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Topic: Elevated ALP

Forum: Not Diagnosed With a Recurrence or Metastases but Concerned —

Meet others concerned about developing a recurrence or metastases.

Posted on: Aug 5, 2020 10:29PM - edited Aug 5, 2020 10:33PM by KMom57

KMom57 wrote:

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?

Dx 10/2019, ILC, Left, 2cm, Stage IIIA, Grade 2, 8/11 nodes, ER+/PR+, HER2- Hormonal Therapy 11/6/2019 Femara (letrozole) Surgery 2/14/2020 Prophylactic ovary removal Surgery 5/17/2020 Lymph node removal: Left; Mastectomy: Left; Prophylactic mastectomy: Right Chemotherapy 7/30/2020 Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Aug 6, 2020 11:01AM - edited Aug 6, 2020 11:03AM by KMom57

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.”

Dx 10/2019, ILC, Left, 2cm, Stage IIIA, Grade 2, 8/11 nodes, ER+/PR+, HER2- Hormonal Therapy 11/6/2019 Femara (letrozole) Surgery 2/14/2020 Prophylactic ovary removal Surgery 5/17/2020 Lymph node removal: Left; Mastectomy: Left; Prophylactic mastectomy: Right Chemotherapy 7/30/2020 Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Aug 6, 2020 11:37AM SpecialK wrote:

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.

BMX w/ TE 11/1/10, ALND 12/6/10. 15 additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 6/18/13-present. Dx 9/27/2010, DCIS, Stage 0, Grade 3 Dx 9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+ (IHC)
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Aug 6, 2020 12:10PM - edited Aug 6, 2020 12:20PM by KMom57

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.

Dx 10/2019, ILC, Left, 2cm, Stage IIIA, Grade 2, 8/11 nodes, ER+/PR+, HER2- Hormonal Therapy 11/6/2019 Femara (letrozole) Surgery 2/14/2020 Prophylactic ovary removal Surgery 5/17/2020 Lymph node removal: Left; Mastectomy: Left; Prophylactic mastectomy: Right Chemotherapy 7/30/2020 Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Aug 18, 2020 09:31AM KBeee wrote:

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!

Karen. Dx 8/5/2013, IDC, Right, 1cm, Grade 2, 0/1 nodes, ER+/PR+, HER2- (IHC) Surgery 8/26/2013 Mastectomy: Left, Right Chemotherapy 9/20/2013 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 12/12/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 1/23/2014 Reconstruction (left); Reconstruction (right) Surgery 1/29/2015 Lumpectomy: Right Dx 2/2/2015, IDC, Right, 1cm, Grade 2, 0/0 nodes, ER+/PR-, HER2- (FISH) Dx 2/25/2015, IDC, Right, 1cm, Grade 3, 0/13 nodes, ER+/PR-, HER2- (IHC) Surgery 2/25/2015 Lumpectomy: Right; Lymph node removal: Right, Sentinel, Underarm/Axillary; Prophylactic ovary removal Chemotherapy 3/31/2015 AC + T (Taxol) Radiation Therapy 8/25/2015 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy Femara (letrozole)
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Aug 18, 2020 11:34AM SpecialK wrote:

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.

BMX w/ TE 11/1/10, ALND 12/6/10. 15 additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 6/18/13-present. Dx 9/27/2010, DCIS, Stage 0, Grade 3 Dx 9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+ (IHC)
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Aug 18, 2020 11:55AM bcincolorado wrote:

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.

Dx 8/2009, IDC, Left, 5cm, Stage IIA, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 1/7/2010 Lumpectomy: Left; Lymph node removal: Left Hormonal Therapy 1/15/2010 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Hormonal Therapy 1/30/2016 Femara (letrozole)
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Aug 18, 2020 12:16PM moth wrote:

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

Seriously???? “Sometimes the future changes quickly and completely and we’re left with only the choice of what to do next." nevertellmetheodds2017.tumblr.... Dx 12/2017, IDC, Left, 1cm, Stage IA, Grade 3, 0/5 nodes, ER-/PR-, HER2- (IHC) Surgery 12/11/2017 Lumpectomy: Left; Lymph node removal: Sentinel Chemotherapy 2/13/2018 AC + T (Taxol) Radiation Therapy 8/12/2018 Whole-breast: Breast Dx 2/2020, IDC, Stage IV, metastasized to liver/lungs, Grade 3, ER-/PR-, HER2- Chemotherapy 3/17/2020 Taxol (paclitaxel) Immunotherapy 3/18/2020 Tecentriq (atezolizumab)
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Aug 18, 2020 06:50PM KMom57 wrote:

