Tumor Markers

[PatS]

I know tumor markers can be elevated for many reasons and have never asked my onc my results since I knew I'd analyze them too much and worry about the fluctuations. Well, since I'm considering starting herceptin (almost 3 years out of chemo and NED after being diag. Stage 3 in 07/2002) and am waiting to see if my insurance will cover it, I decided to ask for a copy of my file and see what they were.

My latest CA 27.29 was 40.5 (normal range 0.0-38.6), which is just slightly elevated, but when do you start to worry? My scores seem to stay at the high end of normal as my previous scores were 33.5, 38.6, 33.2, 37.2, 32.9, 40.2, and 37.3. I guess I expected them to be lower since scans show NED and now wonder if this means something's lurking, waiting to show itself.

Thanks for your help.

Pat

[kristen]

Hi Pat,

It's for this very reason my onc. does not believe in tumor markers. She firmly believes that symptoms will appear before the TM numbers rise. From asking the same questions on this board, a lot of women are "right on" with certain TM's and the return of there cancer. What my onc and these women will tell you is that a cold, different meds for something your on can cause you TM's to rise. So what your onc looks at is a pattern.

Just from being a member and reading posts over the last 18 months or so, it has been my experience, Ok, (let's hope chemo brain isnt' writing this) but they jump up in numbers significantly. Not just by a few points. My onc. does run TM's for me just because I want them. Mine have certainly risen over the months but have always stayed in the normal range, except the CEA, which is over the 3.5, but not over 5 so they don't worry about it. I had mine drawn Monday and I am getting a little mad that they can't seem to find them or they are not back yet. She (the nurse) says she will have them for me by the end of the day (today) still nothing. But I feel great and don't expect to find anything, but I just love to hear that they are in normal range.

It will be interesting what others have to say about this and what there experiences have been with tumor markers. Hang in there.

[lu ann]

Hi Pat,

My tumor marker for ca15-3 were elevated as high as 345 before I started treatment in 2004. They were as low as 21 after radiation and 6 months of taxol, carboplatin, herceptin, and zometa.

Doc felt I was having progression because I had more pleural effusion so he switched me to navelbine (markers rose), then gemsar (markers continued to rise). I then took a 3 months break from all but zometa.

My new onc. put me back on gemsar, herceptin, and zometa. My markers continued to rise to 117, which she said is likely because I had the break. My scans have shown improvement and my plueral effusion has lessoned so she feels the gemsar is going to work.

I don't think your markers are showing progression of the disease as they are not fluctuating much above normal.

Blessings, Lu Ann.

[Ginger]

My onc doesn't believe in the Tumor Markers as he says I have no symptoms. Are they normally only deemed necessary by Doctors when evidence of Metasis or node involvement and not in cases without node involvement? I feel that with hER2 it would be a good idea to track them whether node neg or pos. I had no apparent node involvement but worry about showing up elsewhere. I wonder if most Docs only do the TM for node neg just to make the patient feel better and they really are not needed as my ONC states. He really doesn't go into any other detail as to why not. Minor concern overall but I am thinking of changing ONCs partly for this reason. Have an appt w/him 09 JAN. Thanks!

[Gina]

are VERY significant and VERY important..but, in fairness..., probably much more so for folks who have already mets...because one you have mets..the markers will tend to be higher and more "on the move" and actually can be very helpful in making life-saving decisions about whether or not the "cocktail" you choose is working so that if it is not..you may still have time to try something else...

I, personally, find that a CA 27/29 above 15 usually indicates a serum her-2 that is already out of bounds...but you can "control" the disease adequately, by keeping the CA 27/29 below the 60/70 range, but once it goes over 100, well, things usually tend to start popping up on the scans...if I were the person with an occasional CA 27/29 over 40..I would simply ask for a serum her-2 to be drawn at the same time as my CA 27/29 and see if that serum her-2 number was "normal" or elevated. I have seen these numbers in mets cases and usually, the serum her-2 is not brought down into the single digits until the CA 27/29 is less than 15...also, you must calculate the fact that the CA 27/29 runs about 3 weeks behind the serum her-2 so you DO need to take both numbers over time..preferably just the minute or two before you take your next Herceptin infusion..to be sure you are seeing them at PEAK...and you must take them the next time just before your herceptin and the next ... like that to compare apples to apples.. For instance..if a person gets their markers say...a few days after their most recent herceptin..they will probably be pretty low and normal looking, but by a week or 3 later...it will be an entirely different story...been there...done that--as I have been fortunate to have access to both tumor marker tests for many years now and have measured them MANY MANY different times and ways...smile...don't mean to "frighten" early stage new folks..just want them not to be lured into a very false security by oncs who unfortunately are not really that knowledgeable about how the markers work in real time, that's all...smile..OK..no more soap box...Goodnite, Gina

[Lolly]

We've only uses the CEA tumor marker in my case as it's the only one that was elevated at first diagnosis of mets, at 10.0, with normal being less than 3.0. The marker quickly came down to less than 0.3 within a few months of starting Herceptin/Navelbine, and has never been elevated by more than a 10th of a point even through 2 subsequent recurrences of mets. So for me the current tumor markers are not accurate. My onc is looking into the Her2 Serum test for me, and we'll talk about it at my next visit.

I've always known when I was having a recurrence due to symptoms, but that's because my mets are to the lymph system and the lymph nodes are easy to find and palpate when they're enlarged.

<3 Lolly

when I have recurrences, my serum her-2 is generally over 150 before my CEA goes up..fyi...

[Ginger]

Thanks to all for the replies....very helpful.