Selected Trace Elements and Heavy Metals in the Serum of Postoperative Gastric Cancer Patients and Their Relationship to CEA

  • Abbas Mohsin Abbas College of Dentistry, University of Thi-Qar, Al-Nasiriya, Iraq.
  • Husam M Kredy College of Science, University of Thi-Qar, Al-Nasiriya, Iraq.
  • Maha S Hasan College of Medicine, University of Thi-Qar, Al-Nasiriya, Iraq.
Keywords: Gastric Cancer, Trace Elements, Heavy Metals, CEA


Introduction: Gastric cancer (GC) is the second and fourth most prevalent cancer in men and women, respectively, and is one of the leading causes of cancer death worldwide. Many studies have shown that heavy metal exposure and trace element levels in the body are the most critical etiologies for cancer development. As a result, the goal of our research was to assess the imbalances in the serum concentrations of selected elements (Cu, Co, Se, Ni, Cd, and Pb) in post-operative GC patients against healthy participants/ controls.

Methods: The metal levels were determined using a nitric acid/perchloric acid-based wet digestion technique and flame atomic absorption spectrometry, Serum levels of CEA were measured using a two-site immunoenzymometric assay, which is performed entirely in the AIAPACK SLa test cups.

Results: Pb, Cd, and Ni concentrations were found to be significantly higher in the blood of GC patients than in the blood of controls, but Cu and Co levels were significantly lower in the blood of GC patients than in the blood of controls. In the blood of post-operative GC patients, correlation analysis revealed a positive association between CEA-Cd, CEA-Pb, and CEA-Ni, while the correlation was negative for CEA-Cu. These findings were statistically significant (p < 0.05).

Conclusion: According to our findings, low Co and Se levels, as well as high Pb and Cd levels, may have a role in the development of stomach cancer.

How to cite this article:
Abbas AM, Kredy HM, Hasan MS. Selected Trace Elements and Heavy Metals in the Serum of Postoperative Gastric Cancer Patients and Their Relationship to CEA. J Commun Dis. 2021;53(3):220-226.



Adams SV, Passarelli MN, Newcomb PA. Cadmium exposure and cancer mortality in the third national

health and nutrition examination survey cohort. Occup Environ Med. 2012 Feb;69(2):153-6. [PubMed] [Google


Afzal A, Qayyum MA, Shah MH. Comparative assessment of trace elements in the blood of gastric

cancer patients and healthy subjects. Biointerface Res. Appl. Chem. 2020;11:10824-43. [Google Scholar]

Al Faris NA, Ahmad D. Distribution of trace elements like calcium, copper, iron and zinc in serum samples of

colon cancer–A case control study. J. King Saud Univ Sci. 2011;23(4):337-40. [Google Scholar]

Al-Ansari RF, Al-Gebori AM, Sulaiman GM. Serum levels of zinc, copper, selenium and glutathione

peroxidase in the different groups of colorectal cancer patients. Caspian J Intern Med. 2020;11(4):384-90.

[PubMed] [Google Scholar]

Araujo RL, Gönen M, Allen P, DeMatteo R, Kingham P, Jarnagin W, D’Angelica M, Fong Y. Positive postoperative

CEA is a strong predictor of recurrence for patients after resection for colorectal liver metastases. Ann Surg

Oncol. 2015 Sep;22(9):3087-93. [PubMed] [Google Scholar]

Nawi AM, Chin SF, Azhar Shah S, Jamal R. Tissue and serum trace elements concentration among

colorectal patients: a systematic review of case-control studies. Iran J Public Health. 2019 Apr;48(4):632-43.

