Elevated Liver Enzymes
I am undergoing chemo. Did 4 DD ACs, and just finished 2 of my 4 DD Taxols. My liver enzymes were in the 20's when I started and have been gradually elevating. ALT is now 200, and AST 90. My doctor says not to worry, but wants to scan the liver. How common is this? Is this how liver mets is diagnosed?
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seaofhope,
Have you been taking any pain medicine? My LFTs were very elevated after my surgery when I was taking acetaminophen (tylenol) and some other drugs (percocet or vicodin, I think) that contained acetaminophen. Hopefully it's just something like that for you! Hang in there!
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He's probably just being cautious. Taxol is very hard on the liver. My enzymes were high the whole time I was on Taxol. I don't think they got quite to 200, but I seem to remember ~140.
My onc said with liver mets, the values are often in the thousands, which put it in perspective for me.
Even strenuous exercise can elevate the numbers.
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There are a lot of things that could cause elevated liver enzymes. I've been finished with tx for about a year and a half, and was recently told that my numbers were high. Tylenol and other pain meds can definitely elevate your levels. In my case, I have fatty liver disease as a result of taking Tamoxifen.
I wouldn't worry too much about it. I'm certain it's not mets.
Hang in there!
Karen
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Both my AST and ALT were in the 200s while on chemo. I got scared b/c the readings rose very quickly in between blood draws. Both readings went back down to normal after chemo.
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I hope any of these scenarios are mine tomorrow.
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We hope so too! Please let us know how it turns out, and we'll be thinking of you and sending positive vibes!
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The liver sonogram looked good - ideal specimen they said! No evidence of fatty liver disease. My enzymes keep rising though - ast @90, alt@260. I have to suspend chemo and see a liver specialist. I want to get this chemo over with! I only had two taxols left, though a year of herceptan. Did anyone ever have to suspend chemo for a few weeks?
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Delaying chemo for a few weeks is fine. There are lots of reasons why the enzymes could be rising-but as you've had a good scan result, then hopefully there will be a reasonably innocent explanation. Really pleased about your scan result-what a relief!
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Hi Seaofhope -- my liver enzymes went through the roof last month -- I had a couple of weeks off from chemo to give my liver a rest. After that the levels went down to an acceptable level and I was able to get chemo again. It sure is annoying to suspend chemo when you just want to be finished with it!!! I hope you only have a couple of weeks rest and get those last 2 taxols done!
Edited to add: My onc told me that the liver is very sensitive and there can be many benign reasons for elevated enzymes. I bet the rest from the chemo will put you right back in the normal/acceptable range.
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When my enzymes went over 100 while on chemo we just waited a week and then when they were trending down went ahead with treatment. I remember being very bummed about having to delay chem, but it all worked out in the end. They were up again about 3 months ago. The doctor was concerned that tamoxifen might be messing with my liver, but this time is seems to have been because I just started working out and was building up a lot of lactic acid that my liver had to deal with. There are a lot of reasons for elevated liver enzymes as everyone has said.
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When I was doing chemo my liver enzymes stayed high the whole time. After the first few readings my dr. didn't seem concerned about it. He said there was a high percentage of women that had their level go up during treatment. He also told me not to take Tylenol because it's hard on the liver but instead to take Ibuprofen and not much of it. I agree with the others that pain meds will elevate it. Sounds like you will be just fine after taking a small break. Good luck.
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Most of you here mention that your liver enzymes became elevated during treatment, but returned to normal afterward. In my case they were normal during treatment but have become elevated after treatment. The only exception was ALT which showed slightly elevated levels on the last day of treatment at 47 Units/L (Range: 5 - 37 Units/L).
A blood test this week (three weeks after final chemo) shows very elevated levels of ALT and AST and slightly elevated level of bilirubin. Should I be worried?
Test results (2/23/10):
ALT: 135 Units/L (Range: 5 - 37 Units/L)
AST: 69 Units/L (Range: 10 - 37 Units/L)
Bilirubin: 1.1 mg/dl (Range: 0 - 1.0 mg/dl)
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MaryNY- I wish someone with more knowledge would come around to help you out, but they haven't yet. I will share what little I know about liver enzymes and "should I worry". I have had elevated ALT since i started Taxol/Tykerb 10 weeks ago- everything from 100 to 160. It is normal to get elevated numbers with the Taxol/Tykerb treatment but what makes it a little mystifying is that a week before I even started I had 160, which then came down to 101. Now it changes each week- 160, 100, 110, 135. So I asked the nurse if I should be worried that it could be mets to the liver and she said "no, because your bilirubin and AST levels are fine." Now, I don't know what my AST and bilirubin numbers were, but your's don't seem to be wildly high. I know that at least the ALT number can be affected by lots of different things- even a glass of wine some hours before. Another thing I have heard is that liver mets numbers are up in the thousands.
