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  • Tumor markers doing weird things.

    Hello all. I have recently relapsed, with it having spread to my left para-arortic lymph node, size 2.7 x 2.2 x 3.0 cm. However, I did not have any tumor markers prior to the I/O.

    At the beginning of May, my AFP went up to 109 from my norm of 2. I had a blood test the next day to confirm this was not just a blip, by which point my AFP went up to 126, and my HCG went up, from my norm of <1 up to 2. Due to the results of these I had a CT scan which revealed the metastatis mentioned at the top of this post.

    However, on the 14th June, I had a blood test an hour prior to 3xBEP treatment commencing, the results of which revealed that my AFP had gone DOWN to 115.8, yet my HCG was 3.9.

    1) I am aware that it is possible for AFP to spike up at the start of treatment, but is it normal by any means for AFP to go down prior to treatment commencing? And is there anything I should be specifically keeping an eye on as a result of this?

    2) My original tumor in the testes was 90% Seminoma and 10% Embrynomal Carcinoma. However, everything I have read points to HCG only going up if the tumor is a different (and very nasty) type to either Seminoma or EC. Have I misread, and have getting things for HCG confused with betaHCG? Or am I correct to be concerned?

    3) Slightly off-topic: Is there any way I can get the nurses to listen to me when I tell them I am having adverse side-effects? As they kept telling me they were all psychological, however I had excess acid-reflux to the point where I could hardly breathe, which placed me in the ER overnight.
    13th Dec 2011
    Left I/O, 90% Seminoma 10% EC, no tumor markers prior to or post-I/O.
    12th Jan 2012:
    CT All Clear, no tumor markers.
    23rd May 2012:
    Tumor markers rising.
    31st May 2012:
    CT scan.
    7th June 2012:
    CT scan results show spread to Paraaortic Lymph Node, 2.7cm x 2.2cm x 3.0cm in size.
    Finally given results of first test where markers began to rise. AFP = 109, bHCG = 2. In all other tests AFP = 2 and bHCG < 1
    14th June 2012:
    3xBEP Scheduled to begin.

  • #2
    1) I am aware that it is possible for AFP to spike up at the start of treatment, but is it normal by any means for AFP to go down prior to treatment commencing? And is there anything I should be specifically keeping an eye on as a result of this?
    Was it the same lab? The diff is not that large and lab error could account for it. (126 vs 115)

    2) My original tumor in the testes was 90% Seminoma and 10% Embrynomal Carcinoma. However, everything I have read points to HCG only going up if the tumor is a different (and very nasty) type to either Seminoma or EC. Have I misread, and have getting things for HCG confused with betaHCG? Or am I correct to be concerned?
    Seminoma does not present with AFP as a marker, only HCG. The rise in your AFP points to that 10% EC being the guilty party that is trying to spread. Both are exquisitely sensitive to chemo.
    3) Slightly off-topic: Is there any way I can get the nurses to listen to me when I tell them I am having adverse side-effects? As they kept telling me they were all psychological, however I had excess acid-reflux to the point where I could hardly breathe, which placed me in the ER overnight.
    Tell them that and discuss with your treating oncologist when he makes his rounds. Let him/her know f they are not listening, but careful not to burn any bridges. Be diplomatic but tough. You are your best advocate.
    Best,

    Zsolt


    Friendship is born at that moment when one person says to another; "What! You too? I thought I was the only one." - C.S Lewis

    “Experience: that most brutal of teachers. But you learn, my God do you learn.” - C.S. Lewis


    Mass found 11/20/08
    Left I/O 11/25/08
    Pathology: Seminoma, Stage 1
    Surveillance: All Clear since

    Comment


    • #3
      Originally posted by Aegean View Post
      Was it the same lab? The diff is not that large and lab error could account for it. (126 vs 115)
      Indeedy, it was the same lab. I would have thought that in the two weeks between tests (especially pre-treatment) that the AFP would only have gone up rather than down

      Thanks for the quick response
      13th Dec 2011
      Left I/O, 90% Seminoma 10% EC, no tumor markers prior to or post-I/O.
      12th Jan 2012:
      CT All Clear, no tumor markers.
      23rd May 2012:
      Tumor markers rising.
      31st May 2012:
      CT scan.
      7th June 2012:
      CT scan results show spread to Paraaortic Lymph Node, 2.7cm x 2.2cm x 3.0cm in size.
      Finally given results of first test where markers began to rise. AFP = 109, bHCG = 2. In all other tests AFP = 2 and bHCG < 1
      14th June 2012:
      3xBEP Scheduled to begin.

