Carcinoembryonic Antigen In Patients Suffering from Ulcerative Proctocolitis A.B.S. Mitchell, MB, MRCP, A. Morton Gill, CBE, MD, FRCP, R.T. Orchard, MB, MRCP, and R.A. Parkins, MD, FRCP Carcinoembryonic antigen (CEA) has been measured by radioimmunoassay in samples obtained from all patients suffering from ulcerative proctocolitis and seen within a four-month period. The characteristics of this group of patients have been compared with reported epidemiological studies in this disease, and have been found to have a similar sex ratio and age of onset, but a more limited disease. Among 59 patients, 11 were found to have elevated circulating CEA values. One of the 11 had a colonic carcinoma and another was pregnant. Excluding these two patients, an overall prevalence of elevated CEA levels of 17.5% was found. The prevalence in ulcerative proctitis was 7.1%, and in colitis was 19.9%. The patients in whom elevated plasma CEA values were found were compared with the remaining patients in relation to factors known to be associated with an increased propensity for the development of colorectal carcinoma complicating ulcerative colitis. There was no difference in mean age of the patients at disease onset, nor was there any difference in disease duration, extent, and control. A significant correlation was found between elevated plasma CEA levels and the severity of the initial attack. One patient with premalignant changes in the r e c tal mucosa had consistently normal concentrations of plasma CEA. There was no significant correlation between elevated plasma CEA values and disease activity. The mean age of the two groups of patients was similar. No carcinoma has manifested in any patient during follow-up periods of at least 18 months.

Patients suffering from idiopathic ulcerative proctocolitis have an increased likelihood of developing colorectal carcinoma. This possibility can be abolished by total proctocolectomy. In order to avoid unnecessary operations, groups of patients particularly likely to develop colo:rectal carcinoma have been identified. It has been shown that the risk of carcinoma developing increases with the duration of the disease and the extent of colon involved (1). It appears also to be more likely to occur in those who develop ulcerative colitis when young, although From the Prince of Wales's Hospital, London, Department of Gastroenterology, Chafing Cross Hospital, London, and West London Hospital, London. Address for reprint requests: Dr. A.B.S. Mitchell, Prince of Wales's General Hospital, London N15 4AW, England.

Digestive Diseases,Vol. 20, No. 5 (May 1975)

the influence of the other two factors may be responsible for this (1). It has been suggested that a severe initial attack of colitis results in an increased liability to later development of malignant change (2), and that chronic continuous disease is associated with an increased risk of complicating carcinoma when compared with intermittent disease(2), although malignant change may occur when the disease is quiescent (1). Having defined the type of patient with ulcerative colitis most susceptible to malignant change, the treatment of the individual remains a problem. Prophylactic colectomy may be justified, but such a policy would result in a number of coleetomies performed on patients who would not have developed carcinoma. There

407

MITCHELL ET AL

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