Blood Tests Ordered by Medical Oncologist

Diagnosed with DCIS in July.  Had lumpectomy in August with clear margins from 1 cm to 5 cm and sentinel lymph nodes negative.  In fact, pathology report said no residual DCIS found, only LCIS. Started radiation this past week.  Will see medical oncologist at end of October just before radiation ends.  Had prelim visit with med. oncologist and he suggested I take Tamoxifen as the standard of treatment for DCIS.  Also, my DCIS was strongly ER+ and moderately PR+.  He also ordered up 3 blood tests before my next visit:  a CBC, a Comp. Metabolic Panel, and an LDH which tests for the presence of an enzyme called lactate dehydrogenase (may have the last word wrong). I can see the first two tests, but why the LDH?  From what I could read on the web, the LDH test can show whether there is tissue damage in other parts of the body which can help an oncologist determine if anything else is going on other than what was found during surgery.  Could all of this be the oncologist wanting to establish a baseline for me before I start Tamoxifen and/or to make certain I am in good health before I start the drug?  On the doc's blood test order form, which contains approx. 40 or so tests that can be run, LDH is listed as the third test right under the CBC and the CMP.  This indicates to me that it may be a common test for medical oncologists to order, but I've never heard of it before.

[ncmichigan]

I'm so sorry to hear about your diagnosis, but it sounds like you're getting excellent care.
The LDH test is one of the liver function tests. All drugs are metabolized by the liver and some are harder on the liver than others. I'd recommend discussing this with your doctor, but it sounds like he's probably testing for that rather than anything else. I don't know about tamoxifen specifically causing liver damage, but I think your doctor needs to know if there's any problem prior to starting it. It would seem to be common for an oncologist who will be prescribing any chemotherapy to order it. and monitor it throughout treatment. Each case is individual, of course, and it sounds like your doctor is trying to determine what's best for you and your specific medical condition. Hopefully,
some others may have more information for you, but your doctor is your best source.
I'm wishing you well with your treatment and hoping for a good outcome. Please take care and let us know how you're doing if you wish.
Hugs,
nc

[LadyTE]

You bring up an interesting point.  I am taking Zocor for cholesterol control. And I periodically have to have blood work done on my liver enzyme levels as part of the usual followup when taking a statin drug.  I told the oncologist I was on Zocor, so maybe he wants to make sure my liver is functioning ok.

[ncmichigan]

That sounds very reasonable. It sounds like he's very conciencious and that's a good thing in any doctor, not just an oncologist.
By the way, I was diagnosed with LCIS back in October. I've been unable to start tamoxifen yet because of really severe hot flashes. They started immediately after I went off estrogen at diagnosis. I was only taking 1 mg. and I can't believe it could make that much difference in how I feel. Weak, fuzzy headed, poor memory, saggy skin, no libido, painful sex---the whole ugly lot of symptoms. I've tried vitamin E, evening primrose oil and black cohash---nothing's worked so far. For now I'm getting mammogram and MRI along with clinical breast exam every 6 months. My oncologist says I just may be one of those women who just doesn't feel well without estrogen. The only way I could go back on it is after bilateral prophylactic mastectomeis and I'm just not ready for that yet! I may be some day down the road (I'm 62 now) but in the meantime, I'll just hang in there, try to stay positive and keep doing what I have to do.
Again, my best wishes to you in treatment,
nc

[LadyTE]

So sorry to hear of your problems in going off of estrogen.  I've never been on any hormonal treatments.  Actually, I never had any side effects when I went thru menopause.  Just a few, very, very mild hot flashes, but that was it.  So, I'm a bit anxious to start Tamoxifen.  I sure hope I don't suffer major hot flashes as so many ladies have.  Just finished week 2 of radiation and I'm starting to feel the fatigue.  I just take a nap for a couple of hours, right afterwards, and that helps a lot.  So far, no skin problems.  I've been using creams that nurse gave me.  You take care!  Careful and regular followups are extremely important.

[ncmichigan]

Thank you for your kind wishes. I guess we just all do what we have to do even when Mother Nature isn't so kind to us!
Glad to hear your radiation is going well so far. Hope it continues! Some women don't get severe ide effects from tamoxifen, so I hope you're one of them.
Hugs,
nc