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Serial serum carcinoembryonic antigen (CEA) assays were performed in 148 patients after potentially curative surgery for colorectal cancer. Thirty-seven patients developed proved recurrent tumour in a follow-up period of 2-5 years. Elevated CEA levels were recorded in 36 of these patients and in 27 rising levels preceded clinical symptoms of recurrent tumour. Two distinct patterns of CEA rise were observed: a 'fast' rise in which serum concentrations reached 100 microgram/l within 6 months of the first elevation and a 'slow' rise in which concentrations remained less than 75 microgram/l for at least 12 months. The majority of patients with the 'fast' rise had metastatic spread, whereas most patients with a 'slow' rise had local recurrence alone. This differential pattern may help to predict the site of recurrent tumour.
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