Cancer Markers

[jack14]

As some of you may remember, I have been on immunotherapy (Keytruda), since last May for  stage 4 NSCLC (T1aN3M1b). The staging was based on contralateral lymphadenopathy. No mets anywhere outside my chest. Anyway, my Oncologist has been using the CA19-9 marker to help keep an eye on the progress of my therapy between scans, as this marker, usually reserved for pancreatic cancer, also works with some lung cancers, like mine. The CA19-9 marker has ranged up and down between 76 initially, to a low a few weeks ago of 49 wih last months going back up to 60. For some reason, she has switched the marker to the "Carcinoembryonic Antigen" marker which is currently 5.9 ng/mL. I intend to ask her why and what this means for me but I wanted to ask you guys if you have any ideas? Thanks

[Judy M2]

CEA is a cancer marker in the blood. My oncologist does monitor it for lung cancer. Before I started treatments, my CEA was at 77. As of my January blood work, it is at 2.6. "Normal" range is 0-5. So you are closing in on normal! I actually pay more attention to my CEA as a sign of progress. 

[ChiMama]

Hi jack - I've been having my CEA tested every 3 months for almost 5 years since my colon cancer diagnosis.  As I understand it, 5.9 is slightly elevated but not dramatically so. My levels have always been in the "normal" 2.5 - 3.8 range even when I had an active tumor.  Once it went up to 4.9 and my oncologist went on red alert because mine are always so low.  The next round, it was back down to 2.9.  The test can vary widely between people - some people in a similar situation can have levels in the hundreds.  So it's an indicator for some people and not as much for others, and levels can vary for other non-cancer reasons too.

As far as CA 19-9, I'm not a medical professional so I don't know the intricacies, but those levels still seem high.

Perhaps she could have you do both? I know quite a few people in the CC community who have both tests done.

[Rower Michelle]

Hi Jack

I wanted to let you know the University of Colorado under the direction of Ross Camidge MD routinely tracks tumor markers for lung cancer surveillance.  
 

https://coloradocancerblogs.org/blood-tumor-markers-may-warn-lung-cancer-patients-progressing-targeted-treatments/

A big however is coming—- Mass General, another lung cancer center of excellent does not routinely track these markers as they can be highly unreliable. 
 

I’ve had this debate with my own oncologist twice in the last two years.  He vetoed tumor markers. Said he actually drew his own markers and got “abnormal” readings.  So there he is a total science geek running his own blood work just out of my pesky curiosity.   
 

There are some excellent clinical trials coming along in California that are much better at detecting clinical changes prior to radiologic detection.  
 

For now my doc says scans speak the truth so that’s where we landed.  
 

Michelle

[TJM]

I'm with Rower on this one. My oncologist is not a fan FWIW.

I do hope they succeed in developing a blood test tho. I've had so many scans my wife says I glow in the dark.

Peace

Tom

[jack14]

Thank you everyone for your kind informative responses. A couple of days after I posted this, I received an update of my last labs. Apparently my Onc hasn't replaced the CA19-9 marker, she has just added the CEA one. It has edged up to 63. The nurse called me Friday and told me what it was and said that my Oncologist considers me "stable" and will continue the Keytruda. My next infusion is at the end of the month.

[islandgirls]

I was going to post a new topic on this!!

Boyfriend’s daughter and the snarky oncologist nurse (remember the one who delayed his port placement for two weeks??) have somehow given Boyfriend the idea that his treatment is futile based on his CEA and CA 19-9 levels.

Now, when I tell you all the numbers, you may agree... however, he has not treated the cancer AT ALL when these were drawn, as the latest draw was prior to his first infusion.

CEA was 1890 on Feb. 2nd now 2868 on March 5th

CA 19-9 was 217.9 on Feb. 2nd and now 278.8 on March 5th

But of course I have been fretting when I see the level should be under 25. You can imagine where my mind goes with that...

I came back at Boyfriend with a white page study with a quote citing:

These data mean that you shouldn’t worry about marker elevations in the first few weeks of targeted therapy in the absence of other evidence, such as worsening symptoms, as most of the time things settle down. Perhaps tumor markers shouldn’t even be checked during this early time period at all.

So, I am trying to not be unnerved about it as he is feeling better. Had no real hardships from his first infusion except being tired... 💜

 

[LexieCat]

I've never had either one of those markers checked, and I'm being treated at a major NCI Comprehensive Cancer Center. 

I'm pretty sure if they had any significance for the treatment of my disease, they'd be checking them.

[islandgirls]

@LexieCat When we are on the other side of this, we are meeting for a drink! You always make me feel better!! xo

[TJM]

Like Lexie, I have probably had 20 blood tests over the last 15 months. Not once did they check for those markers. I would think if it was a reliable test it would be an insurance fav....blood tests much cheaper than scans.

I feel really sad for you. Seems you drag your BF to the light, only to have him dragged back to the dark. I truly hope that stops soon.

