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rising ALT&AST

nancy591's picture
Posts: 1057
Joined: Sep 2009

These liver function test continue to rise. One of my doctors think it is chemotherapy induced toxicity. I emailed my Doc in NYC this morning. When I searched online no where did I find it is a complication of liver mets. As of now I have no liver mets. Likely causes are chemotherapy induced or blocked bile duct. I haven't drank any alcohol in awhile and will stop taking tylenol. I do take tylenol sparingly. All my other lab work is pretty good. It would really stink to have a forced chemo break due to toxicity. I guess a new tumor blocking my bile duct is no better. Anyone else have a similar situation?

Posts: 1995
Joined: May 2003

Sorry you're dealing with high numbers, but it's certainly not uncommon. Since our liver filters everything that comes through our body, it's no wonder that it might be on overload right now. Sounds like you're doing all the right things, though. I would say take Milk Thistle, as it cleanses the liver wonderfully. But you may want to research it first. Otherwise, just lots of fluids, especially after chemo, to flush everything through your system easier.

Sending lots of (((Hugs))) and Prayers.

Mwee's picture
Posts: 1341
Joined: Nov 2009

I don't have any answers, but just hope this clears up very quickly for you.
(((HUGS))) Maria

lindaprocopio's picture
Posts: 2022
Joined: Oct 2008

35% of my liver is now crapped up with cancer, and my ALT and AST are still normal. So don't let your mind make the leap to liver mets because of those numbers. Ok?? Usually there are no indicator of liver mets before they show up on a CT/PET. ((((Nancy)))

nancy591's picture
Posts: 1057
Joined: Sep 2009

I just spoke with the NP from the NYC office. She thinks the rising liver enzymes is probably liver involvement. I was like but...but...I know people who have liver involvement and their levels are fine. I guess I won't know until I have my scan next week. The rising levels coupled with my ULTRA high ca125 is cause for suspicion. My ca125 is almost 5x higher then it was when I was initially diagnosed. I was hoping the ca125 was a rising due to liver inflammation from chemo toxicity. UGH. Other than that I feel FINE. Truly, finein regard to symptoms. Fatigued, yes, but thats about it.

lindaprocopio's picture
Posts: 2022
Joined: Oct 2008

I'm thinking "why would she even say something like that to you, knowing you had 7 to 10 days to wait for your scan & results???" But then I thought, if Nancy is like me, she PUSHED for the answer with some kind of pointed question. Try not to worry and just enjoy the weekend; until you get your scan results everything else is just guessing.

& if it IS liver mets, they can be beaten back just like cancer anywhere else. (((Nancy))). My family acted like I was going to die any MINUTE when my scan showed liver mets, and when the liver mets spread and got bigger, they REALLY freaked. But I still feel good, still no symptoms. Please remember, if this turns out to be liver mets, that you only need something like 10% of your liver to be healthy in order to still have adequate liver function.

But you don't know that it's in your liver. Try not to 'borrow trouble'. Taxol is SUCH good stuff after a long break from it like you've had. It'll take care of anything starting up anywhere! Find your peace: I know you can do that. As soon as I get my 'Zen' back, my whole family settles down and is okay with whatever is happening, following my lead. Find your peace, Nancy, I know how strong you are.

poopergirl14052's picture
Posts: 1185
Joined: Nov 2010

Nancy, don't worry too much..easier said than done. I agree and wait for you scan results. It could also be stress as it affects us all in many ways. I will keep you in my prayers and I hope your numbers a a fluke.....val

Lisa13Q's picture
Posts: 683
Joined: Jul 2009

I just sent you a private message as well, but Linda is 100% correct. wait for scan....My mother has 2 liver mets and her AST/ALT are both normal.....I am not sure that the NP should have said liver involvement without a scan....that is truly the only way to know...Remember you have NO symptoms...NONE.....It's not time to panic yet. I think you're CA-125 number really threw you....please try to remember that it has NEVER been a reliable indicator for you. Also, you are on avastin, which is extremely powerful. Your previous scans did not show any liver involvement correct? And now you are on this new relatively unknown powerful chemo that must get flushed through the liver. It causes high BP......it can cause some liver processing issues as well....Remember chemo is tough....sometimes I think it can be as brutal as the damn OVCA....I will be back in MN tomorrow....at around 3:30...please call if you need to.....Love and Prayers, Lisa

carolenk's picture
Posts: 909
Joined: Feb 2011

Just some more info about liver enzymes:

A lot of people without cancer have mildly elevated liver enzymes from their high carb/soft drink diet--causing fatty liver. The liver tissue dies off and is replaced by fatty tissue.