Again, I want to say that I really don't know much about liver enzymes so you might want take what I say with a clip of salt, but hopefully someone else will be by soon!
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Hi krcll: thanks for this information. The radiation onc said she had seen elevated ALT and AST after chemo treatment with CMF. I will be going back for more bloodwork the week after next, so I'm hoping it's improved by then.
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Hi krcll: thanks for this information. The radiation onc said she had seen elevated ALT and AST after chemo treatment with CMF. I will be going back for more bloodwork the week after next, so I'm hoping it's improved by then.
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I had another blood test today and liver enzymes are still high.
Test results (3/15/10)
ALT: 114 Units/L (Range: 5 - 37 Units/L)
AST: 67 Units/L (Range: 10 - 37 Units/L)
Bilirubin: 1.0 mg/dl (Range: 0 - 1.0 mg/dl)Bilirubin is now in the normal range, but ALT and AST are still high and have only dropped a few points from last time. Wondering if the chemo drugs have caused liver damage. I see that high liver enzymes can also be an indication of liver mets. Aagh! but there can be other causes too.
Haven't spoken to my onc about this test yet. Wondering if she will suggest waiting for liver to just correct itself naturally or if she will want to do some other tests or scan or something.
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Mary- Maybe you are dealing with a "fatty liver" situation? The little I know about it, many people have it, you can get it from chemo and it isn't usually something too serious. Has your onc mentioned anything like this as a reason? Otherwise, are you just starting up an ambitious excercise program, taking supplements, drinking alcohol, taking Tylenol? When I was trying to get my liver enzymes down, I heard these thngs can influence the levels. And then several women here have mentioned Tamoxifen- are you on that? I wonder if AIs also affect the liver enzymes?
Anyway, it seems OK news that the enzymes are slightly down for you. When mine were especially high, my onc wasn't so concerned about the level (he said it isn't dangerous by itself) but by the direction they were going. Last week, mine were finally down to 90 (135 and 103 the two weeks before) so I'm officially not worrying about them any more. I'm also eating lots and lots of fruits and vegetables and not too much fat, sugar or carbs just to feel like I am doing everything possible to help out my liver. Who knows if it works?....
Heres crossing my fingers for you, Mary, that everything is fine and that this is just one of those normal variations that a body goes through.
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krcll: No ambitious exercise program here. As far as supplements go, only the ones the onc recommended Vit B6, Vit D3 and Calcium. I don't drink and rarely take Tylenol, although I did take one or two tablets after each Neulasta shot. Although my onc wanted me to start Tamox before beginning rads, I haven't started yet as I felt there might be confusion with all kinds of SEs. I'm glad I didn't start as that would be yet another thing to blame for high levels aos ALT and AST.
Someone mentioned a recent Finnish study that showed that a diet rich in berries may reduce levels of ALT.
"Daily consumption of a range of berries, including lingonberry, sea buckthorn, bilberry, and black currant produced a 23 per cent reduction in levels of an enzyme called alanine aminotransferase (ALAT), a well-established marker of nonalcoholic fatty liver disease (NAFLD), according to findings published in the European Journal of Clinical Nutrition."
So I'm going to start eating more berries. It won't do me any harm and might do some good. There is also another study on milk thistle that sounds interesting - Milk thistle cuts chemotherapy-induced liver inflammation
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Berries are no problem in Norway, but where do you get milk thistle???? Go pick it in the nearest field, or what? I have stayed away from berries while on chemo since I know they are anti-oxidants, so I'm looking forward to eating as many as I want! I'll just have to look up sea buckthorn and bilberry to see what they are....
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Oh, bilberry is just blueberry :-) And buckthorn is a normal berry in Norway- solbær for any scandawegians that should read this.
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The study on milk thistle was done using supplements, the children in the study were given capsules. Yes bilberry is the same as blueberry, though I think they use use the word blueberry usually for the cultivated kind. In Ireland, the wild bilberry is known as fraochán. The berries are very bitter. I'm not
Have you heard of Iscador, an extract of mistletoe, being used as a homeopathic alternative to Tamoxifen? I recently met a Swedish woman who is a breast cancer survivor and that's what she used. Her onc tried to talk her out of it but she went ahead anyway. I hear it's very commonly used in parts of Europe.
I'm not familiar with sea buckthorn. But I've just looked at photos of it online and will be on the lookout for it.
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my daughter has breast cancer. Going through taxol. Her alt is 160. Should give next chemo or wait till normal.
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Ranjana, It's fairly common to have elevated liver levels during (and post) chemo. Don't be shy and feel free to discuss your concerns with your daughter's oncologist.
btw- the steroids were to manage side effects of chemo, I received them prior to the AC-T drugs. All this stuff can play havoc with the liver but usually it's temporary and will (should) be monitored prior to each chemo session.
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