The Colon Club

I'm waiting for the wheels to get rolling since my dx. MRI is scheduled for Dec 1, 2015. I want to be proactive and not just rely on Dr's advice so what blood tests should I be looking for or asking for to help with treatment plan?

The initial bloodwork we got was totally inadequate to our future needs to actually identify and solve problems, as well as sooner. We've been peeved that doctors had no clue or option for additional baseline data.

Here's what I get as an impression is about par for the course at dx:
CBC (with platelets), CHEM14, CEA, PT/INR, Basic liver panel (SOGT,SGPT,ALP),Total protein A/G, maybe Bilirubin

Here's what else we might expect for the "expanded baseline option" from a techie doctor with extra capabilities, for patients that care. Some panels into subsequent blood monitoring, some on a one time or occasional basis:
25-hydroxy vitamin D, hsCRP, ESR, GGT, LDH, ferritin, ceruloplasmin, quantitative D-dimer
CA19-9, AFP, CA72-4, CA125

There is another level of molecular and immunogical testing that hasn't had much coverage yet on this board:
http://www.lexingtonnaturalhealth.com/p ... ancer.html

rp1954 wrote:The initial bloodwork we got was totally inadequate to our future needs to actually identify and solve problems, as well as sooner. We've been peeved that doctors had no clue or option for additional baseline data.

Here's what I get as an impression is about par for the course at dx:
CBC (with platelets), CHEM14, CEA, PT/INR, Basic liver panel (SOGT,SGPT,ALP),Total protein A/G, maybe Bilirubin

Here's what else we might expect for the "expanded baseline option" from a techie doctor with extra capabilities, for patients that care. Some panels into subsequent blood monitoring, some on a one time or occasional basis:
25-hydroxy vitamin D, hsCRP, ESR, GGT, LDH, ferritin, ceruloplasmin, quantitative D-dimer
CA19-9, AFP, CA72-4, CA125

There is another level of molecular and immunogical testing that hasn't had much coverage yet on this board:
http://www.lexingtonnaturalhealth.com/p ... ancer.html

@rp1954 - Thanks for posting this list! I think it will be very useful for those of us diagnosed at Stage I, Stage II or Stage III because it will give a baseline for comparison as we proceed later into the long 5-year surveillance period.

My main question is this: For those of us who are now in the "NED-for-now" category within the 5-year surveillance period, what, exactly, should our doctors be looking for in the lab reports -- if we manage to persuade the doctors to authorize these "expanded bloodwork options"? What are these biomarkers actually tracking, and how do fluctuations in their values predict or forewarn us of what might be brewing behind the scenes?

Some of the biomarkers are obviously cancer-related markers, but other are markers for liver dysfunction, kidney dysfunction, etc. Even others seem to be general markers for general systemic inflammation or general deterioration of immune function (immunodeficiency). etc. Others are signs of metabolic or nutritional deficiencies, etc.

How are our doctors supposed to make sense out of the vast array of biomarker test results that are received? Any suggestions?

Tnx.
.

A lot of the expanded blood panels have other primary uses, but have pregnant, decodable secondary meanings for CRC patients and survivors.

The extra blood panels improve sensititivity for detection while helpng to interpret, filter out and monitor lesser ("benign") disease processes and inflammation. The liver is the most commonly detectable site for mets.

One of the important areas we have to keep an eye out for is hypercoagulability, with the potential for DVT and embolisms. The way we do that is with PT/INR, ESR, hsCRP in the frequent data, with d-dimer and fibrinogen less frequently. Quantitative D-dimer is also a less specific way to monitor for metastasis, and provides us some reassurance that we are not being blindsided on the cancer markers. We would get quantitative D-dimer every time if it weren't so expensive in our locale, maybe 5-8x what most here could get it for, and drawn separately elsewhere.

OSM: ...How are our doctors supposed to make sense out of the vast array of biomarker test results that are received? Any suggestions?

One level is simply trending and watching for abnormalities. Presented as a spreadsheet greatly improves power and utility, and is very fast to scan. The problem remains that even oncologists are weak on uses and areas specific to CRC. As an example CA19-9 has crucial biological and prognostic information at dx from 0 to xxxx. Serum CA19-9 is affected by inflammation, heavy chemo and other diseases, but the area of maximum initial utility starts around 20-22, not 37, and is important to the 0-2 range around diagnosis also.

This brings up two other opportunities to use our power of the internet here:
One is to accumulate useful links, of papers, experience and analysis, in a single thread on a specific blood assay that we could utilize to improve their interpretation. At first, a thread might be dominated by CRC related links on a specific blood panel and then updates of the earliest contributions, on the first page, might function as partial wikis on discussion and interpretation.

The other opportunity is that individuals start their own individual threads where (y)our blood data is kept updated similar to a spreadsheet in the starter contribution, also with event summaries more than just signatures. This kind of clinical base with the extra data would far more powerful than what the doctors have today. It would allow you to see and address the common patterns at first, sooner for all, and evolving for less common patterns.

Data are storable, combinable analyzable and useful over long time periods. They can be shopped around for multiple opinions and improved with later information. Not having the data is often a deadly error.

Thanks for the detailed responses rp1954. Now to make sure I'm getting these done. Is there a "standard" set of tests or is there just too many variables for that to happen? What are the oncologists looking for in the initial bloodwork?

What I described as "par for the course" is about what they are going to start with, +- maybe LDH, and unrelated stuff like thyroid and cholesterol tests.
You may get them to get the CA19-9, expand CHEM12 or 14 to a "Super Chemistry" (packages vary) with the "extra" GGT, LDH, BILI (rubin), hsCRP, ESR and ferritin, maybe fasting insulin. Quantitative d-dimer, any family history of clots or embolisms you might be able claim to dr. If he won't give you 25 hydroxy vitamin D for a colorectal cancer dx, (s)he's behind other doctors here. Remember this is for a baseline or a benchmark and for initially spotting anomalies, you won't use this many panels everytime.

US doctors WILL look askance about all the extra markers (CA19-9, AFP, CA125, CA72-4), it's outside their training and your insurance's guidelines. Also d-dimer may flip ordinary doctors out, so self order only may be best. Some countries' labs will do 6-12 cancer markers, "cancer screen", all together at one time, cheaply, but I haven't seen it for the US yet. Be prepared to advocate and argue for them, then have to order them yourself online.

Because of the inflammation markers, and consistency, it is best if you can get everything together at once, especially if you are able to get the same lab for the next year or two.
[I just realized you're in Canada, I believe they are stickier about "standard", you'll need even better narrative skills, but let us know]

Also, for high dose IV vitamin C, a G6PD test is available and desirable in the initial blood tests, especially for CRC that turns out to be KRAS mutant.