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PET-CT CEA-only Recurrence — SCE Medical Oncology MCQ

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ModerateGI CancersPET-CT CEA-only RecurrenceSCE Medical Oncology

A 55-year-old man with metastatic CRC has a rising CEA during surveillance but CT shows no measurable disease. What is the role of PET-CT in this 'CEA-only recurrence' scenario?

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Correct answer: D — PET-CT is recommended for rising CEA without identifiable disease on CT

CEA-only recurrence (rising CEA, negative conventional imaging) is a common clinical scenario. PET-CT has a sensitivity of approximately 80-90% for detecting CRC recurrence and identifies occult disease in ~50-70% of cases with rising CEA. Locations commonly missed by CT but detected by PET include: small peritoneal deposits, retroperitoneal nodes, local pelvic recurrence and small lung nodules below CT resolution. Finding potentially resectable disease can convert palliative to curative management.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer