Brief Answer:
Could indicate a decrease in burden of cancer cells

Detailed Answer:
Hi XXXXXXX thank you for using Healthcare Magic. The CEA is used as a test to follow to see how the cancer is responding to treatment. If a person has a high CEA known to be related to the cancer he has, a decrease in the level after receiving chemotherapy could indicate that the therapy is working and that many of the cancer cells have been killed.

Of course there could always be a lab error but the fact that is dropped after a couple of rounds of chemo suggests that the response is real. Unfortunately this does not mean a cure, but it could indicate that a remission is very possible with this rapid response.

If a remission is achieved, the CEA will be followed periodically. If it starts to rise again, that would be an indication that the cancer is coming back.

Consider this is a positive event at this stage and hopefully it will continue. Hope this answers your query. If you have further questions, I would be happy to answer them.

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Brief Answer:
A brief jump can occur initially

Detailed Answer:
The CEA was probably on its way up when the first treatment occurred, and there was a delay in the response after the chemo, which is not unexpected. There will most likely be more levels checked to confirm if the trend is downward.

Both treatment and the cancer itself could cause a drop in the platelets, white cells, and hemoglobin. Depending on how low the levels are, yes, it could be dangerous. Platelets less than about 30,000 can be associated with spontaneous bleeding. White cells under 500 to 1000 or so could be associated with serious infections. A low hemoglobin puts a lot of stress on the body because oxygen-carrying capacity is reduced. At what level this becomes a problem depends on other underlying problems. For example, an otherwise healthy person could tolerate a hemoglobin of 7 or 8, though they wouldn't feel very good, but a person with a weak heart or lung problems could be severely compromised and require oxygen and blood transfusions.

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Brief Answer:
The numbers don't matter as much as the trend.

Detailed Answer:
Whether you consider the drop to be from 80 or 65 down to 55 don't really matter. What is important is the trend- if it continues to go down, then that is a sign that the cancer is responding to the treatment. Since it is known the metastatic cancer is present and that in this case the CEA is a good marker to indicate how the cancer is progressing, the height of the level is pretty much irrelevant as long as it continues to go down. It is difficult to say anything about the level of 80 since it occurred so early in the treatment, but the decrease to 55 is reassuring. However, it will be the next measurement that will really give a true idea of whether there has been a good response. If it goes back up, or is going up and down, then the response may not be as good as hoped. But if it is lower again, then you can be more assured that a downward trend has started.

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Brief Answer:
Chemo can cause these changes

Detailed Answer:
Yes, chemotherapy is well known to cause the side effects of low hemoglobin, platelets, and WBC. That is why during chemotherapy, these tests are very closely monitored. A low WBC level significantly increases susceptibility to all sorts of infections, so IV antibiotics would be quickly started if the numbers are low and fevers are occurring. A search for the exact type of infection would be started, but antibiotics are initiated right away as a bacterial infection could progress very rapidly and it may take time for test results to come back.

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Brief Answer:
Yes, it could be sepsis

Detailed Answer:
Sepsis is a major concern in a person who has low blood counts with chemotherapy and cancer. That is why IV antibiotics were started. Low blood pressure and fever can be associated with sepsis, which is a general term for a severe infection that has gotten into the bloodstream. The low WBC count has made him very susceptible to bacterial infections because it indicates his immune system is not working well. This is truly a very worrisome situation as sepsis is life-threatening. Broad-spectrum antibiotics are started immediately to control the infection, which seems to have been done in his case. This was the most important thing to get started. You will have a better understanding within a day or 2 if he is getting better or worse. The BP is not at shock levels, which are much lower and would signify a worse prognosis, so this is reassuring that treatment was started in time. This is a difficult time for you and him so try to keep up your hope and get support from family, friends, and chaplain if necessary.

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Brief Answer:
It may take a day or 2 for a response to treatment

Detailed Answer:
It usually takes a day or 2 to respond to antibiotics with a decrease in temperature when sepsis is present. If the antibiotics were recently started, then it is not unexpected that the temperature will fluctuate awhile. That is why I say you should be able to know in a day or 2 which way this is going. If he is still having fevers after 48 hours of treatment, this might be an indication that the treatment is not working or that another antibiotic is necessary. By then the results of the tests should be back, and the doctors will know which bacteria are the cause and exactly what antibiotics should be used. In the first few days, vital signs are unstable during sepsis, but once the antibiotics kick in, the vital signs will stabilize. This period of time is the most scary. because there is no way to know what the outcome might be. For now, all we can do is pray for the best result.

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Brief Answer:
BP of 90 to 110 considered normal

Detailed Answer:
A blood pressure of this level is within normal limits, although 90 is at the lower limits of normal. If it starts getting into the 70s or 80s, this is considered shock and is an indication of severe sepsis. Infection could occur from anywhere, not just from a flu. Normally there are bacteria present in the body, such as the skin, mouth and gastrointestinal tract. When the WBCs are very low, the immune system is not able to keep these bacteria under control. Also bacteria that enter the body through skin lesions or catheters and would normally be killed by the immune system, could more easily spread and get into the bloodstream. Sepsis is treated with antibiotics. He was appropriately started on them. It is reassuring that liver and kidney tests are normal. With severe sepsis, damage to the liver and kidneys occurs and the tests will be abnormal. The doctors will be closely monitoring these tests to be sure the situation is not getting worse.

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Brief Answer:
Abnormalities related to the liver mets

Detailed Answer:
These are liver tests which can be abnormal because of the liver mets. Since one has decreased, I doubt this is related to sepsis. Liver tests can vary a lot depending on the ongoing situation. Drugs such as chemotherapy can put a lot of stress on the liver and that is probably why the levels went up. The ALP could also get high because of a blockage in the liver, and the drop could indicate this blockage has cleared up. In his case, the liver tests are too nonspecific to give any idea of the status of the sepsis, and are likely related to the mets and chemo.

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Brief Answer:
This is a very big drop

Detailed Answer: XXXXXXX I know that you are very scared and worried with a relative so sick, but asking all these questions of doctors who don't really know the case (I noticed you have asked similar questions of 2 other doctors here at HCM in the last few hours) is not the best idea, since we are only guessing at the situation.

You have a right as a family member of a very sick person to demand that one or more of his caregivers sit down with you and answer all of your questions and give you frequent updates on his condition. Do not be afraid to insist on this. The doctors taking care of him know his situation best and can tell you the most most accurate and current status. Some hospitals also have patient care advocates that can intercede to help you get the best idea of how the situation is unfolding. Check to see if this is available at your hospital.

The drop in ALP doesn't really indicate anything good or bad, it's very nonspecific in this setting. But a drop in hemoglobin from 8.7 to 6.7 in one day is very severe, and is the equivalent of bleeding out of several units of blood. It could also be due to excessive fluids being administered, or other conditions. I can only guess at the possibilities, but his caregivers should have a better idea of what may be happening. I imagine they are probably doing other tests to figure it out and may be very busy, but one of them needs to take the time to meet with you and your family and let you know exactly what is going on.

Please insist on getting this to happen.You should not have to go through the pain of knowing how sick he is without getting some definite answers specific to his condition and an idea of what they think his prognosis is. We can certainly help by answering whatever questions we can, but you need the additional support of people physically present who know what's going on moment to moment. I hope this is helpful; I strongly empathize with you about this very distressing situation.

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