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What causes decrease in CEA after round 2 of chemotherapy?

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Posted on Sat, 30 May 2015
Question: What can a small
Cea decrease after round 2 of chemotherapy mean ?
doctor
Answered by Dr. Vivek Chail (28 minutes later)
Brief Answer:
The decrease in CEA means the chemotherapy is trying to stabilize disease

Detailed Answer:
Hi XXXXXXX
Thanks for writing in to us.

I have read through your query in detail.
Please find my observations below.

1. Hope your father is doing well and his general condition has improved after round 2 chemotherapy with oxaliplatin and raltitrexed.

2. The decrease in CEA can mean that the chemotherapy is trying to stabilize the disease.

3. In other words, the chemotherapy is doing its job and trying to control the tumor progression and extend survival. However the real tumor progression can be commented only after complete treatment cycles are given.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (45 minutes later)
Hi im so glad I heard from u.

As u know cea before chemo was 65, then jumped to 80 and now after 2 rounds it is 55.

Is this a very little
Reduction ?

The appetite issues remain bad he is now Infact 54 kg from 64 kg before the chemo . Oncologist has
Just advised nutritional
Drinks .
doctor
Answered by Dr. Vivek Chail (19 minutes later)
Brief Answer:
Increase his appetite slowly by giving him choice of foods and juices

Detailed Answer:
Hi XXXXXXX
Thanks for writing back with an update.

1. The CEA had shown transient rise from 65 to 80 after first cycle and then back to 55 after second cycle shows that treatment response might be there even if small.

2. Chemotherapy for your father right now can show results in 3 different ways
(i) There can be disease progression
(ii) There can be disease stabilization
(iii) There can be disease regression

3. If CEA levels have come down and he does not have any alarming symptoms like fever or abnormal liver function then it appears that the chemotherapy is working.

4. Let him include foods which he likes and preferably those which will give him proteins and avoid indigestion. Fluids and juices are easily digestible for him.

5. Concerning his appetite if you provide things which he like to eat and if most of it is healthy then he can increase his appetite slowly.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (5 minutes later)
ALP remained the same. Bilirubin was 10 and ALT however was 135?

No fever but fatigue n appetite issues

So would you count from 65 to 55 and not from 80 to 55 right ?
doctor
Answered by Dr. Vivek Chail (10 minutes later)
Brief Answer:
CEA must be watched until fourth cycle

Detailed Answer:
Hi XXXXXXX
Thanks for writing back with an update.

1. The live enzymes will show an accurate picture 4 to 6 weeks after chemotherapy and if ALP is stable then it is good.

2. Bilirubin shows a more direct indication of liver functioning and this has to be carefully monitored. ALT is slightly high but this has no particular significance right now. If there is no fever then last time it was only a reaction to chemotherapy.

3. The CEA has decreased from 65 before treatment to 55 following therapy and must be watched after 4 cycles of chemotherapy. Right now it is just fine that there is a decrease but sometimes it can start rising after fourth cycle of chemotherapy and that is a concern.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (38 minutes later)
So this drop can mean other things too ?

Are there new drugs at all in the pipe line ?
doctor
Answered by Dr. Vivek Chail (17 minutes later)
Brief Answer:
CEA trend is more important and your father is showing response trend

Detailed Answer:
Hi XXXXXXX
Thanks for writing back with an update.

1. The CEA is observed as a trend in the course of treatment and not as a single value at a particular time.

2. In your father the CEA was 65 then it increased to 85 which can be related to transient rise during chemotherapy. Then it has started to decrease and is presently at 55. This means sort of a good news that CEA levels are following a trend of response to treatment.

3. New drugs are under development at any point in time but these require to undergo trial before including them for treatment. The chemotherapy medicines being given are trusted and known to respond in many patients. It is best to continue with the medicines that he is getting right now.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (21 minutes later)
Ok thx

So decease of say 10 points is that small ?

Also how come after round 1 it shot up to 80?

