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AFP test/CEA test

k1
Posts: 220
Joined: Dec 2009

I am a Stage IV patient who had colon resection at end of 2009 (Stage IIA then) followed by recurrence 15 months later with liver metastasis and liver resection in summer 2011.

I am moving through six months of chemo treatment with Xelox and will be finished in a month. My CEA went down immediately after both resection surgeries and then creeped back up over time in each case (and despite the chemo this time), but they are still reasonably low. My liver enzymes have been elevated for quite some time, but also mildly.

At my monthly appointment yesterday my oncologist ordered the usual CEA test AND a new test called AFP, which is a tumor marker for liver cancer mainly, but also testicular and ovarian cancer. I was surprised to learn this because he did not discuss it with me at my appointment and I just got the results online that showed the test results.

The test results look normal, but ...has anyone else ever had this test along with colon cancer lab tests and CEA and if so, what makes oncologists think it needs to be measured in a colon cancer patient with metastasis from liver? Would people really be likely to have separate unrelated cancer in their livers or reproductive organs while undergoing chemo for colon cancer patients or is there another explanation?

K1

tanstaafl's picture
tanstaafl
Posts: 976
Joined: Oct 2010

Some places do cancer markers as a battery for initial, broad investigation, but it is not US "standard". Two common biomarkers that have meaning in CRC are CA19-9 and occasionally CA-125. CA19-9 appears to have meaning about the risk of metastases and the utility of cimetidine and avastin. Some doctors, mostly outside the US, use CA19-9 with CEA on a routine basis for their patients with above average CA19-9.

k1
Posts: 220
Joined: Dec 2009

First, I accidentally typed in the name of the test I had, although not the information on it. It is AFP -- Alpha Feto-Protein Tumor Marker Text.

Thank you for your comments Tanstaafl. FYI: I did already have a CA-125 in the past at the request of my gynecologist (rather than my oncologist), but not a CA 19-9. I have not had any avastin at this point so not sure if CA 19-9 would be applicable.

I'm mystified about this marker test for ASP that I was given, and I have sent a note asking the reason to my doctor's office.

Here is what I found online about the test at http://labtestsonline.org/understanding/analytes/afp-tumor/tab/test (by the way I had the regular AFP test and not the AFP L3 test used in other countries as described below):

The Test
How is it used?
When is it ordered?
What does the test result mean?
Is there anything else I should know?
How is it used?
AFP is used to help detect and diagnose cancers of the liver, testes, and ovaries. It is often ordered to monitor people with chronic liver diseases such as cirrhosis or chronic hepatitis B because they have an increased lifetime risk of developing liver cancer. A doctor may order an AFP test, along with imaging studies, to try to detect liver cancer when it is in its earliest, and most treatable, stages.

If a patient has been diagnosed with hepatocellular carcinoma or another form of AFP-producing cancer, an AFP test may be ordered periodically to help monitor a patient's response to therapy and to monitor for cancer recurrence.

A relatively new test, called AFP-L3%, is sometimes also ordered to compare the amount of total AFP to the amount of one of the AFP variants called AFP-L3. The AFP-L3% test is not yet widely used in the U.S. but has gained wider acceptance in other countries such as Japan. The test is used to help evaluate the risk of developing hepatocellular carcinoma, especially in those with chronic liver disease. An increase in the percentage of L3 to total AFP indicates an increased risk of rapidly developing this disease and also of having less chance of survival.

When is it ordered?
A physician may order an AFP blood test when he:

suspects that someone has liver cancer or certain cancers of the testes or ovaries. Cancer may be suspected when, for example, lumps are felt in the abdominal area during a physical exam or when imaging tests detect possible tumors.
is monitoring a patient with chronic liver disease for the emergence of hepatocellular carcinoma or another type of liver cancer.
is monitoring the effectiveness of treatment in a patient who has been diagnosed with and treated for a cancer of the liver, testes, or ovaries.
is monitoring for cancer recurrence.
An AFP-L3% is sometimes ordered to help evaluate the risk of hepatocellular carcinoma when a patient has chronic liver disease. This new test, however, is not widely used and its ultimate clinical utility has yet to be established.

Sundanceh's picture
Sundanceh
Posts: 4306
Joined: Jun 2009

K,

I recently instructed 'our' onc to start ordering a CA19-9 test once again...my old place was good about it, but I suppose our guy has other ideas...but I told him I've already given you the blood, so do the test.

It's always been an interesting marker for me...you see, back when this spread to my liver...the CT's appeared to show a mass in the pancreas. The CA19-9 test, while also being a good test marker for crc, is also used as a PRIMARY marker for pancreatic cancer as well. That's really more of what the test is designed for, though it can be an additional marker for crc to use as a gauge with everything else being tested.

