help! worried about liver blood tests

[Pam P]

I just got the results of my blood work. My ALP which has been slightly high for the last year or so (normal I think is about 135 or less) - mine has ranged from normal to maybe 175 at highest. A few weeks ago it was 144. This latest one done last week was 1557 !! All my other blood work was stable/normal.

How can the ALP skyrocket so quickly? What does this mean? Is this a 1st sign of liver mets? I have no other symptoms. I had PET & CT in July - except for the bone mets they were normal -- nothing in the liver.

I have been on xeloda for a few weeks & I asked the onc. if it would be the xeloda messing up this test. He said he hasn't seen xeloda cause this - could be a possibility, he said, but not likely. He ordered another blood draw today to compare -- of course I probably wont' know the result till Monday.

I need your wisdom & experience on this. thanks.

[al from canada]

Dear Pam,
ALP is one of the markers least sensitive to liver related problems. as it is also related to (mostly) bones, heart and other tissues. If everything else is normal, my suspiciton would be that your bone mets may be acting-up. I know that with my wife, neupogen will cause a rise in ALP as that sqeezes your marrow to produce more WBC. It could also be a result of many other drugs including wine.
Regards,
Al

[Pam P]

Al -- Thank you so much for your response. Your messages are such a gift to this site -- and always forthright & encouraging. I have to admit that I enjoy a couple glasses of wine a couple of evenings a week. But that's not a new routine for me, so I don't know if that would cause such a sudden change in the counts. I'm surprised that you say the ALP is least sensitive to liver -- I thought it was primarily for liver function - and included bone info too. Thanks again. Pam

[Gina]

Hi, Pam,

From my research and personal experience with ALP and bone mets, Al from Canada, as usual..smile...is RIGHT on the money. When I had liver involvement first (12 lesions...left and right lobes), the ALP was just 80 but the liver enzymes were OFF THE CHARTS...now, all the liver mets have long since cleared but I have this one troublesome bone spot on my sternum...just one...but my ALP goes up, UP , UP, every time it is active and down, down, down, when it returns to normal size and shape as it is doing now for the SECOND go round. One of the best explanations I have ever read was in the Making of Herceptin book, where one woman mentions that Herceptin was great all over her body except in one place where she had a lot of lymphodema and scar tissue...where she "felt" intuited or whatever, that the herceptin, just couldn't really deeply penetrate... Ironically, I think this is EXACTLY what has been happening to me. The spot where the bone lesion is now is less than 1 cm from the site of my original tumor and there is so much scar tissue under the skin (adhesions too) from my surgery that I swear it is as if somehow the FULL capacity of the Herceptin is somehow being obstructed...it is interesting to note that I never had bone mets until for another minor surgery (Just a belly-button Lapro), they forced me to do general anesthesia (which was ridiculous as I had the whole breast cut off while awake with just the "block") and tubed me (breathing machine)...from the moment I woke up I felt like my sternum had been stretched out of place and the scar tissue disturbed...it was so painful...a month later, the bone scan lit up on that one spot and I have had it off and on every since. Best advice...worry less about the ALP and find out ASAP what your serum Her-2 markers are...my guess is if your ALP is over a thousand, you will truly faint when you get your her-2 result...but do not despair...just ask for the highest loading dose of herceptin, try 8mg per kg of body weight, and restart weekly infusions...dropping to 6 to 4 to 2 for a while till you get the bone stuff back in control with herceptin as you will and then, work on a less frequent maintenance dosing from there... I think folks get confused about TREATMENT dosing with Herceptin and just MAINTENANCE...when the cancer is agressive and growing and tumors/lesions are present, you have to be agressive with your HERCEPTIN dosing as a TREATMENT...only later, afer periods of stability as born out on CT scans and blood work, should you consider going on some of the maintenance programs...which soon, I think there will be many varieties. Although 6 is not common, maintenance every 4 weeks is doable...and other strategies...remember at one time for 3 years...I maintained NED with only 5 or 6 doses of Herceptin alone..once A YEAR!!!! So almost anything is possible-- odd I know, but it is true, I have all the graphs and scans to substantiate every stat I air in this forum...and carry around more than 8 3" and 4" binders documenting every procedure, stat, and bloodtest. I say that just to encourage you to be informed about your case..you don't have to be as whacky as I am about it, but remember, .it is YOUR BODY and YOUR LIFE...Cheers, Gina