BlueCross BlueShield of Tennessee Medical Policy Manual

Serum Tumor Markers for Gastrointestinal Cancer


Serum tumor markers are substances that are shed by certain tumors into circulation where they can be detected and measured. Carcinoembryonic antigen (CEA) is a glycoprotein found in high levels in those individuals with colorectal cancers (CRC) and has been investigated as a tumor marker for CRC. Other gastrointestinal tumor markers that have been studied are those related to mucinous glycoproteins. The mucinous glycoproteins of the gastrointestinal tract include CA 19-9, CA 242, and CA 72-4. The marker may be expressed by the tumor itself or the body in response to the presence of a tumor. Diagnosis of a suspected malignancy requires a tumor marker that is specific for a given tumor. Since most tumor markers are expressed both in normal, benign conditions as well as malignancies it is necessary to establish cut-off points to determine normal vs abnormal values.

Serum tumor markers have been investigated in a wide variety of malignancies to detected disease recurrence and/or progression of the disease. This policy focuses on tumor markers for gastrointestinal malignancies, including, colon, rectal, gastric and pancreatic cancers.


See also: Serum Tumor Markers for Breast Malignancies




A CEA level is not a valuable screening test for colorectal cancer due to the large numbers of false-positive and false-negative reports often provided. Further, routine use of CEA levels alone for monitoring treatment response should not be recommended.


Burstein, H., Mangu, P., Somerfield, M., Schrag, D., Samson, D., holt, L., et al. (2011) American Society of Clinical oncology clinical practice guideline update on the use of chemotherapy sensitivity and resistance assays. Journal of Clinical Oncology, 2011 (36), 1 - 4.

Centers for Medicare & Medicaid Services. NCD for carcinoembryonic antigen (190.26). Retrieved September 29, 2014 from

Centers for Medicare & Medicaid Services. NCD for tumor antigen by immunoassay – CA 19-9 (190.30). Retrieved September 29, 2014 from

Ivankovics, I., Fernandes, L., Saad, S., & Matos, D. (2008). Peripheral and mesenteric serum levels of CEA and cytokeratins, staging and histopathological variables in colorectal adenocarcinoma. World Journal of Gastroenterology, 14 (43), 6699 - 6703. (Level 2 evidence)

Kim, J., Kim, N., Sohn, S., Kim, Y., Kim, K., Hur, H., et al. (2009) Prognostic value of postoperative CEA clearance in rectal cancer patients with high preoperative CEA levels. Annals of Surgical Oncology, 16 (10), 2771 - 2778. (Level 2 evidence)

National Cancer Institute. (2013). Colon cancer treatment (PDQ®).Retrieved February 25, 2014 from

National Comprehensive Cancer Network. (2014, March). NCCN clinical practice guidelines in oncology™. Colon cancer (V.3.2014). Retrieved February 25, 2014 from

National Comprehensive Cancer Network. (2014, January). NCCN clinical practice guidelines in oncology™. Pancreatic adenocarcinoma (V.1.2014). Retrieved February 25, 2014 from

U. S. Food and Drug Administration. (2008. July). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K072901. Retrieved July 27, 2011 from:

Wang, R. F., Song, R. R., Peng, J. J., Cai, G. X., Liu, F. Q., Wang, M. H., et al. (2014). The prognostic value of preoperative serum CEA and CA 19-9 values in stage I-III colorectal cancer. Gastroenterology, 61 (132), 994-999. Abstract retrieved September 29, 2015 from PubMed database.




Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

This document has been classified as public information.