Blood tests

I`m am to see a new dr. on Monday...an internist. I am (as per Tony`s suggestion) taking copies of my diagnosis as well as my last blood test results. There certainly is an awful lot of info on the 3 pieces of paper I have! Would someone be able to tell me what might be the most important thing to look for on the blood test? My family dr (the one I was designated to see for the next three years) won`t do anymore blood tests because he says I`m cured...."they took the cancer,(one year ago yesterday) no need to worry". Since he wouldn`t even discuss my tests with me I was wondering if maybe someone might be able to point out a few important `things` that I might look for. I would then like to go to the new dr. and be semi-intelligent about what I`m asking....if any of this makes sense? I`m not asking for an interpretation of the report, but I have read a few posts about tumor markers and I`m not sure what those are. I guess I`m just not sure what to look for. And then, how would I know what the `norm` is. There are all these numbers but nothing to say if they are high, normal or low. They really should offer `explanation classes` for non medical people! Thank you for any help you might be able to offer! jamie

When I asked whether my cancer was lobular or ductal recently the doctor asked why I wanted to know.
It beggars belief. Knowledge is power, I refer frequently to Susan Love and learn a huge amount from that resource - but, as I said above, I can`t retrieve the information easily from my memory!
I found that the surgeon (who I never see these days, he`s busy with new cases and quite rightly) was very open and would tell me anything I asked, even when I said that I didn`t know what to ask he`d tell me. Then I`d forget.
The Breast Care Nurses have been wonderful, they`ll explain ad nauseam and never show any impatience, never say that they`ve told me that before. I can contact one at any time knowing that she`ll get back to me. Since they have access to my records they`re better informed than my GP. I love them.

<< Most doctors feel this is of limited value in this situation because it is unusual that the markers show an identifiable change before other symptoms show, and in most cases of recurrence there is not much treatment indicated until symptoms occur anyway. >>
I am not so sure that most dr`s feel that way or that if they do is because of the rhetoric they have been spoon-fed. The reason for that--is that if metastases are detected, the philosophy and emphasis of treatment are no longer curative, but palliative. And the statistics that are quoted indicate that there is no difference in overall survival (as a large group) if metastases are treated `early` or if they wait. What that does, however, allows the insurance companies to reduce their costs and lessen the overall impact that cancer treatment can impact the companies. In other words its a measure of cost-effectiveness, which also plays a significant role in the establishment of treatment protocols. These are not based on an individuals` needs but on cancer patients, overall, as a group. There is more individualization, initially, in terms of basic treatment. Then again, each patient is then lumped into a category, whether or not all the parameters of the individual case `fit` and then they are treated accordingly. Some dr`s individualize the treatment protocol more than others. When it comes time to treat for metastases, that`s a whole `nother issue. If there is no difference in survival if one is treated sooner or later, than why put forth the money to treat `sooner`? The problem with those statistics is that there is no standardization of control for identification of `recurrence.` What some dr`s identify as `recurrence` or even more advanced states of cancer, other dr`s do not. Take for instance one of the conditions of my early scan reports--the first done. It showed several retroperitoneal nodes. The report stated that it wasn`t likely associated with breast cancer. It`s not for 85% of those with the most common type of breast cancer. However, it is the third most common site for metastases for the 2nd most common type--invasive lobular which I had. Then, the size of those nodes--most were less than 1 cm. I was told that they are not considered significant unless they are over 1 cm. Well, those nodes that do get to be 1 cm had to have been less than 1 cm initially. Many dr`s treat for the presence of those nodes. However, there are no controlled studies for such. Then there is the problem of lumping everyone together. The mean length of survival after mets are discovered is about 2.5 to 3 years. Yet, there are many living over 10 years at this time. Many physicians are now starting to look at treatment as a way of control rather than just being palliative. Those physicians are giving patients hope and even feel that a `cure` or method of long-term control may be possible within these patients` lifetime. Some doctors see treatment of breast cancer as an art which must be individualized for each patient. Then there are the others--who treat each in accordance with a single, given standardized `cookbook` plan (prescribed recipe)... Off my soapbox--time to get ready for my training walk--meet at 6:15 a.m. This is for the breast cancer 3 day--60 mile walk. My husband and I are both doing the training walk this morning. I am up now--because of the pain I am in. My non--lymphedema arm. I am guessing it`s mets. It has been hurting now for 30 days straight. I did a little gardening last month--pulling weeds--but was using my lymphedema arm more. This arm started hurting in the shoulder 10 mos ago). I told my onc. at each appt. since; yet he never wrote about it in my charts. It now hurts daily, waking me up at night. I didn`t do the gardening until the day after my appt. in August. I called him after it was hurting for a week. He told me to see my regular dr. My regular dr. was out so I saw another dr. whom I neve saw before. She took an x-ray and ordered an EKG `cause it was my left arm (I was quite sure I was not in need of the ekg but did as suggested). I was told that all was normal. Since it continued to hurt I called my onc., again. He called back (after looking at the x-ray) and said that the internist should have ordered more x-rays since it showed a bony growth (bone spur?). He ordered it. The report indicated changes which I couldn`t quite interpret. We asked for a new PET scan. We received the rhetoric of why it wasn`t indicated. Meanwhile, I saw a private internist last spring. He took my scan reports and films to a private oncologist. They felt as if something were going on back then (when I was experiencing the sciatic pain from the mass or cyst in my spine). However, we were working on getting further CT scan of liver. The private dr`s recommended a PET scan then, but we didn`t turn that request until recently. Meanwhile, I am not unconvinced that what is going on is not mets. If one looks at this logically, it is more likely to be mets than not--particularly in my spine/vertebrae. Of course I would like to believe that they are just degenerative changes related to `age`--exacerbated by the aromatase inhibitor. We shall see...gotta `run`...

understand that my oncologist is looking at the liver function results and the factors that may hint at bone involvement (e.g., alk phos). They don`t seem to do the CA-type tumor markers in my follow-up blood tests. I`m about 3 years post diagnosis, with (as yet, anyway!) no known metastases. They`re having me do blood tests every time I see my medical oncologist -- every 6 months currently -- and at my annual physical with my primary care.
Jamie, there are quite a few web pages that describe blood test results and what the various elements mean. One picked at random (i.e., I`m incompetent to assess it for "goodness" is:
I`d suggest that you try googling something like "blood test results". The actual numerical results (i.e., what specific number counts as "abnormally high" or "abnormally low" will tend to vary by lab (due mostly to differences in testing methodology, I guess), so I`d suggest not relying too heavily on that sort of info on the web. But you should be able to get a general idea of what the various tests mean.
I always ask for a copy of my test results. My primary care uses a different lab than my oncologist, but both printouts have the normal range indicated on the printout, and any abnormal values for me are flagged. I`m surprised to learn that they`re not all done that way!
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