrete more CEA). CEA is elevated more in tumors with lymph node and distant metastasis than in organ-confined tumors (varies directly with tumor stage). Left-sided tumors tend to have higher CEA levels than right-sided tumors. Tumors causing obstruction produce higher CEA levels. Aneuploid tumors produce more CEA than diploid tumors. Liver dysfunction increases CEA levels as the liver is the primary site of CEA metabolism.
Antibodies to CEA are also commonly used in immunohistochemistry to identify cells expressing the glycoprotein in tissue samples. In adults, CEA is expressed only in cancer cells, especially adenocarcinomas, such as those arising in the colon, lung, breast, stomach, or pancreas. It can therefore be used to distinguish between these and other similar cancers. For example, it can help to distinguish between adenocarcinoma of the lung and mesothelioma, a different type of lung cancer which is not normally CEA positive. Because even monoclonal antibodies to CEA tend to have some degree of cross-reactivity, occasionally giving false positive results, it is commonly employed in combination with other immunohistochemistry tests, such as those for BerEp4, WT1, and calretinin.
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