I have no idea if this is affecting your or not but it is something to consider.

I use Milk Thistle (herb) to protect my liver after chemo. My liver was enlarged from the Percocet post-operatively but I changed to oxycontin and started on Milk Thistle and the problem resolved. Now I am off pain meds altogether.

good luck,


nancy591's picture
Posts: 1057
Joined: Sep 2009

thanks Carolen. Well, I definately don't drink soft drinks. My drink of choice is water and one cup of coffee in the morning. I drink plenty of water, about 64oz daily and have been for the past several years. I don't really eat too many carbs either. I enjoy the occasional bagel and sometimes a piece of cake but I usually don't consume many carbs on a daily basis. I've always ate healthier then most people I know. Pre cancer I was very much into diet and exercise going back at least 10years.

I'd like to think chemo toxicity is the cause but it doesn't look like it really all that common since I didn't get a lot of replies. I like to think of myself as a strong, healthy person despite cancer. Like most women on here I was never sick! Even while on chemo my young kids and husband will have a run of the mill cold and I'd be fine.

Once my scan is done I many look into the milk thistle.

upsofloating's picture
Posts: 473
Joined: Dec 2009

Nancy, my liver enzymes rose while on Gemzar last year and dr ordered an ultrasound of liver with req to also focus on gall bladder. I was to have ct scan shortly and questioned need for it. NP said it shows different detail/info than scan. It turned out normal, enzymes returned to normal when took chemo break, but a couple of months after restarting Gemzar in Fall, enzymes rose again - and got higher by the month. A month after stopping in Dec they returned to normal. Do not assume mets are cause and i 'm surprised NP would say that - how thoughtless. These tough chemos can cause issues like this.

To go from no mets to rising enzymes in such a short time seems quite unusual to consider mets first. Keep that thought, take a deep breath, relax, another deep breath, and just live in the moment, smile, laugh, and enjoy being here.

Cindy Bear
Posts: 570
Joined: Jul 2009

Hang in there Nancy... I agree a lot of different things could be causing this, it's hard to be patient and not worry I know, but until the scan there's no real way of knowing what's going on. In the meantime, try to relax and de-stress.. enjoy your family and the warmer weather. Might I also recommend some retail therapy?
Hugs and prayers,

Posts: 272
Joined: Jan 2011

Hi Nancy, I was so sorry to read about your high ALT & AST levels. I had the same thing happen to me when I was on my previous chemotherapies. Up until 2010, I became more and more alarmed and asked my 2 previous oncologists about it and they said to me that it was nothing to worry about, once you're off chemo it will come down. But, I know when a person is dealing with a cancer diagnosis everything worries that person. I know that I am constantly worrying about this and that now so much so that it causes anxiety. I'm still on Avastin and Cytoxan and will probably be going for a CT scan soon.

I also feel better when I can actually speak to a doctor about anything that concerns me. I have nothing against nurses or NP, but I prefer to talk to a doctor. However, this hasn't always been possible in the oncologist office. I do have an excellent gyn/onc who always calls me back as soon as possible and my primary care physician is the same way. I think it's important to have a good team of doctors. I wish you the best with your upcoming CT scan.

Posts: 1223
Joined: Jun 2008

My liver numbers were high when I fist was dx almost 4 years ago. They sent me to a famous liver specialist and she did many kinds of tests on me, and told my onc that I would never be ablet to continue chemo long term. When I went into remission, for eight months after first line chemo, the number came down and I have tolerated a lot of chemo since then, as you knowm with only a slight rise occasionally. The liver specialist did say that I had a slightly fatty liver. I found it very strange because I have also excersized faithfully for yeasr and had a very healthy diet. The few months of high liver counts is still a mystery to me.

I hope your scan will give you some more info, and set your mind at ease.


nancy591's picture
Posts: 1057
Joined: Sep 2009

All your responses have truly brought me comfort. Thanks for sharing stories of higher liver tests. Remaining ever hopeful and waiting till Wednesday for the CT.

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