The relationship of the possible hepatic toxicity of chemotherapeutic drugs and carcinoembryonic antigen elevation

Abstract

The value of the serum level of carcinoembryonic antigen (CEA) as an indicator of recurrent colorectal carcinoma has been accepted, and the use of serial CEA levels to monitor postoperative chemotherapy has been suggested. However, elevated CEA levels may be associated with nonneoplastic conditions, of which the most difficult to evaluate is hepatic disease. The effect of chemotherapy on hepatic function and therefore on CEA level is not clear. We discuss a patient who, after a potentially curative resection for adenocarcinoma, demonstrated a rise in CEA level in the absence of recurrent carcinoma. This rise correlated with administration of intravenous 5‐fluorouracil. Liver biopsy demonstrated severe fatty infiltration with no evidence of cirrhosis. The possible liver toxicity of chemotherapeutic drugs must be considered as a factor responsible for the rise in CEA. Simultaneous assessment of hepatic function is essential to the accurate interpretation of CEA levels, especially in patients receiving chemotherapy.