... CA19-9/ESR and LDH....were in the normal range pre-chemo...
Actually LDH and CA19-9 persistently in the upper half of the normal lab ranges tend to be problematic for patients previously dx'd with advanced CRC
need to be tracked. Elevated CA19-9 is more common with distant lymph nodes.
LDH and ESR could be ordered with the CBC with differentials
(extended chem), perhaps without much fight. Maybe hsCRP too. US doctors tend to resist on the CA19-9, because of misconstructed diagnostics (ASCO et al
evaluated overall CRC detection sensitivity for stages 1-4 against CEA, vs CRC severity
and cheap therapeutic targeting). This is unfortunate for a lot of CRC patients. Especially upon initial CRC dx, before surgery, and immediately after surgery for early information and therapeutic options that are life changing and life saving.
Other doctors have recomputed some diagnostic cutoffs for CRC
with CA19-9 at 25 to 27 units, instead of the usual 34 to 40 unit cutoff for pancreatic cancer diagnostics. Personally I think CA19-9 patients should be further tested
at 19 units and above once already dx'd with CRC
, to maximize longevity for stage 2,3, and 4 CRC patients with higher CA19-9 values, and for CRC patients that would probably benefit from longer term, targeted cimetidine. Also CA19-9 enhanced diagnostics may help toward formulas with superior survival without the disability of oxi- for the personalized, sialyl Lewis targetable patients. This potentially represents a majority of stage 3 and 4 CRC pts at initial dx.
'...so I don't have a baseline to track effectiveness.
So start one. We find drs that cooperate or we order for ourselves.
...was the pre-chemo able to shrink the nodes ?
The first time, before 1st surgery, "pre-chemo" wiped out a lot of stuff, most clearly in the peritoneum, and seemed to have slowed or stopped the spread from existing PALN.
The 2nd surgery, we used the pre-surgical period to test chemo chemistry until some marker activity dropped substantially but the PALN didn't actually shrink, we just needed to stop their spread and transformation to more mets. The CA19-9 mostly dropped to baseline (past and future values); the CEA stabilized high but was not steel resistant.
I know it won't be curative but I would like to try and get rid of the largest nodes if I can.
That's what we did with continuous
chemistry (= 5FU + off label stuff), much of it even during surgery.
Drugs like cimetidine and celecoxib can continuously bathe susceptible nodes and mets 24 x 7 for years
without the side effects and disability of oxi-.