Re-start chemo based on rising CEA?

tko683 · February 2013

I am having a hard time undertanding something. My husband has been receiving treatment for Stage 4 rectal cancer since June 2011. He had liver resection after FOLFOX and then radiation. Before the rectal surgery could be done new liver lesions appeared. He then started FOLFIRI which continued until November of last year when Pet scans showed no evidence of disease. They decided a chemo break would be a good idea to see what would happen. In January when they did a CEA check it had tripled since the last check and was at the highest level ever since he was diagnosed. It was at 14. The doctor said he needed to go back on chemo and they would continue to check the CEA. I am confused because I have heard that CEA can go up for many reasons and right now he is receiving chemo based on a number. Has anyone else restarted chemo based on a rising CEA? Thanks so much for any advice about this. Wishing you all the best in health.

Dyanclark · February 2013

CEA

I think your Dr. is giving good advice some say CEA rise can be for other reasons. I can tell you when my husbands CEA rises he has new cancer growth. A CEA of 14 doesnt sound so scary, it can go into the thousands. Anytime my husbands CEA rises I want the Dr. to do something. My husband is at 5 right now and he is on chemo. Dr. said probably just two more rounds of Irinotecan and then oral Xeloda to keep CEA in check. He has been as high as 46 and as low as 1.9 the Irinotecan is working for now.

luvinlife2 · February 2013

CEA

That's a 2 month break and a CEA that tripled. I think your Dr. is probably right given the nature of colon cancer and the fact that it's the highest numberyour husband has ever had. I've had 3 breaks in my chemo regime and all 3 times my CEA started to rise as soon as the chemo was out of my system (about 8 weeks). Is your husband going to have another PET to confirm this? My onc pretty much always confirms with a CT scan. It's not good to have a lot of scans but there really isn't any other way to confirm progression I'm aware of other than doing a CTC (circulating tumor cell) test which most oncologists aren't ready to embrace yet. Even my nat onc who firmly believes in the CTC tests prefers a CT scan when given the choice.

mdeora · February 2013

CEA Rise

Hello,

My mother is also a stage 4 colon cancer patient. Her cancer was diagnosed in feb 2010. Since than she have took

15 chemo cycles

colon surgery + liver resection.

3 chemo cycles post surgery.

Now after 3 months without any treatment, her CEA is rised to 180. Eariler after surgery it was just 18. Tomorrow we are meeting the doc. for this. Would like to know if anyone have gone through similar experience and the advice for further treatment.

tko683 · February 2013

luvinlife2 said:
CEA
That's a 2 month break and a CEA that tripled. I think your Dr. is probably right given the nature of colon cancer and the fact that it's the highest numberyour husband has ever had. I've had 3 breaks in my chemo regime and all 3 times my CEA started to rise as soon as the chemo was out of my system (about 8 weeks). Is your husband going to have another PET to confirm this? My onc pretty much always confirms with a CT scan. It's not good to have a lot of scans but there really isn't any other way to confirm progression I'm aware of other than doing a CTC (circulating tumor cell) test which most oncologists aren't ready to embrace yet. Even my nat onc who firmly believes in the CTC tests prefers a CT scan when given the choice.

scans coming in March

Thanks for your answers. Yes my husband is scheduled for scans at the end of March, Pet scan and MRI of abdomen, and chest x-ray. I am assuming he will be on chemo until then. It is very discouraging to have the cancer come back so fast. I hope this chemo continues to work for him.

sdp · February 2013

mdeora said:
CEA Rise
Hello,

My mother is also a stage 4 colon cancer patient. Her cancer was diagnosed in feb 2010. Since than she have took

15 chemo cycles

colon surgery + liver resection.

3 chemo cycles post surgery.

Now after 3 months without any treatment, her CEA is rised to 180. Eariler after surgery it was just 18. Tomorrow we are meeting the doc. for this. Would like to know if anyone have gone through similar experience and the advice for further treatment.

CEA rise after resection
I had a slight increase In CEA after resection and RFA And no treatment for three months after resection. The Ct-pet scan showed very small three dots light up and the Docs have adopted a wait and watch approach. I then started on maintenance chemo of erbitux. Next scan is after the erbitux 12 cycles is over, which is mid february 2013.

