BMJ Case Reports 2018; doi:10.1136/bcr-2017-223233
  • Reminder of important clinical lesson

Persistent elevation of carcinoembryonic antigen as first presentation of a medullary thyroid carcinoma

  1. Alberto Midões
  1. Cirurgia Geral, Unidade Local de Saúde do Alto Minho EPE, Viana do Castelo, Portugal
  1. Correspondence to Dr Aires Martins, aires75martins{at}
  • Accepted 22 February 2018
  • Published 11 June 2018


Carcinoembryonic antigen (CEA) is still the most widely used tumour marker for gastrointestinal cancer. CEA was originally thought to be a specific marker for colorectal cancer, but it turned out to be a non-specific marker for further studies. CEA levels can be elevated in breast, lung and liver cancers, among others, including medullary thyroid cancer. The authors report a case of a 73-year-old woman who had a right hemicolectomy for an ascending colon adenocarcinoma and showed a persistent elevation in the CEA marker during follow-up. After several imaging tests, recurrence of the colon cancer was not found, but the presence of thyroid nodules had been detected. The diagnosis of a medullary thyroid carcinoma was made after the finding of a high value of calcitonin. The patient had a total thyroidectomy with resection of the central and lateral lymph nodes.


  • Contributors AMa: performed initial colon surgery, patient follow-up, design of manuscript, research, manuscript revision and approval. AG and TA: analysis, revision and approval. AMi: director of general surgery department, revision and approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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