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Ask Dr. David Your Own Question

Dr. David
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 45216
Experience:  Board Certified Oncologist
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I want to spk to a oncologist

Customer Question

I want to spk to a oncologist
Submitted: 2 years ago.
Category: Oncology
Expert:  Dr. David replied 2 years ago.

Dr. David :

This is Dr. David

Dr. David :

yes,

Dr. David :

what is your question?

Customer:

Hi my dad had a cea blood test may which was 3 then in June the value was 4. It rose by 1 point . Can this mean progression of the disease.

Customer:

He had dukes c1 Colon cancer surgery in march ,

Dr. David :

CEA changes from 3 to 4 is not really a meaningful change

Dr. David :

and most likely does not reflect progression of cancer.

Dr. David :

for dukes C1 after surgery, he should be getting chemotherapy.

Dr. David :

is he getting chemotherapy?

Dr. David :

this can cause his CEA levels to change.

Dr. David :

also smoking can cause elevation of CEA levels above 5

Customer:

He initially did nt want chemo but if all agreed . He's been on xleoda - oral tablets for three weeks only now . Surgery was in march .

Customer:

He is a smoker yes. Should we request a pet scan I is it normal for a 1 point rise to occur in 1 month?

Dr. David :

no, he doesn't need a PET scan just because the CEA changed from 3 to 4

Customer:

He initially refused chemo as worried about the harsh side effects but for sum reason he does not have v bad effects of the tablets Apart from tierdness, pins and needles ?

Customer:

For progression or reoccurence what level should a cea reading usually be?

Dr. David :

CEA levels in the 100s range is worrisome.

Dr. David :

that is good he is tolerating the xeloda

Dr. David :

xeloda can sometimes cause pins and needles.

Dr. David :

he might benefit from neurontin medication.

Dr. David :

best of luck to you and him

Dr. David :

let me know if you have other questions.

if done for now, please leave positive rating below the chat box so I can get credit for helping you today

you can always reach me with "a question for Dr. David" if you have any other questions

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Customer:

Is the oral tablets good for preventinG mets? That's our main worry .

Dr. David :

yes, xeloda can help decrease chances of recurrence and metastasis.

Dr. David :

xeloda breaks down into 5FU inside of the body.

Customer:

When would it be wise to do a pet scan ?

Customer:

Would thebe the tht only test first to detect mets etc ?

Dr. David :

a PET scan should be used once or twice a year for patients who have colon cancer to assess their disease status and when the results could change the direction and course of treatment.

Dr. David :

it is not the only way to detect metastasis.

Dr. David :

CT scans can also detect metastasis.

Dr. David :

and if he is on xeloda, a scan should have been done before he started xeloda

Dr. David :

and when he stops his xeloda, you could do another scan.

Customer:

We asked the oncologisy to do a scan and he said not yet .dont know why.

Dr. David :

I'm not sure why either.

Customer:

Also should a cea level rise like that from 3 to 4 in 1 month?

Dr. David :

perhaps they want to wait until after the xeloda therapy.

Dr. David :

yes, cea can raise from 3-4 in a month without cancer recurrence

Customer:

As surgery was in march shud we get one done privately

Customer:

? Just

Customer:

To

Dr. David :

he is 4 months from surgery.

Dr. David :

no, he doesn't need a PET scan now

Customer:

Check ?

Dr. David :

what he needs is a CT scan of the abdomen and pelvis if he has not had that done.

Dr. David :

has he had a regular CT scan with IV and oral contrast performed of the chest and abdomen and pelvis?

Customer:

Ok. Last ct of abdomen was march after his operation as he had fluid from

Customer:

The surgery . Last chest ct was January .

Customer:

Would a pet detect small tumors and not a ct?

Dr. David :

a PET would not detect small cancers that CT scan with contrast could not detect.

Customer:

Ok . Do u think we should get a scan done then now?

Dr. David :

he is getting xeloda which is oral chemotherapy.

