Evaluation of Heart Transplantation with CEA

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Evaluation of Heart Transplantation with CEA

• by Ri ???

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Case

• 62 y/o Male
• AR AS s/p aortic valve replacement with
  mechanical valve
• Old MI s/p CABG
• VT s/p ICD
• Gouty arthritis
• Smoke()

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Brief history

• C.C.
• Frequent ICD shock in these days
• suffered from near syncope in 2007/4/4 s/p ICD
  checked
• Sent to ICU for frequent DC shock on 5/12
• Due to decompensated heart failure with repeated
  lung edema and VT, heart transplantation was
  considered.

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• Review the heart transplantation survey report,
  elevation CEA was noted
• CEA122.5 ng/mL
• Then

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Heart transplantation

• Indication of transplantation
• Absolute and relative contraindications to
  cardiac transplantation

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Malignancy

• immunosuppressive therapy may accelerate the
  progression of early occult malignancy and limit
  the survival benefit after transplantation.
• Broad screening is not cost-effective, but other
  age- or symptom-driven screening tests is need
  for transplant candidacy.
• Stool OB, mammograms and PAP smears, PSA, and
  chest x-rays as a minimum.
• Patients with preexisting non-skin malignancy
  should have an oncologist consult regarding
  grade, duration of remission, and prognosis.

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Carcinoembryonic antigen

• CEA is a complex immunoreactive glycoprotein
• CEA is the first tumor marker which can be
  detected in serum
• Cancer of colon and rectum, pancreas, breast,
  ovary, or lung
• Cirrhosis, pancreatitis, kidney failure,
  inflammatory bowel disease, peptic ulcer disease,
  COPD, or an obstructed bile duct, etc.

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Carcinoembryonic antigen

• The CEA blood test is not reliable for diagnosing
  cancer or as a screening test for early detection
  of cancer
• CEA is the preferred tumor marker for following
  patients with colorectal cancer during or after
  treatment
• Some doctor also use for following other cancers

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Case discussion

• Elevated CEA was noted and CEA122.5 ng/mL
• But CEA is is not reliable for diagnosing or
  screening
• Therefore maliganancy cant be confirmed
  immediately

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Further evaluation

• Echo
• Colonscope
• CT
• Other image test

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Result of patient

• Abdominal echo showed cecum and ascending colon
  wall thickness, colon tumor was suspected.

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• 05/29, CT With/Without Contrast-Chest
• 1.Bilateral apical lung bullous emphysema.
• 2.There are consolidation patches at the
  posterior basal segment of bilateral lower lobes.

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• Colonscopy on 6/1
• 1.Colitis, ascending to transverse colon
• 2.Internal hemorrhoid, mild
• 3.Fecal material in colon
• 4.Bleeding tendency. So random biopsy was not done

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• Colonscopy on 6/8
• 1. Internal hemorrhoid, mild
• 2. Incomplete study of colonofibroscopy, much
  fecal material related

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• 06/12, CT Pelvis and Abdomen
• 1. The colon are dilated, but no definite
  abnormal soft tissue mass is identified.
• 2. There is no evidence of LAP at mesenteric
  region.
• 3. There is no evidence of destructive bone
  lesion.

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• 06/22, Whole body FDG (??)
• 1.A focal mild hypermetabolic area at left lower
  pelvis (Fig. 1, bowels). Possibly due to
  physiolocal or inflammation uptake of bowel.
  Please further workup if clinically indicated.
• 2.Mildly increased tracer activity at bilateral
  basal lung fields (RgtL)
• 3.Cardiomegaly.
• 4.No significant other hypermetabolic lesion
  noted.

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Conclusion

• CEA was useful as following test, not diagnosing
  or screening
• Malignancy should be confirmed before
  transplantation
• Fully colonscopy should better be completed in
  OPD follow-up

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Reference

• Listing criteria for cardiac transplantation,
  Leslie W. Miller, M.D. Past President, American
  Society of Transplant PhysiciansTRANSPLANTATION
  Vol. 66, 947951, No. 7, October 15, 1998
• Heart Transplantation How to Select Patients ?
  What Are the Alternatives ?, V. Conraads, Acta
  chir belg, 2004, 104, 290-296
• Tumor Markers and Colorectal CancerUtility in
  Management, Nigel P.S. Crawford, etc., Journal of
  Surgical Oncology, 200384239248
• Up to Date database
• Website http//www.a-s-t.org/index.cfm, American
  Society of Transplantation
• Website http//www.cancer.org/docroot/home/index.
  asp, American Cancer Society