Hi All,
After recurrence was diagnosed in May 2018, just last month, the surgery to remove the tumor in the same area as the original cancer from 4 years ago was said to be successful. Surgeons said it wasn't touching any organs and was surrounded by some fatty or other tissue. Pathology report, per oncologist, came back indicating margins were clean. One surgeon had mentioned while operating, did not see any visible cancer on nearby organs. This all seemed to bode well. After recovering from surgery, took another blood test just a few days ago and CEA came back as 3.3. This is not the historic low. At some point 4 years ago after surgery and chemo for the initial colon cancer, either after surgery or after the 6 months of chemo (Folfox) that followed, CEA fell
to 1.xx. So the expectation would be that after this last surgery, CEA would fall to 1.xx if the tumor was the only cancer detected and it was cleanly removed?
Could CEA still be in the process of dropping post-surgery (to be reflected in next month's CEA test), or should it have immediately dropped to historic lows again (1.xx) right after surgery? In other words, is it normal to have some lag time between surgery and tumor removal and CEA bottoming out?
Thank you in advance!
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Just as a little background, if it helps:
- Diagnosed with colon cancer 4 years ago. Diagnosed at that time as Stage 3b. High risk with a somewhat aggressive cancer.
Had surgery to remove (required total colectomy - removal of large intestine) to remove tumor, plus some lymph nodes, then
had 6 months of chemo (Folfox), after which a CEA test was performed and the result was in the 1.xx range.
- Quarterly blood tests and 6-month CT scans showed normal for about 1.5 years (CEA still in the 1.xx-2.xx range).
- About 1.5 years in, CEA pattern stopped hovering in the 1.xx-2.xx range, up and down, and showed only increases practically
each quarterly blood test. 2.xx, to 2.5x to 3.1x, etc.. until the most recent CEA test in May of this year at 6.8x, when
both a CT scan and PET scan showed a mass in the same abdominal region as the original cancer 4 years ago. An operation
was performed the 1st week of June and was told the mass was not on any organ but was surrounded by some fatty or other
tissue and was removed successfully. Pathology report came back and oncologist said it appears the cancer was removed and
the margins were clean. But she also said something about it being on top of something and nothing could be done about that.
This was an odd statement and didn't get clarification about it at the time. She said also that now that it is out, we want to hope
that it doesn't come back, because the fact that another mass grew in the same general area 4 years later suggests some
microscropic residual cancer dropped in that area and was growing, and that the chemo apparently didn't kill it off (suggesting
some of the cancer became resistant to FolFox), so it doesn't look like a viable avenue to try chemo again since Folfox is
the best known treatment and if it doesn't completely to kill all cancer, there's really no other alternative. But then she indicated
at a post-op meeting that she has other treatments but will have to see based on the situation whether she'll need to use/try them.
She also mentioned being a rare candidate (10-15% of all patients) for immunotherapy, if, God forbid, it came down to it and things
got to a point where it would be needed to be tried. She said about 30-40% of all qualified candidates responded well to it.
- A few weeks after the early June surgery (which happened just weeks ago), a blood test was done just a few days ago and CEA
result came back 3.3. Have to go back thru records to see if after the first colon cancer was diagnosed and after the surgery of 4
years ago, if the CEA was also not at rock bottom immediately after surgery and gradually was still dropping to 1.xx range, or if
it immediatelly dropped to 1.xx range. Or if it only dropped to 1.xx range after the 6 months of chemo that had followed that
surgery.
- Worried now after the CEA result form the blood test done a few days ago, because CEA looks like a reliable indicator here,
having been historically accurate so far.. if the surgery went well and the only detectable cancer was removed in early June
via surgery, shouldn't the CEA have dropped to 1.xx (the rock bottom range based on historic results)? Could it suggest the
cancer wasn't cleanly removed, even though the pathology report seems to say it was?
- Have sent an email to the doctor asking if the same CEA test used (as always) in the past was also used this time. Since the ranges
of normal for different tests can differ. Also asked if it would have been expected post sugery and succcessful tumor removal to
see CEA lower than 3.3 (like 1.xx instead should have been expected?).
same area