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Someone PLEASE help me to understand CEA levels and white bloodcell counts

aprilgreen25's picture
Posts: 7
Joined: Jun 2003

Hi everyone,

Michael went in this morning for his second treatment and they wouldn't give it to him. The nurse says that his CEA level was too high and his White bloodcell count was too low. The Dr explained to him that they had never treated anyone as tall and big as him before. They said that they had given him too much Oxiliplatin and 5fu/luco. He asked for them to explain, and he was given the "medical explaination" instead of the "explain it to us like we're a 2 year old explaination". Can anyone tell me what is good versus bad on both of these counts?

Also, I have searched the web high and low to find info on the staging process. Michaels primary tumor was completely removed as were the two possitive lymph nodes. His begining stage was T3-N1 because the pet scan performed before his pre-surgery chemo/rad showed no signs of metastasis. After 6 weeks of chemo/rad, the pet scan showed that the tumor was "cold", but the cancer had went into his liver with 2 nodules on one lobe and 5 on the other. Following his surgery, he was told to wait 4-6 weeks for chemo. The latest CAT scan shows that the liver nodules have doubled in size and there are now two nodules in his lungs. Ok, now that I have aimlessly rambled on, I will ask my question. Since the primary tumor and both lymph nodes are gone, how do we stage it? Is he still considered as having CRC or is it now just called metastatic disease? I know that I write alot each time, but I am just so confused by all of this. Thanks again to all who read this and respond.

Be well,

ron50's picture
Posts: 1480
Joined: Nov 2001

Hi April, from what you've said your husband should have been diagnosed as stage 4, Which means that the ca has gone thru the colon entered the lymphatics and has travelled to distant sites. Colon like most ca has a fiarly set pattern ,liver is usually the site of the first secondary followed by lung. The CEA is a cancer embryonic antigen ,it normally is up to a reading of 4 in a healthy person,it is not rgularly used as a primary diagnostic tool for colon ca but is more often used to monitor for recurrence. With the blood count the chemo drugs are really hard on blood and it sounds like they have overdosed your husband a little due to his size. Normally they weigh you prior to chemo and they have a chart that tells them how much drug to give per lb of body weight,it isn't an exact science that is why they constantly do blood tests during chemo and if neccesary give you some medicine to build up your blood counts. Hope I've been able to explain things a little wish your husband good luck from me and that goes for you also,cheers Ron

Posts: 6
Joined: Mar 2003

Dear April: I found the easiest explanation of staging in a reference book called The Merck Manual, which I believe may be available online. My understanding is this: less than 4 lymph nodes positive at surgery + tumor not spread beyond the colon = Stage II. Stage III is more than 4 positive lymph nodes at surgery but no "distant metastasis". (In other words, the tumor may have grown outside the colon walls but has not spread to another major organ like the liver.) Stage IV would refers to cases where the cancer has spread to another "distant" organ, such as the liver or lungs or peritoneum.
(Be sure to check the Merck for a really good explanation.) Also, the original site of the tumor is always the "type" of cancer you have. For example, I was diagnosed w/ colon cancer, stage III, in Aug. 2000. After 1 1/2 years disease free, it recurred in Jan. 2003, this time in my peritoneum (the lining of the abdominal cavity). I am now Stage IV, recurrent metastatic colon cancer.

As for chemo dosages, people react differently to the chemo and in my experience the docs can't always predict when the white blood cell counts will drop (or platelets, or red blood cells, etc.) But his counts will most likely rebound within the week & he'll be ready for treatment then.

My best to both of you.

Posts: 2
Joined: Jul 2003

Others have given good comment on most of your message, but the CEA issue deserves attention. CEA is an over-rated, not accurate indicator. It was the only game is town and is accurate less than 40% of the time. There is a newer blood test, first getting marketed that claims to increase the accuracy considerably. It is not yet widely known or used, but hopefully it will replace CEA as a decision maker. Good luck with the chemo. The white cell count is critical in their determining dose and next treatment. Chemo is rough, at least for me. My best prayers for all.

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