Because, that's where they thought the spread was...though it turned out in the liver instead. Big relief there, because you know pancreas is pretty much sayonara.

So, early on my CA19-9's were off the chart...way off the chart....like in the 600's...they stepped down to the 300's when I left my old practice.

When I landed at UTSW, I told the guy I wanted this test...he initially ordered....they were about 108 or so at the lowest.....my last one was 133....and I'm waiting on the latest result from my blood draw Monday.

As with most markers, the numbers can be skewed and never be really conclusive.

The RANGE VALUE for CA19-9 is 0-37 U/ml (Units per milliliter).

-Craig

Sundanceh's picture
Sundanceh
Posts: 4306
Joined: Jun 2009

Well, shoot, K...

MyChart just updated me on my latest CA19-9.......

1-6-0

Yep, 160....steadily climbing...my question always has been, "What does it really mean?" And "What does it represent to me?"

12/3/2010 1/26/2011 11/30/2011 2/1/2012
103 133 139 160

Now that I'm thinking about it, there is a new spot on my liver...and the number has climbed pretty high in such a short amount of time. I think I've got a liver problem again...say it ain't so.

-Craig

thingy45's picture
thingy45
Posts: 583
Joined: Apr 2011

I am at a loss. Here in Canada I do a CEA test and it is supposed to be under the number 5.
Anything more then that is a problem I was told.
After my operation I was 1.0 and my onc likes to keep it that way.
Craig you are talking about Ca 19-9.
Why is it different in USA then in Canada

Sundanceh's picture
Sundanceh
Posts: 4306
Joined: Jun 2009

CEA and CA19-9 tests are different and carry different values.

CEA
0-5

CA19-9
0-37

I'm not sure why it is not offered in your area...CA19-9 is a primary marker for pancreatic cancer...can be used as a test for liver.

-Craig

smokeyjoe
Posts: 1428
Joined: Feb 2011

I'm in Canada too, I wondered do you get PET scan where you are or just the CT, seems here in Ont. we only get CT....don't even know what would warrant an onc. to order a PT, they just don't use them here.

k1
Posts: 220
Joined: Dec 2009

Craig, now you make me wonder if I should ask for a C19-9 as well, but I'm still trying to figure out why I got the Alpha-Feto-Protein test. The onc is out of town this week, so I probably won't get an answer till next week.

Meanwhile, I've been unconscious this weekend from chemo and am just "coming to" tonight. It was number 11 of 12 treatments so I will be finished with this round, my first, this month. While those around me think this will be a joyous occasion and I'll be cured, anyone on this board knows that is not always the case.

I hope that the liver spot and your C19=9 numbers turn out to be minor blips.

K1

tanstaafl's picture
tanstaafl
Posts: 976
Joined: Oct 2010

Perhaps he just wanted an AFP to make more sure to himself that it was a liver met and not a sneaky primary HCC (liver cancer).
----
While other (relatively)"benign" conditions like severe inflammation or pancreatitis can elevate CA19-9, some papers appear to imply that CA19-9 is an indicator of potential for adenocarcinoma metastasis, and treatability with cimetidine and/or Avastin. But we can kiss (y)our onc's ASCO, zzzzz. Because CEA is more prevalent in cancer patients generally (including less advanced stages), ASCO ignored CA19-9 as lacking sensitivity, when it appears more of an indicator for molecular treatment, severity and type of risk.

Also we can't go back and get this data. Before and sometime after surgery seem to be the crucial collection times. We get my wife's CA19-9 tested ~2 months apart if nothing too much is going on, but used CA19-9 frequently before 2nd surgery to help identify an active immunochemo dose to stop a CA19-9 rise going exponential (peaked and dropped about 2/3 toward a highish baseline).

k1
Posts: 220
Joined: Dec 2009

I wonder if chemo itself wouldn't just cause liver enzymes to stay elevated? Anything as toxic as chemo being infused in your body for nearly six months would seem to have the potential to make your resected liver inflamed just trying to filter the stuff.

K1

smokeyjoe
Posts: 1428
Joined: Feb 2011

Tanstaafl, if you see it spike what do you do to bring it down, do you increase certain supplements for a period of time till the next blood work??

pete43lost_at_sea's picture
pete43lost_at_sea
Posts: 3915
Joined: Nov 2010

my onc has refused each time i have asked for ca199, but i think a few tests would be interesting.

i done everything else, it would be a shame to miss out on something.
great discussion.

hugs,
Pete

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