Elevated ALP
Can somebody talk me off the cliff again? In Feb my ALP was 88. In jun, it was at the upper end of normal 114, but my MO said the difference was likely due to the fact that the Feb one was done by a different lab. Now, last week my pre-chemo labs done at the same lab as the Feb test, show an ALP of 118, which is over the top of the range, and 30 points higher than the Feb results. I'm scared. What can cause elevated ALP other thanbone or liver Mets? Edited to add: I've had two surgeries since the Feb results. Could that cause it?
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My MO says that it is something to watch, but if I'm asking how concerned he is at this point, the answer would be “not very much." He said that if I am asking if it's in my bones, the recent bone scan showed nothing of concern. I told him I don't trust imaging because the imaging all missed the ILC in my breast and nodes. He explained that bone scans look at different things. It looks at the turnover in the bone....basically the bone is “making room for" the cancer, and the bone scan detects those changes in (I think he said) calcium deposits or something. I might not have that exact, but basically bone scan is not relying on detecting the cancer itself, but rather the changes In the bones as a result of cancer. He said is it 100 percent accurate? No. But by the time cancer in the bones gets big enough to change the AP, he would expect to see it in the bone scan. I also asked if surgery could change the AP reading (I had two surgeries between my Feb and July labs) and he said absolutely. On the increase in ALT and AST he said that was not a concern. You can run ALT and AST at two different times the same day and get very big differences. I'm still really scared. Any input out there? Edited to add; I also asked if the massive ibuprofen I took after surgery could change the AP and he seemed skeptical about that. Said “potentially.”
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Were you prescribed antibiotics and/or narcotic pain meds with your surgeries? If so, they can be responsible for changes in ALP. So can issues with your gallbladder or parathyroid. How are your calcium and Vit D levels? I had pretty elevated ALP (well above the high end of the range - in the 170's) for about a solid year, and my onc was concerned enough to order a bone scan. I suspected a tooth extraction, but when I asked my maxillofacial surgeon he said that is possible right afterward, but not as far out as I was from that surgery and still elevated. I declined the bone scan and asked to wait, and the ALP did eventually return to the normal range. I am frequently an outlier on labs, and slow to return to normal ranges.
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Narcotics and antibiotics both after my mastectomy. And I took a pretty good amount of ibuprofen for a lengthy period after I stopped taking the narcotics. I still have a good bit of inflammation on one side, and stitches struggling to dissolve. But I'm 9 weeks out of surgery. Should the surgery still be affecting the labs?
On Calcium and Vit D, my calcium is solidly midrange. Vit D unknown, though I did start taking supplements for both after I started the letrozole.
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When you have surgery, you're given a lot of meds for anesthesia, etc. Many of those are processed through the liver. I would not be surprised to see an increase. Look for trends over time. Hoping they return to previous levels!
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It is also important to note that you are currently on chemo, which I did not realize when I responded in the above post - it is pretty much expected that your liver function numbers will be somewhat elevated as chemotherapeutic agents are processed by the liver and the kidneys. What will be more important to watch is how your values normalize once you are done with chemo.
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If that is the only number that is off ALT and Bili are also part of liver function testing as well (husband had a transplant so know that well). Your liver can rebound as well.
If this is the first time your labs are off and if they continue to be off be careful.
I do know that spinach can raise those numbers as well as other dark veggies as well so keep that mind when you are eating and if you eat a lot it can affect your lab work.
Also of course do not drink at all because it definitely affects those numbers.
It sounds like your MO is going to monitor you and assume your PCP gets copies as well (I know ours does) and both can monitor those for you and advise.
Best wishes to you.