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.
Dx 10/2019, ILC, Left, 2cm, Stage IIIA, Grade 2, 8/11 nodes, ER+/PR+, HER2- Hormonal Therapy 11/6/2019 Femara (letrozole) Surgery 2/14/2020 Prophylactic ovary removal Surgery 5/17/2020 Lymph node removal: Left; Mastectomy: Left; Prophylactic mastectomy: Right Chemotherapy 7/30/2020 Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Aug 18, 2020 11:23PM Halfabanana wrote:

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

Dx 10/24/2012, DCIS, 6cm+, Stage 0, ER+, HER2- Surgery 12/5/2012 Mastectomy: Right; Reconstruction (right): DIEP flap Dx 12/17/2012, IDC, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- Hormonal Therapy 1/20/2013 Arimidex (anastrozole) Surgery 10/24/2013 Reconstruction (right) Surgery 12/26/2013 Reconstruction (right): Nipple reconstruction
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Aug 24, 2020 10:02AM KMom57 wrote:

ALP still rising. MO wants a PET. I’m terrified.

Dx 10/2019, ILC, Left, 2cm, Stage IIIA, Grade 2, 8/11 nodes, ER+/PR+, HER2- Hormonal Therapy 11/6/2019 Femara (letrozole) Surgery 2/14/2020 Prophylactic ovary removal Surgery 5/17/2020 Lymph node removal: Left; Mastectomy: Left; Prophylactic mastectomy: Right Chemotherapy 7/30/2020 Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Aug 24, 2020 10:31AM - edited Aug 24, 2020 10:33AM by KMom57

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?

Dx 10/2019, ILC, Left, 2cm, Stage IIIA, Grade 2, 8/11 nodes, ER+/PR+, HER2- Hormonal Therapy 11/6/2019 Femara (letrozole) Surgery 2/14/2020 Prophylactic ovary removal Surgery 5/17/2020 Lymph node removal: Left; Mastectomy: Left; Prophylactic mastectomy: Right Chemotherapy 7/30/2020 Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Aug 24, 2020 11:01AM KMom57 wrote:

Have a PET scheduled for Weds.

Dx 10/2019, ILC, Left, 2cm, Stage IIIA, Grade 2, 8/11 nodes, ER+/PR+, HER2- Hormonal Therapy 11/6/2019 Femara (letrozole) Surgery 2/14/2020 Prophylactic ovary removal Surgery 5/17/2020 Lymph node removal: Left; Mastectomy: Left; Prophylactic mastectomy: Right Chemotherapy 7/30/2020 Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Aug 25, 2020 05:10PM KMom57 wrote:

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.

Dx 10/2019, ILC, Left, 2cm, Stage IIIA, Grade 2, 8/11 nodes, ER+/PR+, HER2- Hormonal Therapy 11/6/2019 Femara (letrozole) Surgery 2/14/2020 Prophylactic ovary removal Surgery 5/17/2020 Lymph node removal: Left; Mastectomy: Left; Prophylactic mastectomy: Right Chemotherapy 7/30/2020 Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Aug 25, 2020 05:20PM moth wrote:

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 ..

Seriously???? “Sometimes the future changes quickly and completely and we’re left with only the choice of what to do next." nevertellmetheodds2017.tumblr.... Dx 12/2017, IDC, Left, 1cm, Stage IA, Grade 3, 0/5 nodes, ER-/PR-, HER2- (IHC) Surgery 12/11/2017 Lumpectomy: Left; Lymph node removal: Sentinel Chemotherapy 2/13/2018 AC + T (Taxol) Radiation Therapy 8/12/2018 Whole-breast: Breast Dx 2/2020, IDC, Stage IV, metastasized to liver/lungs, Grade 3, ER-/PR-, HER2- Chemotherapy 3/17/2020 Taxol (paclitaxel) Immunotherapy 3/18/2020 Tecentriq (atezolizumab)
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Aug 25, 2020 05:32PM - edited Aug 25, 2020 05:36PM by KMom57

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.

