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Suggest Treatment For Elevated Liver Enzyme Levels

Posted on Thu, 15 Jun 2017

Question: 53 year old female had colon cancer 1 year ago removed left side with 25 lymph nodes 2 positive 12 treatment chemo finished January 2017 developed neuropathy 2 weeks after treatment. When port was placed the doctor collapsed my lung. Oncologist nurse called and told I had chronic elevated liver enzymes several weeks after treatment and to see PCP who did sonogram with suspicious area then did MRI with non cancerous cyst? Asked to repeat in 3-6 months due to colon cancer history. My question is that I developed a breathing issue about a month ago about the time the neuropathy started to go up my legs where I could not get a deep breathe. PCP had CT Scan of lungs performed which showed no issues. Now my oncologist does not want to perform CT Scan with contrast that had been scheduled prior to these issues of my abdomen because they checked my liver(mri) and lungs(ct scan). Is there other areas that should be checked in a more thorough CT Scan with contrast that I did not have. My breathing issue has subsided but I developed a pain in my left side, lack of appetite, noisy stomach, and lethargic dead dog tired(not sleepy) symptoms. I went to a regular nurse practitioner who told me my stomach is not on my left side so that bothered me. I also have a colonoscopy scheduled for XXXXXXX Do you have any recommendations of what type of doctor I need to see that will take these symptoms and get to the bottom of this issue.

Answered by Dr. Dr. Ivan Romich (28 minutes later)

Brief Answer:
see next

Detailed Answer:
Hi and welcome to HealthcareMagic.

There are many factors in your case which may contribute to your symptomatology.

First, chemotherapy may have toxic effect for many months after the last cycle.

Toxic neuropathy is possible and common side effect especially if FOLFIRI or FOLFOX protocols were done.

Your lung issue may be related to previous pneumothorax that was caused by port placement. Such incidents may leave scar on pleura and then lungs may not expand properly. This may not be seen on CT scan. This may be evaluated by lung ventilatory tests.

Of course, since you are oncologic patient, metastases should alway be considered and most of them would be seen on regular CT scan. However it would be good to do so called PET-scan which scans whole body and may reveal even small signs of metastases anywhere in the body, including lungs.

Your other symptoms may also be side effects of chemo, but most important thing is to have sufficient nutrition. If you cant take enough calories by food then try to have some supplements such as Prosure or Ensure.

Take vitamins and antioxidants in natural products or as supplements.

In your case, a multidisciplinary approach is required. Your oncologist, gastroenterologist, and nutrition specialist should find the optimal management of your symptoms and future follow-up plan.

We are here to help as well whenever you need us.

If you have any further questions feel free to ask me.

Wish you good health.
Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Dr. Ivan Romich (2 hours later)

Do you consider a pet scan over a Ct scan and MRI to be s better choice for metastasis check ups? My oncologist choice is Ct scan. It concerns me that my unusual low level pain relates to the area that my colon was removed. My pcp doctor recommends MRI of liver in 3 months and my oncologist ordered Ct scan with contrast of abdomen in 6 months. What do you recommend?

Answered by Dr. Dr. Ivan Romich (16 hours later)

Brief Answer:
PET scan

Detailed Answer:
PET scan is most accurate and sensitive diagnostic tool for follow up of oncologic diseases,especially colon tumors. This is not just my opinion,but also official guidelines. MRI is good but not better alternative. Contrast CT scan is not sensitive for tumors smaller than 0.5cm. PET scan will detect all metabolic active nodes and may detect early metastasis.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. Ivan Romich (7 hours later)

I finished chemo in January and felt good several months later. Developed breathing issue about a month ago where I could not get deep breath. Seems to have gotten better but now have low level pain on left side bottom of rib cage with lack of appetite and energy. That is where my colon was removed and the collapsed lung side from port placement. Do you have any ideas on what I can do to improve this issue or type of doctor? Is this stomach issues? Anxiety? The low level pang/pain and lack of appetite is real.

Answered by Dr. Dr. Ivan Romich (13 hours later)

Brief Answer:
everything combned

Detailed Answer:
Hi and welcome.

This may be both stomach or psychological issue. It would be good to see pain management specialist, which is usually neurologist. There are some medications which have sedative, anxiolytic and analgetic effect at same time. This will be sufficient for pain which is not caused by clear organic issues. Loss of apetite is another problem commonly seen among oncologic patients and after chemotherapy. There are anergetic and proteins supplements, but also apetit bossters such as Megestrol Acetate or Dronabinole. These should be prescribed by your oncologist. In every case it would be wise to take antiacid medicines regularly such as Pantoprasol or Ranitidine.
Wish you good health. Regards

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Above answer was peer-reviewed by : Dr. Vaishalee Punj