[PubMed] [Google Scholar]

Bhatti I, Patel M, Dennison AR, Thomas MW, Garcea G. Utility of postoperative CEA for surveillance of

recurrence after resection of primary colorectal cancer. Int J Surg. 2015 Apr;16(Pt A):123-8. [PubMed]

[Google Scholar]

Bibi K, Shah MH. Appraisal of metal imbalances in the blood of thyroid cancer patients in comparison

with healthy subjects. Biol Trace Elem Res. 2020 Dec;198(2):410-22. [PubMed] [Google Scholar]

Cobanoglu U, Demir H, Sayir F, Duran M, MerganD. Some mineral, trace element and heavy metal

concentrations in lung cancer. Asian Pac J Cancer Prev. 2010;11(5):1383-8. [PubMed] [Google Scholar]

Davis CD, Feng Y. Dietary copper, manganese and iron affect the formation of aberrant crypts in colon of rats

administered 3, 2′-dimethyl-4-aminobiphenyl. J Nutr. 1999 May;129(5):1060-7. [PubMed] [Google Scholar]

Demir DÇ. Determining the levels of some trace elements and heavy metals (Cu, Mn, Mg, Fe, Zn, CO,

Pb and CD) in the cancers of lip and oral cavity. Research Square, 2021. [Google Scholar]

Deng K, Yang L, Hu B, Wu H, Zhu H, Tang C. The prognostic significance of pretreatment serum CEA

levels in gastric cancer: a meta-analysis including 14651 patients. PLoS One. 2015 Apr;10(4):e0124151.

[PubMed] [Google Scholar]

Govatati S, Malempati S, Saradamma B, Divyamaanasa D, Naidu BP, Bramhachari PV, Narayana N, Shivaji S,

Bhanoori M, Tamanam RR, Rao PS, Nallanchakravarthula V. Manganese-superoxide dismutase (Mn-SOD)

overexpression is a common event in colorectal cancers with mitochondrial microsatellite instability. Tumour

Biol. 2016 Aug;37(8):10357-64. [PubMed] [Google Scholar]

Hall IH, Lackey CB, Kistler TD, Durham RW Jr, Russell JM, Grimes RN. Antitumor activity of mono-and dimetallic

transition metal carborane complexes of Ta, Fe, Co, Mo, or W. Anticancer Res. 2000 July-Aug;20(4):2345-54.

[PubMed] [Google Scholar]

Huff J, Lunn RM, Waalkes MP, Tomatis L, Infante PF. Cadmium-induced cancers in animals and in humans. Int

J Occup Environ Health. 2007 Apr-Jun;13(2):202-12. [PubMed] [Google Scholar]

Kochi M, Fujii M, Kanamori N, Kaiga T, Kawakami T, Aizaki K, Kasahara M, Mochizuki F, Kasakura Y,

Yamagata M. Evaluation of serum CEA and CA19-9 levels as prognostic factors in patients with gastric

cancer. Gastric Cancer. 2000 Dec;3(4):177-86. [PubMed] [Google Scholar]

Lee EC, Yang JY, Lee KG, Oh SY, Suh YS, Kong SH, Yang HK, Lee HJ. The value of postoperative serum

carcinoembryonic antigen and carbohydrate antigen 19-9 levels for the early detection of gastric cancer

recurrence after curative resection. J Gastric Cancer. 2014 Dec;14(4):221-8. [PubMed] [Google Scholar]

Lener MR, Gupta S, Scott RJ, Tootsi M, Kulp M, Tammesoo ML, Viitak A, Metspalu A, Serrano-Fernández P, Kładny J, Jaworska-Bieniek K, Durda K, Muszyńska M, Sukiennicki G, Jakubowska A, Lubiński J. Can selenium levels act as a marker of colorectal cancer risk? BMC Cancer. 2013 Apr;13(1):1-6. [PubMed] [Google Scholar]

Lin Y, Kikuchi S, Obata Y, Yagyu K; Tokyo Research Group on Prevention of Gastric Cancer. Serum copper/

zinc superoxide dismutase (Cu/Zn SOD) and gastric cancer risk: a case‐control study. Jpn J Cancer Res.

