Neoplasia: CEA in colorectal cancer: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Neoplasia: CEA in colorectal cancer

Sample item

A 60-year-old man had resection of stage III colon adenocarcinoma, with a preoperative CEA of 28 ng/mL. What is the most appropriate use of CEA now?

AReplacing colonoscopic surveillanceBSerial postoperative measurements to detect recurrenceCEstablishing the tissue diagnosis of colon cancerDScreening his asymptomatic relatives for colon cancer

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Serial postoperative measurements to detect recurrence

CEA is an oncofetal glycoprotein that is raised in many colorectal cancers but also in smokers and in inflammatory conditions, so it is unsuitable for screening or diagnosis. Its value lies in follow-up: failure to fall after resection or a later rise suggests residual or recurrent disease and prompts imaging.

Option by option

A. Replacing colonoscopic surveillance
CEA cannot detect new adenomas or localise disease, so it supplements and does not replace colonoscopy.
B. Serial postoperative measurements to detect recurrence (correct)
A rising CEA after resection signals recurrence and prompts further evaluation.
C. Establishing the tissue diagnosis of colon cancer
Diagnosis rests on histology of biopsy tissue, not on a serum marker.
D. Screening his asymptomatic relatives for colon cancer
CEA is too insensitive and nonspecific for screening relatives.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is B, Serial postoperative measurements to detect recurrence. CEA is an oncofetal glycoprotein that is raised in many colorectal cancers but also in smokers and in inflammatory conditions, so it is unsuitable for screening or diagnosis.

Why is "Replacing colonoscopic surveillance" not the answer?

CEA cannot detect new adenomas or localise disease, so it supplements and does not replace colonoscopy.

Why is "Establishing the tissue diagnosis of colon cancer" not the answer?

Diagnosis rests on histology of biopsy tissue, not on a serum marker.

Why is "Screening his asymptomatic relatives for colon cancer" not the answer?

CEA is too insensitive and nonspecific for screening relatives.

What concept does this question test?

It tests Neoplasia: CEA in colorectal cancer in Pathology. Its value lies in follow-up: failure to fall after resection or a later rise suggests residual or recurrent disease and prompts imaging.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neoplasia: CEA in colorectal cancer?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.