Peace

Tom

[TJM]

A side note. I took my first real trip in 14 months this weekend. Went up to Seattle to hang with some buddies and watch March Madness. Such a great time! Took the train so low stress. BS'd for hours, ate good food and (icing on the cake) my alma mater has made it to the Sweet 16 (Oregon State)!

It is for weekends just like this that I fight the beast!

Peace

Tom

[islandgirls]

@TJM sigh You nailed it. I feel like it’s when parents get their kids back from the ex’s after a weekend visit and they have to undo some of the behaviors... We don’t live together so sometimes we go a few days without seeing each other. So yes, when I see him again, I literally have to push the darkness out of him.

We were at dinner with his friends this weekend, (all vaccinated) talking about the diagnosis and he got up to go to the men’s room. The friends asked, “Is there hope?” Whereupon I launched into my spiel of immunotherapies, advanced treatments, clinical studies, etc. So they said to him when he got back to the table, “We are so glad you are doing treatment.” He said, “Yeah but Daughter and his nurse (🙄) said two of my numbers are bad, so...” 

He is lying next to me, sleeping, right now. Before he fell asleep I told him how happy I was that he enjoyed dinner and for him to stay over tonight. I reiterated how he sailed through his first treatment (or in my opinion as not even nauseated and eating like a champ!) and he said, “Yeah but the end of the tunnel seems so far away...”

He seems pretty down. I am initiating him getting a weekly massage and am suggesting some counseling. How can he not be overwhelmed? But I just gave him a pep talk that went something like this: Remember when we talked that if you chose treatment you have to go all in? Like the biggest poker game of your life? Well this attitude of, “Yeah I guess I did okay with my first infusion” is NOT going to cut it!!

Tough Love from his Island Girl! 💜

Oh, and YEAH for your jaunt to Seattle! Sooo happy for you! Enjoy every minute that you have fought so hard to experience!

[Jesse L.]

Remember, with all the new therapies out there it's more like treating someone for a chronic condition than anything else. Yes, I know that some of those therapies are rough, but they do work. I myself am staring at 4 sessions of Cisplatin and Alimta and I'm told it's no picnic, but I'm committed to doing it. The alternative is not good at all... And I understand as well that even if I achieve NED, I may face this all over again. Well, then it starts over; you catch it early and do what it takes to stay alive. Period.,l.

[TJM]

Good luck Jessee

[LouT]

In 2010 I was diagnosed with colon cancer.  I had a resection and follow up checkups 8 times in the first two years and then 4 times over the next two years.  There were many tests and scans taken, but CEA was always one of the indicators that the surgeon reviewed in determining my status.  It is not a definitive test, but one viewed in light of other factors being examined.  Here is a brief explanation about results and what they can mean.

A normal result is less than 5 nanograms per milliliter. Results might vary between labs. A higher-than-normal CEA level that increases over time might signal that your cancer has grown or has come back after treatment.

But high levels of CEA do not always mean you have cancer. These other conditions can also increase levels:

Breast cysts

Chronic obstructive pulmonary disease, which is a breathing disorder

Mucinous cystadenoma of the ovary or appendix

Infections such as cholecystitis and diverticulitis

Inflammatory bowel disease, which causes diarrhea, pain, weight loss

Liver disease

Lung problems

Ulcers

Pancreatitis

[jack14]

6 hours ago, LouT said:

In 2010 I was diagnosed with colon cancer.  I had a resection and follow up checkups 8 times in the first two years and then 4 times over the next two years.  There were many tests and scans taken, but CEA was always one of the indicators that the surgeon reviewed in determining my status.  It is not a definitive test, but one viewed in light of other factors being examined.  Here is a brief explanation about results and what they can mean.

A normal result is less than 5 nanograms per milliliter. Results might vary between labs. A higher-than-normal CEA level that increases over time might signal that your cancer has grown or has come back after treatment.

But high levels of CEA do not always mean you have cancer. These other conditions can also increase levels:

Breast cysts

Chronic obstructive pulmonary disease, which is a breathing disorder

Mucinous cystadenoma of the ovary or appendix

Infections such as cholecystitis and diverticulitis

Inflammatory bowel disease, which causes diarrhea, pain, weight loss

Liver disease

Lung problems

Ulcers

Pancreatitis

I have some identified diverticula in my decending colon (CT scans). And some pretty bad chronic constipation that has been going on for a few weeks now. I believe that it may be a flareup (diverticulitis and a resulting stricture?).

I also have mild COPD, (empysema). Those two things right there might have caused my CEA to go up to 5.9. I just had my CA19-9 marker that was 63 three weeks ago is now 61 and the PA said that is stable. No word on another CEA check, if, they have even repeated it. Anyway thanks Lou, you sure have been through a lot. Bless you and I surely hope that you don't have anymore issues. Ialso hope I don't end up with something in my belly....