      Comment


      • #4
        I would think that the AFP could fluctuate a bit - tumors are dynamic, with parts growing and dying. Maybe that could account for the small change in AFP on that one AFP test?
        Heidi

        Husband - age 51
        10/20/10 - Primary mediastinal seminoma - 10 x 9.3 cm; ß-HCG = 33 (<2.6); AFP = 3.5 (<9); LDH = 274 (100-200 )
        11/1/10 4X BEP
        12/7/10 End Cycle 2 - ß-HCG = 2; AFP = 4.6; LDH = 139 ; 4XBEP changed to 3 as tumor now 2.1 x 3.7 cm
        2/15/11 - Post-chemo PET ; residual 8 mm x 2 cm
        6/29/11 - Lung nodules stable or smaller, chest mass continues to shrink & markers all normal
        Surveillance since 6/11

        Comment


        • #5
          Hi all, I am back, and this time I have more questions along the lines of tumour markers doing weird things.

          I have had blood tests taken since my last post, and completed 3xBEP treatment. Here are the results taken from each blood test done prior to commencning each cycle (including the results mentioned in the first post in this thread):

          Cycle 1: AFP = 115.8 HCG = 3.9 LDH = 373
          Cycle 2: AFP = 7.0 HCG = <2.0 LDH = ? (The hospital lost my results)
          Cycle 3: AFP = 4.3 HCG = <2.0 LDH = 873

          I am somewhat worried as my AFP and HCG have normalised, but nothing I have read on here has pointed to LDH skyrocketing so much during chemo when the other markers have gone down. Does anyone with experience of this happening to them, or knowledge of this subject area have any suggestions as to what may have caused such a spike in LDH during chemo?

          Also, as a minor side note (and slightly off-topic), does anyone know if acid reflux caused by chemo is typically a short-term side-effect or permenent?
          13th Dec 2011
          Left I/O, 90% Seminoma 10% EC, no tumor markers prior to or post-I/O.
          12th Jan 2012:
          CT All Clear, no tumor markers.
          23rd May 2012:
          Tumor markers rising.
          31st May 2012:
          CT scan.
          7th June 2012:
          CT scan results show spread to Paraaortic Lymph Node, 2.7cm x 2.2cm x 3.0cm in size.
          Finally given results of first test where markers began to rise. AFP = 109, bHCG = 2. In all other tests AFP = 2 and bHCG < 1
          14th June 2012:
          3xBEP Scheduled to begin.

          Comment


          • #6
            LDH isn't really just a "tumor marker" it is an indicator of cell damage this article explains it pretty well:

            http://labtestsonline.org/understand...s/ldh/tab/test


            Also, most report the reflux goes away after the chemo is over. I never had that problem, so I don't know personally.
            Jan, 1975: Right I/O, followed by RPLND
            Dec, 2009: Left I/O, followed by 3xBEP

            Comment


            • #7
              Yay! Thanks for the info!
              13th Dec 2011
              Left I/O, 90% Seminoma 10% EC, no tumor markers prior to or post-I/O.
              12th Jan 2012:
              CT All Clear, no tumor markers.
              23rd May 2012:
              Tumor markers rising.
              31st May 2012:
              CT scan.
              7th June 2012:
              CT scan results show spread to Paraaortic Lymph Node, 2.7cm x 2.2cm x 3.0cm in size.
              Finally given results of first test where markers began to rise. AFP = 109, bHCG = 2. In all other tests AFP = 2 and bHCG < 1
              14th June 2012:
              3xBEP Scheduled to begin.

              Comment

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