I would suggest that you get a Ct-pet scan done. This will tell you with some accuracy as to where the lesions are, how big, and also u can have options to deal with them. In my case if the spots are not very large I can get an RFA done.

Let us know what the Ct-pet scan shows and what options your doc gives you.

Sdp

PatchAdams · February 2013

Why?

If new liver lesions appeared quickly after the end of chemo, it sounds like he has an aggressive cancer. I am assuming the onc / surgeon don't think another liver resection could be done??

Chemo doesn't cure liver mets. It might shrink them too small to be seen. Have you considered a 2nd opinion?

My CEA was 6.4 (high normal at my lab is 3.9) when I had a solitary liver met.

tko683 · February 2013

PatchAdams said:
Why?
If new liver lesions appeared quickly after the end of chemo, it sounds like he has an aggressive cancer. I am assuming the onc / surgeon don't think another liver resection could be done??

Chemo doesn't cure liver mets. It might shrink them too small to be seen. Have you considered a 2nd opinion?

My CEA was 6.4 (high normal at my lab is 3.9) when I had a solitary liver met.

Very concerned

PatchAdams, I think it must be aggressive also but nonoe has told us that. The doctor said after the last scan that he needed to be able to see the mets in order to operate and last scan did not show anything. I am hoping he can have surgery again but our surgeon never gives us too much information at any one visit. I do like him though, he is the best in this area and at a top notch hospital-Duke-The Cea is confusing, my husbands was 5.8 when he was diagnosed with 5 lesions, but they were all smallish. Now it is 14 so we are concerned. They are going to check the CEA again next week. Thanks for your comments.

Phil64 · February 2013

my experience

I was initially treated with FOLFOX / Oxciliplaten. I received 11 treatments. My CEA rose slightly during treatment and flucuated under 10. The oc thought this could be from chemo. When it went above 10 they became concerned. Twelth and final treatment was scheduled on 12/13. They canceled teh treatment and instead began an aggressive search for cause of the CEA increase. Multiple CT Scans showed all clear. However, MRI of liver showed multiple lesions.

Just started FOLFIRI / Erbitux as a second line of chemo treatment. Hope is to reverse the tumor growth and become a candidate for surgery. I just finished treatment 1 of this new cocktail.

See http://pscamihorn.me/cea-history/ for my cea history (on my blog).

Wishing you success in the cancer battle!

God Bless,

Phil

tko683 · February 2013

Phil64 said:
my experience
I was initially treated with FOLFOX / Oxciliplaten. I received 11 treatments. My CEA rose slightly during treatment and flucuated under 10. The oc thought this could be from chemo. When it went above 10 they became concerned. Twelth and final treatment was scheduled on 12/13. They canceled teh treatment and instead began an aggressive search for cause of the CEA increase. Multiple CT Scans showed all clear. However, MRI of liver showed multiple lesions.

Just started FOLFIRI / Erbitux as a second line of chemo treatment. Hope is to reverse the tumor growth and become a candidate for surgery. I just finished treatment 1 of this new cocktail.

See http://pscamihorn.me/cea-history/ for my cea history (on my blog).

Wishing you success in the cancer battle!

God Bless,

Phil

Same here

Thanks for the information. I was thinking our doctor should have done some sort of a search for the cause of rising CEA but she did not. She just assumed it was cancer. He is having an MRI of his liver next month so we will see what that shows. Wishing you success with FOLFIRI! My husband has tolerated it well so far(he has had 16 treatments).

Blessings,

Teri

tko683 · February 2013

sdp said:
CEA rise after resection
I had a slight increase In CEA after resection and RFA And no treatment for three months after resection. The Ct-pet scan showed very small three dots light up and the Docs have adopted a wait and watch approach. I then started on maintenance chemo of erbitux. Next scan is after the erbitux 12 cycles is over, which is mid february 2013.

I would suggest that you get a Ct-pet scan done. This will tell you with some accuracy as to where the lesions are, how big, and also u can have options to deal with them. In my case if the spots are not very large I can get an RFA done.

Let us know what the Ct-pet scan shows and what options your doc gives you.

Sdp

Thanks

Thanks Sdp for the information. My husband is having scans at the end of March so hope to know more then. Wishing you the best with your treatment and upcoming scan.

Re-start chemo based on rising CEA?

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