blood work prior to chemo

My husband has recurrent head and neck cancer with metastasis to lung, upper esophagus.  He has had radiation and now chemo.  Two weeks ago, he was unable to have treatment due to elevated liver enzymes.  Two improved , but last week his alkaline phosphate (sp?) was over 500.  He had a bone scan which showed nothing definitive.  Doctor opted to do no further testing.  Should I be concerned or push for more testing?

[Fernando Roque, MD]

Hi.  In your husband's case, the elevated alkaline phosphatase (ALP) can mean either liver damage (probably from the chemotherapy) or from bone metastases.  I am more inclined to think that your husband's elevated ALP comes from liver damage, since other liver enzymes are also increased, and the bone scan did not yield any signs of bone metastases.  The fact that two of the liver enzymes have started coming down probably means that his liver is beginning to recover.  Sometimes it takes a while before the ALP comes down as well.  I wouldn't be too concerned at this point, but I would probably order a repeat of the liver enzymes and liver function tests before resuming chemotherapy.