Customer:

If mets were developin or more lymph nodes getting affected, does the rise in cea start slowly then goes up slowley each month ?

Dr. David :

no, CEA of 4 is still normal.

Dr. David :

it sounds like you are very worried and anxious about this.

Dr. David :

he does not need to get a scan now.

Dr. David :

he needs to continue to take his xeloda chemotherapy agent for now.

Dr. David :

let me know if you have other questions.

if done for now, please leave positive rating below the chat box so I can get credit for helping you today

you can always reach me with "a question for Dr. David" if you have any other questions

here is my website if you need to reach me again:

http://www.justanswer.com/medical/expert-dr-david/

Thanks for using JustAnswers.com

Customer:

Ok

Dr. David :

let me know if you have other questions

Dr. David :

if done for now, please leave positive feedback below

Dr. David :

we only get credit for helping clients after positive feedback

Dr. David :

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Dr. David :

is my website if you nee to reach me again.

Dr. David :

thanks for using JustAnswer.com

Customer:

If nodes were getting affected again or organs would the cea b higher?

Dr. David :

yes, the CEA level would be much much higher.

Customer:

Yes worried about this small rise

Dr. David :

don't be worried about this small rise.

Customer:

With 10 nodes which were affected he has a high chance mets right ?

Dr. David :

yes.

Dr. David :

but his chemotherapy is to help him decrease his chances of metastatic disease.

Customer:

Hope he finishes the course as he did not want chemo initially n the family persuaded him. But he started 10 weeks post surgery will that make a difference ?

Dr. David :

no, that is fine to start 10 weeks post surgery.

Dr. David :

at least he started.

Dr. David :

do you have any other questions?

Customer:

Thx a lot

Dr. David :

you are welcome

Dr. David :

please leave positive feedback below

Dr. David :

so I can get credit for helping you today.

Dr. David :

best of luck to you and your father.

Dr. David :

thanks for using JustAnswer.com

Dr. David :

do you see the ratings area below?

Customer:

Last q . what if the next cea shows a further rise to say 5 or 6?

Dr. David :

CEA of 5-6 is not a worrisome level.

Customer:

Ok

Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 45216
Experience: Board Certified Oncologist
Dr. David and other Oncology Specialists are ready to help you
Customer: replied 2 years ago.

Hi dr

Expert:  Dr. David replied 2 years ago.
hi
Customer: replied 2 years ago.

We got the third cea result today which is now 6. So may was 3. June 4 and July 6. We are very worried with this constant rise ?

Expert:  Dr. David replied 2 years ago.
6 is still low.

he is on xeloda which is good.
Customer: replied 2 years ago.

Avdr said this could mean mets ? But ur the oncologisy . But why would it b rising?

Expert:  Dr. David replied 2 years ago.
chemo inflammation can cause the rise

smoking can cause CEA to be elevated above 5

CEA of 6 does not mean mets.
Customer: replied 2 years ago.

But what could b making it rise per month? Could it b cancer agsin in the lymph nodes or liver lungs?

Expert:  Dr. David replied 2 years ago.
the levels are still low

rise of CEA from 3-6 is not a big change.

cancer in the lungs and liver would cause much higher levels

I would not stress on CEA of 6
Customer: replied 2 years ago.

Ok thx. Yes I'm worrying now .cud this mean cancer cells lurking in the body which eventually can cause mets ?

Expert:  Dr. David replied 2 years ago.
no, CEA level is not worrisome like that.
Customer: replied 2 years ago.

What level would be a concerning level?

Expert:  Dr. David replied 2 years ago.
when the CEA is in the >50 to >100 range.
Customer: replied 2 years ago.

Can this rise mean any kind of progression of the disease? May it was only 3?

Expert:  Dr. David replied 2 years ago.
I have said no already

a rise from 3-6 does not mean progression of disease.
Customer: replied 2 years ago.

Ok.so pet scan not necessary yet? What if every month it just increases as so far over three months it has increased ?

Expert:  Dr. David replied 2 years ago.
PET is not necessary.

his levels are still low

they are not at a worrisome level.
Customer: replied 2 years ago.

Will these levels get back to


Normal range Of under 5? Or what can b done to lower them?

Expert:  Dr. David replied 2 years ago.
they are low already.

they don't have to be lowered.
Customer: replied 2 years ago.

Ok. But it says when I read that normal


For non smokers is less than 2.5 and for smokers 5 and under?


Also, the main worry is if it was 3 in may why didn't it remain the same?

Expert:  Dr. David replied 2 years ago.
because even if you had CEA levels drawn in you without colon cancer it could be between 3 to 6 range or even higher.
Customer: replied 2 years ago.

Thx. I read that a persistent rise of cea levels indicates cancer has returned ? As my fathers is jumping up from 3,4 and now 6


Would this not be regarded as a rise?


 


Im getting very concerned as in may it was only 3 so y a sudden jump


 

Expert:  Dr. David replied 2 years ago.
this is not the case

his levels are still too low

CEA is also not 100% reliable.

and many things and any sort of inflammation in the body can cause CEA rise from 3-6

you can't stop worrying about this no matter how much I reassure you.
Customer: replied 2 years ago.
I know I really need to calm down but ad the op went so well And he in xeloda we thought hel b fine but this increase got us all worried again . I know u r an onco n would know more as previously you have been always correct in ur advice .

I should stop worrying right . If next month it gets to say 8,9 is this still normal ? He does smoke alot
Expert:  Dr. David replied 2 years ago.
his doctor is not worried about the CEA up to 6.

only you are worried about this.

I am not worried about a CEA of 6.

he needs to stop smoking.

if next month is CEA is 8 or 9, that would be fine as well. I would still not worry.
Customer: replied 2 years ago.

Yes I agree he's got to stop smoking . We have told him so much . Do u think he needs a ct scan ?

Expert:  Dr. David replied 2 years ago.
no, he doesn't need a scan

his oncologist hasn't ordered a scan

I would trust his oncologist.
Customer: replied 2 years ago.

Could the rise in cea each month mean that there are still cancer cells in the body though? And that all the cells were not removed during surgery ?


It is always possible to catch all the cells at surgery right ?

Expert:  Dr. David replied 2 years ago.
no, the CEA level is low

it does not reflect cancer in the body

you could get a CEA yourself and get a CEA of 6 yourself without a history of colon cancer.
Customer: replied 2 years ago.

The fact that for a dukes c1 they just giving him xeloda alone, is that enough to kill any cancer cells ?

Expert:  Dr. David replied 2 years ago.
it would be bette if he got FOLFOX chemo regimen

but he doesn't want it.
Customer: replied 2 years ago.

Is that diffetent to xeloda? I thonk he was only offered xeloda or the iv form

Expert:  Dr. David replied 2 years ago.
FOLFOX is a regimen of 5FU, leukovorin and oxaliplatin chemo which is better than just 5FU chemotherapy which is the IV version of Xeloda.
Customer: replied 2 years ago.

Ok. I don't know why they did not offer that .I should calm down then right and not worry about the rise? I


Think


Cuz in may it was only 3, we are panicking why it's gone to 6 now in 2 months

Expert:  Dr. David replied 2 years ago.
yes, you should calm down and not worry about the CEA

your doctor is not panicked.

it is still at a very low level.
Customer: replied 2 years ago.

But the worry is that Could this b the start of tumors forming and then as time goes by it will increase more n more?

Expert:  Dr. David replied 2 years ago.
that can happen with any colon cancer, even if the CEA levels don't rise.
Customer: replied 2 years ago.

So this def cannot be mestates right ? Could it b cells left behind during surgery and therefore cea increasing ?


 


We thoughther on the mend then this now happens .Whole family wirried

Customer: replied 2 years ago.

Hi, my dad saw the dr Monday and he did not mention the cea increase even .


 


Fo u think they can look to change the chemo drug if the cea is rising ?


 


How long does it take for xeloda to work? He been on it three week so far

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