good MRI, the war beneath the waves

The CT in March showed shrinkage (repeat old news).  The July MRI, including a high resolution liver scan and diffusion weighted scan for peritoneal mets is clean,  consistent with the March CT.  Relief.

This past year wife has had several small, brief CEA surges and some climb in liver function values.   The first CEA surge also produced a CA19-9 surge that has decayed more slowly, over six months.  The CEA surges jump up more than 5 std deviations from previous trends and decay quickly after a month or two but show repeated higher CEA values in the mean time.   Stuff like ....  2.1  2.3  2.2  2.1  2.3  2.1  then wham 4.2, 4.1, 4.0,  2.2 ....

This last surge showed possible transient signs of hypercoagulability.  Of course one only can know a transient is a transient in the review mirror of experience, after several anxious weeks or months waiting for more test results.   Once again I can't get as satisfactory technical answers as we would like.  Hope is that the fibrinogen is released from a necrosed met, rather than a growing met.  Scared by the low INR (potential embolisms), we have suspended the celecoxib for a few months, after a good five month run.  I have had to track down new biomarkers for myself.    D-dimer appears  reassuring for us - it is low and that means less chance of an embolism and the latter, bad stage of cancer dissemination.

The MCV suggests that immunochemo's treatment activity may still be improving.  However, too much of a "good thing" in MCV means potential for dangerous cytopenias later though (worn out bone marrow), such as happens with standard chemo.   Balance - not too much and not too little, even with immune stimulation supplements, is important.   Right now I think MCV in the 103 - 107 range, is a good target range.  Above 110, marrow damage has an increased likelihood of therapy related myelodysplasia syndromes or leukemias from longer, stronger treatments with less friendly molecules.