Carcinoembryonic antigen (CEA) describes a set of highly related glycoproteins involved in cell adhesion. CEA is normally produced in gastrointestinal tissue during fetal development, but the production stops before birth. Therefore CEA 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 are glycosyl phosphatidyl inositol (GPI) cell surface anchored glycoproteins 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. Immunologically they are characterized as members of the CD66 cluster of differentiation.
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.
In humans, the carcinoembryonic antigen family consists of 29 genes, 18 of which are normally expressed. The following is a list of human genes which encode carcinoembryonic antigen-related cell adhesion proteins:
^Thomas SN, Tong Z, Stebe KJ, Konstantopoulos K (2009). "Identification, characterization and utilization of tumor cell selectin ligands in the design of colon cancer diagnostics". Biorheology46 (3): 207–25. doi:10.3233/BIR-2009-0534. PMID19581728.
^Ballesta, AM; Molina, R; Filella, X; Jo, J; Giménez, N (1995). "Carcinoembryonic antigen in staging and follow-up of patients with solid tumors.". Tumour biology : the journal of the International Society for Oncodevelopmental Biology and Medicine16 (1): 32–41. PMID7863220.
^Maestranzi, S.; Przemioslo, R.; Mitchell, H.; Sherwood, RA. (Jan 1998). "The effect of benign and malignant liver disease on the tumour markers CA19-9 and CEA.". Ann Clin Biochem. 35 ( Pt 1): 99–103. PMID9463746.
^Duffy, M. J.; Van Dalen, A.; Haglund, C.; Hansson, L.; Klapdor, R.; Lamerz, R.; Nilsson, O.; Sturgeon, C.; Topolcan, O. (2003). "Clinical utility of biochemical markers in colorectal cancer: European Group on Tumour Markers (EGTM) guidelines". European journal of cancer (Oxford, England : 1990)39 (6): 718–727. doi:10.1016/S0959-8049(02)00811-0. PMID12651195.edit
^Leong, Anthony S-Y; Cooper, Kumarason; Leong, F Joel W-M (2003). Manual of Diagnostic Cytology (2 ed.). Greenwich Medical Media, Ltd. pp. 51–52. ISBN1-84110-100-1.
^Hammarström S (April 1999). "The carcinoembryonic antigen (CEA) family: structures, suggested functions and expression in normal and malignant tissues*1". Seminars in Cancer Biology9 (2): 67–81. doi:10.1006/scbi.1998.0119. PMID10202129.