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It probably is just due to chemo. But to reduce strain on the liver, consider - with your medical team - reducing/eliminating Tylenol and any supplements. (Ibuprofen/ Advil affects liver less than Tylenol if you need pain relief)
supplements - Are you taking any? I dropped l-glutamine (often recommended for neuropathy prevention on a taxane) because I think it was messing with my liver. Some other supplements can also affect liver fnxn
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Thank you for the responses. The ALkaline Phosphatase is the only number off, but it was pre first chemo lab so the chemo isn’t causing it. My MO says it’s a non-specific level, so it could be just the surgery. But he will watch it as it’s also elevated with both bone and liver issues. I don’t know. I can’t help but worry.0
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Hi KMom,
I didn’t have chemo, but my ALP has been consistently high for the past three years, approaching 200 most of the time. I have quarterly labs because of it and see my gastroenterologist every six months. When it first started, he ordered a bone scan which was clear, additional liver labs, and an abdominal CT. Nothing was of note aside from a fatty liver. Over the last 18 months, I have also had abdominal ultrasounds, with one scheduled for October. The last two ultrasounds have caught a gallbladder polyp, which needs to be monitored, as it can be pre-cancerous if it grows to a certain size. I even had a liver biopsy a year ago. My mother died of non-alcoholic cirrhosis. I asked him if I could be someone who just has an elevated ALP for no reason, and he said that it is always an indicator of something, which simply has not yet become evident. If evidence of cirrhosis is found, he can start early intervention. I just hope it isn’t a recurrence brewing I’m hoping that with all your treatment, it is just a side effect for you
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ALP still rising. MO wants a PET. I’m terrified.
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The rest of my labs, including calcium, were fine I was told. What needs to be done to track this down? I asked for Vit D test. I don't know what else I should be doing. I had a bone scan in June, an abdominal CT in June. Both clear. I just never trust imaging because it missed my ILC in the breast for so long. Is there something else that can be/needs to be done? Anybody know?
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Have a PET scheduled for Weds.
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Feeling so scared. If there were Mets causing my ALP rise, wouldn’t it show on the Bone Scan and CT I just had in late June? The CT said the “Liver enhances normally without any suspicious lesions.“ The ALP had already risen when I had those tests.
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the waiting is so hard, isn't it? Is your ALP still elevated? Every once in a while this spring I had repeat LFTs pulled within a couple days and there was a bit more variability & fluctuation than I expected. Hoping yours was a weird aberration ..
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Yes. It actually increased 11 in three weeks. I've been over and over my last CT and bone scan and of course pulling all sorts of things out to worry about. The CT noted an enlarged left supraclavicular node, and a periaortic node, both below the threshold for lymphadenopathy. My MO said it was to be expected as I was just out of surgery, but of course now I'm wondering. CT also noted two bone lesions which MO said were tiny and were bone islands. Literally nothing else was mentioned on CT except post ALND axillary changes. Everything else is normal normal normal normal. But I'm so scared. I was taking a lot of pain meds when I got that first high ALP. And I’ve had two chemo infusions since then. None of my other labs are off except glucose. It’s always high.
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K Mom,
Obviously, I'm not a doctor, but most of the time my LFTs are all normal, and I've got bone mets and liver mets. My ALP did jump last summer -- it was in the 140s, if I remember correctly -- after I had a microwave ablation of my largest liver lesion. It gradually came down, and it's in the normal range now, but it does jump around there a bit. Last summer when I asked about it, my MO said -- it's not that high -- we'll watch it, but I'm not concerned.
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BevJen and JavaJana thank you both. I haven't talked to my MO yet, but he did text shortly after my PET today that it was “normal." Still worrying but a little bit less than this morning. After I have a chance to ask specific questions, hoping I will be able to let it go. So hard to do. Edited to add: I talked to him. He said nothing lit. That sometimes the ALP rises due to chemo, inflammation etc and that’s what we should assume has happened in my case.
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So glad the PET was normal!
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Posting here since I have been also dealing with elevated ALP. The first time was 6 months after finishing chemo and radio, while still on Herceptin, and six months after starting an aromatase inhibitor, Arimidex (Anastrozole); It was 157; then, for the next year I had labs almost every month, and it stayed in the high end of normal, in the 90s or low 100s. Then Covid came, no labs in ten months, and when I got the next labs, again elevated, 129. Freaked out and asked for a bone scan. It just came back as "No scintigraphic evidence of osteoblastic metastatic disease" i.e., clear (I am jubilant!) but with areas of "uptake" here and there, explained as "likely benign" and "likely degenerative"; I wonder how they can tell what is what but hey, I will take it. Phew! It has been a very stressful week/month.
Best to all,
LaughingGull
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Glad you got good news Laughing Gull!
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