High Liver Function (AST and ALT ) Tests

[Gene]

My wife's been on chemotherapy for about 1 YR for breast cancer with mets to the liver. She started on Xeloda, was moved to Abraxane + Carboplatin + Avastin, and 3 months ago to Doxil. On the first two regimens, there was improvement at first. The abraxane + did so well for a time that at the last reading in early November no tumors in her liver were greater than 8mm and there was only one under 2mm spot left outside the lobes. But the radiologist did say they were "numerous" in her right and left lobes, and some were new compared with two months earlier. This prompted the oncologist to move her to Doxil. She's been tolerating Doxil well. Better than the earlier regimens.

Preparatory to her fourth four-week treatment yesterday, her blood was tested and showed AST of 97 and ALT of 99. For the past 3 months, the AST has been 41-48, and the ALT has been 29-50, The last readings a month ago were AST:48, ALT:44.

The oncologist said he didn't know yet what this means, but we're fearing it indicates tumors are spreading in the liver. We have scans scheduled, but not until mid February. Meanwhile, we are very anxious.

Are there any other likely possibilities that are less worrisome than tumor spread in the liver ?

[CCF-RN,MSN-rf]

Dear Gene:  When liver enzymes become elevated in the setting of known liver metastasis, there is obvious concern that the liver disease is progressing.  Other things the doctor will consider are whether she is taking any medications (including chemotherapy and other medications) that may also cause elevated liver enzymes.  Xeloda can sometimes cause an elevated bilirubin level but the other drugs do not commonly cause any abnormalities with the liver enzymes.  The scans and future blood tests will help her doctor to clarify the cause and significance of her elevated liver enzymes.

[Gene]

Thank you for your answer. Let me ask one more thing if you don't mind. It's important to us.

We're going on a cruise for 8 days. My wife likes her wine. Is it possible for her to have some, say a glass a day, or is it too much risk given the situation.

[lizziecee]

Hi Gene -
sorry your wife is having to cope with bc mets - I don't have them as yet, but having specialised blood tests Monday for hemochromatosis as my gastro suspects liver problems (I also have Crohn's).Don't know whether the breast cancer or Crohn's will get me in the end, but I am going to have a good time living until then.
Wine - I didn't even drink until I was about 30 yrs old, but do like my white wine with dinner.  I have just lost a wonderful friend to Crohn's and pancreatic cancer, at 41 yrs old, but she still had her glass (or two) of wine every evening. I do believe there has to be quality of life,especially in the face of the life threatening illnesses we have to cope with and if your wife is going to enjoy a great cruise, let her have a glass of wine, without guilt! I will raise my glass to her and hope she has many years to live.
Liz.

[boninclyde]

Please tell your wife to have a glass or two of wine. She still can enjoy life. I am not a doctor but they say some wine is good for you. Have a great time. Also there can be age spots on the liver which show up on scans and have nothing to do with liver cancer. There are lots of women at breastcancer.org who have been through the same thing and it was nothing.

[Gene]

Thanks so much for your comments and best of luck with your coming blood tests and your conditions. We've been leaning in the direction you suggest, and will probably go that way. We're hoping as well for some medical basis to ease, as you put it well, feelings of guilt.

[Gene]

In my wife's case, liver mets were confirmed by biopsy as well as subsequent scans. The question we had now, brought by the recent liver function test, is: have the mets spread since the last scan ? The answer seems to be: probably yes. We'll have new scans after the trip.

Thanks for your suggestion. We are putting a high value on my wife's quality of life.