Oct;93(10):1071-5. [PubMed] [Google Scholar]

Lin Y, Wu C, Yan W, Guo S, Liu B. Five serum trace elements associated with risk of cardia and noncardia

gastric cancer in a matched case–control study. Cancer Manag Res. 2020 Jun;12:4441-51. [PubMed] [Google


Longtin R. Selenium for prevention: eating your way to better DNA repair? J Natl Cancer Inst. 2003 Jan;95(2):98-100. [PubMed] [Google Scholar]

Lukinac L, Bolanca A, Nöthig-Hus D, Kusić Z. Follow-up of patients with gastrointestinal cancer by tumor marker determination. Acta Med Croatica. 1997;51(2):73-7. [PubMed] [Google Scholar]

Lustberg M, Silbergeld E. Blood lead levels and mortality. Arch Intern Med. 2002 Nov;162(21):2443-

[PubMed] [Google Scholar]

Messner B, Knoflach M, Seubert A, Ritsch A, Pfaller K, Henderson B, Shen YH, Zeller I, Willeit J, Laufer

G, Wick G, Kiechl S, Bernhard D. Cadmium is a novel and independent risk factor for early atherosclerosis

mechanisms and in vivo relevance. Arterioscler Thromb Vasc Biol. 2009 Sep;29(9):1392-8. [PubMed] [Google


Morais S, Costa FG, Pereira MD. Heavy metals and human health. In: Oosthuizen J, editor. Environmental

health - emerging issues and practice. InTech; 2012; p. 227-45. [Google Scholar]

Mulware SJ. Trace elements and carcinogenicity: a subject in review. 3 Biotech. 2013 Apr;3(2):85-96.

[PubMed] [Google Scholar]

Nawrot TS, Thijs L, Den Hond EM, Roels HA, Staessen JA. An epidemiological re-appraisal of the association

between blood pressure and blood lead: a metaanalysis. J Hum Hypertens. 2002 Feb;16(2):123-31.

[PubMed] [Google Scholar]

Pasha Q, Malik SA, Shah MH. Statistical analysis of trace metals in the plasma of cancer patients versus

controls. J Hazard Mater. 2008 May;153(3):1215-21. [PubMed] [Google Scholar]

Seifert JK, Böttger TC, Weigel TF, Gönner U, Junginger T. Prognostic factors following liver

resection for hepatic metastases from colorectal cancer. Hepatogastroenterology. 2000 Jan-

Feb;47(31):239-46. [PubMed] [Google Scholar]

Shen L, Lu ZH. New perspectives on medical treatment of gastric cancer. Zhonghua Wei Chang Wai Ke Za Zhi.

Feb;15(2):103-8. [PubMed] [Google Scholar]

Sohrabi M, Gholami A, Azar MH, Yaghoobi M, Shahi MM, Shirmardi S, Nikkhah M, Kohi Z, Salehpour D,

Khoonsari MR, Hemmasi G, Zamani F, Sohrabi M, Ajdarkosh H. Trace element and heavy metal levelsin colorectal cancer: comparison between cancerous and non-cancerous tissues. Biol Trace Elem Res. 2018

May;183(1):1-8. [PubMed] [Google Scholar]

Takahashi Y, Takeuchi T, Sakamoto J, Touge T, Mai M, Ohkura H, Kodaira S, Okajima K, Nakazato H; Tumor

Marker Committee. The usefulness of CEA and/or CA19-9 in monitoring for recurrence in gastric cancer

patients: a prospective clinical study. Gastric Cancer. 2003;6(3):142-5. [PubMed] [Google Scholar]

Waalkes MP. Cadmium carcinogenesis. Mutat Res. 2003 Dec;533(1-2):107-20. [PubMed] [Google Scholar]

Wang W, Chen XL, Zhao SY, Xu YH, Zhang WH, Liu K, Chen XZ, Yang K, Zhang B, Chen ZX, Chen JP, Zhou ZG, Hu JK. Prognostic significance of preoperative serum CA125, CA19-9 and CEA in gastric carcinoma. Oncotarget. 2016

Jun;7(23):35423-36. [PubMed] [Google Scholar]

Yang YW, Dai CM, Chen XH, Feng JF. The relationship between serum trace elements and oxidative stress of

patients with different types of cancer. Oxid Med Cell Longev. 2021 Jul;2021:4846951. [PubMed] [Google


Zeng H. Selenium as an essential micronutrient: roles in cell cycle and apoptosis. Molecules. 2009

Mar;14(3):1263-78. [PubMed] [Google Scholar]