Elevated AST and ALT

[sandybliv]

I am a 51 year old, female, breast cancer survivor. I have been taking Tomxifen for the past 4 years.  I was diagnosed in 2000, had a lumpectomy, 13 nodes removed and 3 were cancerous.  I had chemo and radiation and have been doing well since except for elevated liver chemistries.  In September 2003 my AST was normal and my ALT was elevated to 80, my doctor (GI) said lets watch it for a few months.  In October I had more blood work and my AST was 40 (normal) and ALT was normal (60).  I also had a cat scan of liver and that too came back normal.  Each month I have had my enzymes tested and they fluctuated from normal to slightly elevated.  In January my AST was 40 and ALT was 67, in February they jumped from, AST 118 and ALT to 207, that is quite a large increase from my previous tests done in the last year.   I went back in March and AST was 80 and ALT was 159.  I have been taking Tomxifen for the last 4 years and stopped taking it several weeks ago.  I also have been abstaining from my usual glass of wine for about a month.  I do not take Tylenol or anything else except 40 mg of Nexium and two Milk Thistle tablets Daily(100 mg).  

MY GI now wants to do a liver biopsy.  My oncologist was convinced it was nothing to be concerned about, blaming the Tomxifen.  But now after these last readings she too also thinks a biopsy is in order.  I am concerned that we are missing some steps here.  I question that the next step to be a biopsy, when there are other tests that can be definitive., I appreciate my GI’s.  “alarmist” approach but I think that we should look into other scan’s of liver, ultrasound of liver, gall bladder, bladder, kidneys etc before doing such an invasive procedure.

What are your thoughts on my fluctuating liver enzymes?  I am scared that my cancer is back.

[Kevin Pho, MD]

Tamoxifen increases liver function tests in 2% of cases.  Regarding the return of cancer, if the CT scan and ultrasound are negative, it is less likely that the elevation is due to cancer.  

You can do other tests - such as tests for hepatitis - but with the negative imaging tests and markedly elevated ALT/AST (into the triple digits), I agree that the liver biopsy is a reasonable next step.  If the enzymes were below 100, waiting would be reasonable but the enzymes above 100, the biopsy is reasonable.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[sandybliv]

I too had elevated enzymes, it was caused my taking tylenol and having a couple of glasses of wine.

[sandybliv]

also, besides the tomxfin and glass of wine....  I got melenoma on my arm, in September, everything came out alright.

[bbmax]

I agree you could have a CT scan of abdomen and have an AFP lab test to check for poss. tumor activity in liver. A CT or MRI would show something (ie liver cysts, or any poss. malignacy if there is any)...Hope it all looks OK.I am a nurse but also someone who has had scans of liver.
Good Luck

[sandybliv]

thanks bbmax, I am going to proceed with biopsy.  I would rather be informed than not.  Wish you well.