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      Significance of CEA and VEGF as Diagnostic Markers of Colorectal Cancer in Lebanese Patients

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          Abstract

          Carcinoembryonic antigen and vascular endothelial growth factors are among the most important prognostic markers of colorectal cancer. Testing for these markers independently has been of limited value in screening for this tumor. The aim of this study is to determine the importance of simultaneous blood CEA and VEGF level determinations in diagnosis of colorectal cancer. Thirty-six patients diagnosed with colorectal cancer along with eight healthy controls were tested by ELISA for CEA and VEGF levels in serum and plasma, respectively. The positive predictive value of these markers was 95.4% for CEA and 89.5% for VEGF, and for combined CEA and VEGF was also high at 88%. Combined CEA and VEGF blood level assay constitutes a useful panel in detecting patients with colorectal cancer. Positive results allow selection of a subgroup of patients with a high tumor risk; therefore, such tests comprise valuable tumor diagnostic tests to add to current detection methods.

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          Role of the vascular endothelial growth factor pathway in tumor growth and angiogenesis.

          Daniel Hicklin, Lee Ellis (2005)
          New blood vessel formation (angiogenesis) is a fundamental event in the process of tumor growth and metastatic dissemination. Hence, the molecular basis of tumor angiogenesis has been of keen interest in the field of cancer research. The vascular endothelial growth factor (VEGF) pathway is well established as one of the key regulators of this process. The VEGF/VEGF-receptor axis is composed of multiple ligands and receptors with overlapping and distinct ligand-receptor binding specificities, cell-type expression, and function. Activation of the VEGF-receptor pathway triggers a network of signaling processes that promote endothelial cell growth, migration, and survival from pre-existing vasculature. In addition, VEGF mediates vessel permeability, and has been associated with malignant effusions. More recently, an important role for VEGF has emerged in mobilization of endothelial progenitor cells from the bone marrow to distant sites of neovascularization. The well-established role of VEGF in promoting tumor angiogenesis and the pathogenesis of human cancers has led to the rational design and development of agents that selectively target this pathway. Studies with various anti-VEGF/VEGF-receptor therapies have shown that these agents can potently inhibit angiogenesis and tumor growth in preclinical models. Recently, an anti-VEGF antibody (bevacizumab), when used in combination with chemotherapy, was shown to significantly improve survival and response rates in patients with metastatic colorectal cancer and thus, validate VEGF pathway inhibitors as an important new treatment modality in cancer therapy.
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            The carcinoembryonic antigen (CEA) family: structures, suggested functions and expression in normal and malignant tissues.

            S Hammarström (1999)
            The human CEA family has been fully characterized. It comprises 29 genes of which 18 are expressed; 7 belonging to the CEA subgroup and 11 to the pregnancy specific glycoprotein subgroup. CEA is an important tumor marker for colorectal and some other carcinomas. The CEA subgroup members are cell membrane associated and show a complex expression pattern in normal and cancerous tissues with notably CEA showing a selective epithelial expression. Several CEA subgroup members possess cell adhesion properties and the primordial member, biliary glycoprotein, seems to function in signal transduction or regulation of signal transduction possibly in association with other CEA sub-family members. A modified ITAM/ITIM motif is identified in the cytoplasmatic domain of BGP. A role of CEA in innate immunity is envisioned. Copyright 1999 Academic Press.
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              Is it reasonable to add preoperative serum level of CEA and CA19-9 to staging for colorectal cancer?

              Chien-Chih Chen, Shung-Haur Yang, Jen-Kou Lin … (2005)
              Carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) are the most common tumor markers for colorectal cancer. The aim of this study was to evaluate the possibility of adding them into the current staging system by analyzing their prognostic significance. The study population was patients (n = 574, 67.1 +/- 11.3 years old, 397 males) who received potentially curative resection of colorectal adenocarcinoma (stage I-III) between January 1994 and August 2002, including preoperative measurements of CEA and CA19-9. Clinicopathological characteristics and associated follow-up data were retrospectively collected by reviewing available medical charts. CEA higher or equal to 5 ng/ml was defined as abnormal (CEA+). The CA19-9 level was set at 37 U/ml (CA19-9+). Patients were further divided into four groups (1, 2, 3, 4) according to the results of these two markers (CEA/CA19-9: -/-, -/+, +/-, and +/+). Survival was analyzed for AJCC staging, CEA (+) versus (-), CA19-9 (+) versus (-), and four groups. CEA and CA19-9 survival curves were not significantly different. However, the combined use of the two markers revealed a significant survival benefit (P = 0.035) of group 1 ("-" for both markers) over 4 ("+" for both) in stage II. Patients with an elevated level of both CEA and CA19-9 in stage II of colorectal cancer have a significantly poorer prognosis than those with normal levels of these markers. We recommend adding both CEA and CA19-9 to the current staging system.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Clin Cancer J
                Journal ID (publisher-id): TOCCJ
                Title: Open Clinical Cancer Journal
                Publisher: Bentham Science Publishers Ltd. (Sharjah )
                ISSN (Electronic): 1874-1894
                Publication date (Electronic): 08 November 2007
                Volume: 1
                Pages: 1-5
                Affiliations
                [1 ]Department of Biology, Faculty of Sciences I, Lebanese University, Hadath, Lebanon
                [2 ]Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
                [3 ]Currently at: Department of Biology, Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
                Author notes
                [* ]Address correspondence to this author at the Departments of Biology and Biochemistry, Faculty of Sciences I, Lebanese University, Hadath, Lebanon; Tel: +961-3-430515; Fax: +961-5-460796; E-mail: ra98@ 123456aub.edu.lb
                Article
                Publisher ID: TOCCJ-1-1
                DOI: 10.2174/1874189400701010001
                PMC ID: 2490598
                PubMed ID: 18665243
                SO-VID: ce2b7393-9bd4-4c11-bc8a-5deea3d43a02
                Copyright © 2007 Bentham Science Publishers Ltd.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.5/), which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 24 August 2007
                Date revision received : 27 August 2007
                Date accepted : 22 October 2007
                Categories
                Subject: Article

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: carcinoembryonic antigen,vascular endothelial growth factor,colorectal cancer
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: carcinoembryonic antigen, vascular endothelial growth factor, colorectal cancer

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