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Can "CA 27.29" be an indication of cancer recurrance?

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Oncologist, Surgical
Practicing since : 2004
Answered : 59 Questions
I had 2b breast cancer 15 1/2 years ago. It was ER positive and I had 6/13 positive nodes. My oncologist has always done the 27.29 cancer marker test. This past XXXXXXX I went for my yearly check up and my markers were 95. Two weeks later they were 107. I then had an bone scan (clear), Cat scan (clear) and a Pet Scan. The pet scan showed three lymph nodes that lit up. One in my groin the size of a marble, and 2 deep in my chest the size of a pea. I had a needle biopsy on the groin and it came back negative. The onc had me then get an excisional biopsy. It came back benign just hyperplasia. The two in my chest are too deep to biopsy so he put me on aromison. My markers are now 29. So does that mean I definitely have a recurrance and am now stage 4? Or can other things cause tumor markers to rise. I feel fine, but know my days are numbered. IS there any hope in any of this? My onc cannot seem to give me a straight answer.
Posted Thu, 27 Feb 2014 in Cancer
Answered by Dr. Krishna Kiran Kannepalli 13 hours later
Brief Answer: CA 27.29 is not a reliable test. Detailed Answer: Hi. Thanks for the query. Before I answer your question, you need to know certain facts. You have had a long disease free survival. All your tests until now reveal no evidence of recurrence. CA 27.29 needs to be interpreted in the clinical context and not individually. It is very rare for breast cancer to manifest in the groin without being detected elsewhere. Even the excision biopsy you had was probably unnecessary. CA 27.29 should be used only when there is documented metastatic disease to monitor response to therapy. It has no role to detect metastases in the absence of previous metastatic disease. I suggest that you stop measuring your CA 27.29 levels. It is only causing you anxiety without being of any help. Even the NCCN guidelines do not recommend CA 27.29 testing for follow up when there is no metastatic disease. Putting you on Aromasin in the absence of metastatic disease is also not advisable. In case you need a definite proof, the chest nodes can be needle biopsied by EBUS guidance if they are in the mediastinum. I hope I have ansered your query. Please feel free to get back in case of any further queries.
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Follow-up: Can "CA 27.29" be an indication of cancer recurrance? 3 hours later
So it is possible I may not have mets even though my counts were high and now are normal with the aromasin? Why would the chest nodes light up? Thank you.
Answered by Dr. Krishna Kiran Kannepalli 22 hours later
Brief Answer: FNAC can give an answer Detailed Answer: Hi. Chest nodes can light up on PET even if they are inflammatory. One can't rule out or confirm metastatic disease based on PET findings alone. Now a days, EBUS ( endobronchial ultrasound ) guided Fnac of the nodes can be done to confirm the cause. It is a very safe procedure and gives accurate results. I suggest that you discuss it with your oncologist whether it is feasible in your case. This way you can be sure what you are dealing with.
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