BTW, these were the questions I faxed yesterday:
1. Why won’t he be tested for CEA right away?
2. Will there be CBCs done routinely? Renal function tests? In Japan, it is standard to test renal function before doing chemo.
3. Tumor can be graded from biopsy at colonoscopy. What was it?
4. Why not tested for genetic mutations or other biological abnormalities that might influence treatment or staging? There is a range of new genetic tests that can be done to determine whether a patient will be a good candidate for this or that type of therapy. Some of these tests require tissue specimens captured in a certain way or preserved in a certain way. If these options are not discussed beforehand, then later on it may not be possible to get the desired test done because the opportunity to do so was missed.
5. Relative to #4, Oncotype DX test -- a genetic test that is mainly relevant for patients diagnosed as T3N0M0. The test is useful for determining whether such a patient would benefit from chemo or not. The test needs to be done before the decision is made about starting any first line chemo. This test has very specific specimen requirements. Will the surgery collect the specimen in a manner that will be appropriate for: http://colon-cancer.oncotypedx.com/en-U ... ingASample
6. Is there any anticipation of needing PET scanning?
7. Michael’s father died of pancreatic cancer in his early 60s. He was diagnosed with type 2 diabetes a few decades earlier. Michael was recently diagnosed with type 2 diabetes. Apparently, sudden diabetes is an early predictor of pancreatic cancer as it affects insulin production. While diet has also largely influenced the condition in Michael, he has dramatically changed his diet yet his blood glucose levels remain high. Shouldn’t he be tested for CA19-9?
8. The easiest CA19-9 information patients can get is the CA19-9 blood levels before and after treatments, especially surgery. Although other conditions can raise CA19-9, it is a targetable biomarker in CRC. Those advanced CRC patients who had the common CA19-9 biomarker in their tumor tissue had dramatic improvements in survival. According to another patient, after analyzing various literature, he decided he should buy cimetidine for post op use if peak (presurgical) blood CA19-9 was in the 20s (or higher). Cimetidine has been used with great successes in CRC perioperative use - before, during and after surgery to prevent further metastasis due to immune suppression. Interestingly, in the six to eight months leading up to Michael’s initial March 27th hospitalization, he stocked up on cimetidine for the “stomach” issues he was experiencing. Cimetidine could have a dramatic effect if taken before initial surgery, but is said to be not so useful if applied long after surgery has occurred. Shouldn’t Michael be a candidate for cimetidine?
9. CEA, CA19-9, lactate dehydrogenase (LD or LDH), 25 hydroxy vitamin D, ESR and hsCRP all before treatment or surgery (and 5-10 days after) are among the tests that are part of a standard of care for a patient with Michael’s profile.
10. Michael had/has severe anemia, HCM, and a host of issues comorbid with the cancer. Given this fact, combined with his need to have cardiologist clearance for the surgery May 5th, shouldn’t he have these tests done?
11. An LD/LDH blood test may be used: 1) As a general indicator of the existence and severity of acute or chronic tissue damage, 2) To detect and monitor progressive conditions such as anemia, and 3) To help stage, determine prognosis, and/or monitor treatment (i.e., chemotherapy) of cancers. Also, an LD/LDH test on pleural, peritoneal or pericardial fluid and help determine whether the accumulation of fluid is due to injury and inflammation (exudate) or due to an imbalance of pressure within blood vessels and the amount of protein in the blood (transudate). This information is helpful in guiding treatment.
12. The same in #10 applies to the other listed tests.