Bone metastasis rise in CA2729

[EBP]

In 1983 I had a lumpectomy for breast cancer that was ER+, invasive, small (tumor undetected by mammogram but self-found by palpation),and lymph-node negative.  I was given radiation but no other adjuvant therapy. Bone metastases were discovered in 2002, with no other metastasis apparent in CT scan. I was on Arimidex and Zometa until about 6 months ago when my CA2729 began rising steadily, and my oncologist changed me to Aromasin, continuing the Zometa.  My MRIs and x-rays have since shown no progression of bone metastases, but the CA2729 continues to rise. (My bone metastasis is apparently so slow-growing that it was not detected on the original nuclear bone scan, although subsequent MRIs showed numerous lesions, confirmed as breast cancer metastases by spinal biopsy.) My oncologist says that the next step would be Xeloda therapy, but I would like to know whether there should be a renewed search for different metastases (through CT, PET, MRI, etc.)? Would further metastatic discovery make a difference in treatment?

[CCF-RN,MSN-rf]

Dear EBP: The use of CA27.29 to detect breast cancer recurrence at present is controversial. When other alternative causes of elevated CA 27.29 have been eliminated, an abnormal test result may indicate recurrent disease. However, there has been no evidence to date that treatment based solely on CA27.29 elevation significantly improves overall survival rates. The American Society of Clinical Oncologists (last update in 1997) guidelines state that at present the data are insufficient to recommend routine use of CA27.29 for screening, diagnosis, staging or surveillance following primary treatment. Although an increasing CA 27.29 can detect recurrence following primary treatment, the clinical benefit is not established. When discussing clinical benefit they are talking about will this have an effect on disease free or overall survival? Will the benefit of early treatment outweigh the risks of treatment side effects? The answers or evidence in regards to these questions is not currently available.



Elevated levels may be found in-patients with other diseases such as ovarian cysts, uterine fibroids, intestinal or colonic problems, medication; Paxil, hepatitis, tuberculosis, systemic lupus.



In many clinical settings, this test is not done because it is too difficult to interpret results. In the absence of other information that would confirm disease progression, it makes sense to stick with the current plan. The CA27.29 may not be a reliable enough test on which to base independent clinical decisions.



In other words, we would only change the treatment plan if there was clear evidence of disease progression.  This would be confirmed through bone scans or CT.  When to do these exams is somewhat individual but definitely should be done if there are new symptoms.

[hrhlrh]

I was diagnosed with bone mets in my left iliac crest last Sept. and was taking Zometa and Faslodex. My CA 27-29 was coming down until April, then gradually began to go back up. I had another bone scan in June, after 3 months of rising CA 27-29's, which showed increased activity in several places. Last week, July 21, 2004, the dr. started me on Arimidex because the CA 27-29 popped up 40 points. If this blood marker is NOT a good indicator of advancement of the disease, what is? Just pain? I have no pain the the areas that show increased activity since the first bone scan. But my hip, especially in the exit site area of the radiation treatment, hurts. I am 57 and do know that every pain is not cancer, but the pain is still pretty anxiety-producing. I am getting a second opinion in August. I would like to look at alternative theories and am eating as healthy of foods as I can, although it looks like everything out there causes cancer. Does anyone have any thoughts about this? Thanks for listening.

[Alive125]

A related discussion, Bone mets--Painless lump in skull/scalp was started.

[43lady]

A related discussion, bone mets pain was started.