Dx 10/2019, ILC, Left, 2cm, Stage IIIA, Grade 2, 8/11 nodes, ER+/PR+, HER2- Hormonal Therapy 11/6/2019 Femara (letrozole) Surgery 2/14/2020 Prophylactic ovary removal Surgery 5/17/2020 Lymph node removal: Left; Mastectomy: Left; Prophylactic mastectomy: Right Chemotherapy 7/30/2020 Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Aug 25, 2020 05:53PM JavaJana wrote:

as others and your doctor have said, liver function tests are very non-specific and can fluctuate for many reasons. If it is any consolation to you, I do have bone Mets and my LFts, calcium, and phosphorus levels are normal. They had nothing to do with discovering the Mets (PET and pain did).

Xgeva 9/2/2020. History: 2 Borderline Serous Ovarian Carcinoma TAH/BSO, 0/15 nodes - 2/18/20. Benign Papilloma/ADH Left breast, excisional biopsy 10/11/2016 Dx 10/1/2019, IDC, Left, <1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2+ (IHC) Dx 10/23/2019, LCIS/DCIS, Right, 0/1 nodes Surgery 11/18/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right Dx 3/25/2020, IDC, Stage IV, metastasized to bone, 0/2 nodes Targeted Therapy 4/7/2020 Perjeta (pertuzumab) Chemotherapy 4/8/2020 Taxotere (docetaxel) Targeted Therapy 4/8/2020 Herceptin (trastuzumab) Hormonal Therapy 8/12/2020 Femara (letrozole)
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Aug 25, 2020 07:05PM BevJen wrote:

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.

Dx 11/2003, ILC, Left, Stage IIIC, ER+/PR+, HER2- Dx 6/2006, ILC, Stage IV, metastasized to other, ER+ Dx 5/2019, ILC, Stage IV, metastasized to liver, ER+/PR+, HER2- Surgery 7/5/2019 Targeted Therapy 8/1/2019 Ibrance (palbociclib) Radiation Therapy Surgery Lymph node removal: Left, Sentinel; Mastectomy: Left, Right; Reconstruction (left): Pedicled TRAM flap; Reconstruction (right): Pedicled TRAM flap Chemotherapy TAC Hormonal Therapy Faslodex (fulvestrant) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lymph node removal; Mastectomy; Reconstruction (left): Pedicled TRAM flap; Reconstruction (right): Pedicled TRAM flap Hormonal Therapy Femara (letrozole)
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Aug 26, 2020 04:15PM - edited Aug 26, 2020 05:51PM by KMom57

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.

Dx 10/2019, ILC, Left, 2cm, Stage IIIA, Grade 2, 8/11 nodes, ER+/PR+, HER2- Hormonal Therapy 11/6/2019 Femara (letrozole) Surgery 2/14/2020 Prophylactic ovary removal Surgery 5/17/2020 Lymph node removal: Left; Mastectomy: Left; Prophylactic mastectomy: Right Chemotherapy 7/30/2020 Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Sep 2, 2020 09:32AM KBeee wrote:

So glad the PET was normal!

Karen. Dx 8/5/2013, IDC, Right, 1cm, Grade 2, 0/1 nodes, ER+/PR+, HER2- (IHC) Surgery 8/26/2013 Mastectomy: Left, Right Chemotherapy 9/20/2013 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 12/12/2013 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 1/23/2014 Reconstruction (left); Reconstruction (right) Surgery 1/29/2015 Lumpectomy: Right Dx 2/2/2015, IDC, Right, 1cm, Grade 2, 0/0 nodes, ER+/PR-, HER2- (FISH) Dx 2/25/2015, IDC, Right, 1cm, Grade 3, 0/13 nodes, ER+/PR-, HER2- (IHC) Surgery 2/25/2015 Lumpectomy: Right; Lymph node removal: Right, Sentinel, Underarm/Axillary; Prophylactic ovary removal Chemotherapy 3/31/2015 AC + T (Taxol) Radiation Therapy 8/25/2015 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy Femara (letrozole)

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