If can do chemoembolization would that increase survjval further ? Can the chemo put a patient in remission at all ?
doctor
Answered by Dr. Vivek Chail (4 minutes later)
Brief Answer:
Rise after first cycle shows that chemotherapy is working

Detailed Answer:
Hi XXXXXXX
Thanks for writing back with an update.

1. The decrease of 80 to 55 is significant. What I mean is that it must be watched till fourth cycle.

2. The rise after first cycle happens in many patients and shows that chemotherapy is working.

3. Chemoembolization is not possible due to the multiple nature of lesions in liver. Chemotherapy can put a brake but will not get it back to normal.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (24 minutes later)
Ok
If chemo
Works can it shrink them?

We are uk but Germany dr is able
To do TACE on liver and TACP for peritoneal nodules. Should we go for these ?
doctor
Answered by Dr. Vivek Chail (3 hours later)
Brief Answer:
Review of liver and peritoneal lesions is important before TACE and TACP

Detailed Answer:
Hi XXXXXXX
Thanks for writing back with an update.

1. It is important to know how many cycles of chemotherapy have been suggested and when will they review the response to chemotherapy.

2. TACE and TACP might extend survival by 11 to 14 months

3. Since the appearance of the liver and peritoneal nodules are expected to change with chemotherapy therefore a review of the post chemotherapy liver and peritoneal lesions is important when you discuss with the Germany doctor.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (18 minutes later)
How would the appearances change with chemo if worked ?

Can ppl
Survive even 3/5 years ?
doctor
Answered by Dr. Vivek Chail (20 minutes later)
Brief Answer:
1 in 10 patients of stage 4 cancer colon might survive for 5 years or more

Detailed Answer:
Hi XXXXXXX
Thanks for writing back with an update.

1. After chemotherapy the lesions might reduce in size, number and distribution.

2. The peritoneal nodule might show decrease in size.

3. Patients under recommended treatment and good supportive care might survive for 5 years or even more and this is possible in 1 out of 10 patients (roughly 11 percent in a research study done on colon cancer patients from 2004 to 2010). Hope your father responds well to the chemotherapy he is taking.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (2 hours later)
Ok
Thx a lot . But a decrease from 65 to 55 is small right ?
doctor
Answered by Dr. Vivek Chail (7 minutes later)
Brief Answer:
It might be small but is significant and promising

Detailed Answer:
Hi XXXXXXX
Thanks for writing back with an update.

1. It might be a small decrease but significant.

2. Where irinotecan has failed to show a response we find oxaliplatin and raltitrexed promising.

3. I hope it decreases more and reaches 45 after another cycle.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vivek Chail (2 hours later)
I forgot to ask . Yest his third cycle he had severe arm pain and was getting fast breathing . Drs came in and left the remainder of the chemo ( half hour of it left ) And gave a painkiller - morphine

What could this be ?
doctor
Answered by Dr. Vivek Chail (5 hours later)
Brief Answer:
Pain and shortness of breath during chemotherapy are present in some people

Detailed Answer:
Hi XXXXXXX
Thanks for writing back with an update.

1. The chemotherapy agents are strong medicines which have side effects.

2. Pain in the arm and shortness of breath are temporary symptoms which might be experienced during chemotherapy infusion. Morphine is a strong pain reliever.

3. The pain should improve within hours of chemotherapy. If the pain persists and there is development of swelling in the arm then please inform his doctor to check for any clots in the veins of the arms.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Vivek Chail

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Practicing since :2002

Answered : 6839 Questions

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What causes decrease in CEA after round 2 of chemotherapy?

Brief Answer: The decrease in CEA means the chemotherapy is trying to stabilize disease Detailed Answer: Hi XXXXXXX Thanks for writing in to us. I have read through your query in detail. Please find my observations below. 1. Hope your father is doing well and his general condition has improved after round 2 chemotherapy with oxaliplatin and raltitrexed. 2. The decrease in CEA can mean that the chemotherapy is trying to stabilize the disease. 3. In other words, the chemotherapy is doing its job and trying to control the tumor progression and extend survival. However the real tumor progression can be commented only after complete treatment cycles are given. Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek