Patient replied :
What I really want to know, is if, after all of those negative scans, just two months ago, there could be painful cancer so soon in the pelvis? Wouldn't it take time for the cancer to grow, before it could become painful? And on both sides of the pelvis? And wouldn't it take longer than just two months to go from negative to a situation where it is painful?
This pain tends to hurt more in different places at different times. Hurts more when I sit in a chair (because I am sitting on a sore part). I have not tried analgesics, so I don't know. It does NOT usually hurt at night.
From your description of the pain and previous negative scans, I would definitely NOT think of it being due to cancer in your case. It may be something else. Please consult with your doctor for a physical examination, which you may need to ascertain the cause of pain if it is not due to Neupogen.
Patient replied :
I know you told me you don't use tumor markers in your part of the world. I also know they are considered unreliable, but that isn't helping me right now. I'm hoping you can help me with this. My ca 15 3 is 42 and my doctor seems worried about it. He says it is bad to have elevated markers. I had hoped it could be elevated just from the inflammation of surgery, but he says general inflammation won't raise it. I don't know why it could be raised, if metastasis has not already happened, or is not right around the corner. I don't have any of the normal things that cause false positives (except I have a small benign ovarian cyst, that the doctor says is not enough to raise it). There was a study done that says neupogen can raise the ca 15 3 marker, but my doctor doesn't believe that either. I know 42 isn't that high, but my surgery was in January. My last measure of the tumor marker was in April, and it was 42 (it had been 69 in March). I am really scared. I have such a good ALLRED score (8)--and now it may be too late to cure me. The metastasis may already be happening. Help!
I really wish that general inflammaton could give a false positive, or that neupogen could. But, as I said, I have a really good doctor, and he doesn't believe those can do it. I feel doomed.
Any Oncologist would really not consider Ca 15.3 levels in an adjuvant setting at all (IN ANY PART OF THE WORLD). Even if it is elevated, I will not bother as it does not interfere in the treatment / prognosis / metastatic work up.
The treatment in your case is pretty standardized and you are given the best possible treatment as proven by scientific evidence. Moreover the good ALLRED score is what is going to help you with hormonal therapy. You have multiple options of hormones even if the first line fails (which is a rare phenomenon).
Please be doubly assured that you are going to be VERY FINE and the treatment is going to be fine with you.
Patient replied :
Thank you so much.
But, now that the tumor marker HAS been considered, and I know that it is elevated, it makes me worry that I am going to have metastasis soon and my good ALLRED score will not get to help me. The good ALLRED will be wasted, if I don't get to the AI's before the metastasis starts, and my understanding is that if the tumor marker is raised, metastasis is just around the corner. (even if it is only raised a little bit). (I cannont start AI's until I have my second surgery and radiation is finished).
I understand what you are saying, that knowing the tumor marker doesn't change the course of treatment. I guess it is just that I am scared that it indicates that we are going to find metastasis soon. Do you think that this is true?
Please let me know why should you think in this aspect. Allred score remains till a negative hormone biopsy is reported in any of your specimen ( which is never going to happen ).
You can discuss with your oncologist if you can start on AI during radiation. There is no harm in doing that but at the same time, no evidence to say that early AI is beneficial. It remains the same as such with both modalities. I can reassure you that everything is going to be OK with you as your prognosis is going to be good because of your Allred score.
Would be glad to answer any further queries.