alkaline phosphatase

[CatLady2022]

So I read somewhere after googling can cancer be detected on regular CMP panel because I had a CMP panel in October 2021 (normal) and then X-rays in January 2022 (also normal). I had a chest X-ray, lumbar spine X-ray because I fell in my house and feared a broken bone. All clear. Neither blood work or X-rays were concerning to my GP. I was diagnosed stage IV metastatic immediately following Covid in mid March 22. Covid so mild the only symptom I had was extreme groin pain where I had to sit with a heating pad between my legs. This puzzles me still one year later so I asked onc if cancer can be found on normal X-rays of lumbar spine. She said sometimes but not always. So I googled to see if cancer can be found in blood work because I had a normal CMP in October 2021. My MBC is only in my bones but spread so much that my oncologist didn’t know how I was still walking when I first saw her after an MRI was done (late March, 2022) diagnosed me metastatic. So yes, blood work may sometimes show bone problems including cancer on CMP panel. It shows in the Alkaline Phosphatase being high. So I went back on all of my CMP tests beginning October 2021. Here are the results.

Alkaline Phosphatase levels

106 normal 10/21

I had mild case of Covid 3/22

151 high 4/22

Treatment with verzenio/letrizole began first week of May 2022

200 high 5/22

229 high 6/22

139 normal 7/22

140 normal 8/22

122 normal 9/22

108 normal 10/22

107 normal 11/22

95 normal 12/22

84 Normal 1/22

80 normal 2/6

I don’t remember the exact date I began treatment with verzenio/letrizole but I would imagine it was sometime after diagnosis and after they ran all tests, scans, including a bone biopsy to confirm metastasis. I need to look back on paperwork to get that exact date. Closest I can get to exact date is first week of may 2022.

I’m still confused! Maybe I will never understand.

[Silver126]

I had normal Alkaline Phosphatas levels when I was diagnosed in 2020. It went up when I started Ribociclib + Letrozole. My oncologist told me the rise was treatment related. She was right, it came back to normal levels when I had progression on Afinitor + Exemestane and now it’s again rising with IV chemo Caelyx which is working (basing on scans). I thin I’ve understood that Bloodwork results are to be analyzed as a whole and the rise of a single enzyme sometimes isn’t so important. Did you ask your oncologist?

[CatLady2022 in reply to Silver126]

Yes I asked her and her response was that if it was Covid related, we would probably never find out for sure. I’m not trying to say Covid causes this to happen to every person but I think it happened to me. Would knowing change things for me, not medically speaking but it would in my head because, I’m worried cancer will be inherited to my two kids. I’ve done genetics testing twice, once with my first round of cancer in 2014 where the basic genes that causes breast cancer were tested and then again with caris testing a few months ago where only one gene raised slight concern. I never had any of the risk factors for BC. Never drank, never smoked before BC, ate extremely healthy after BC. Unless cancer for me is environmental which is always a possibility for everyone, I guess I’m still looking for an excuse ya know. Don’t y’all wonder why and maybe if not for my two kids and the worry I feel for them going forward, maybe I wouldn’t worry so much but I can’t help that mother worry in my head keeps talking. 😂

Is your cancer in the bone only?

[Andersl in reply to CatLady2022]

My alkaline phosphate rose from normal to very high after I started my first round of chemo. Its an expected side effect of treatment. Rest assured its no indicator of genetic susceptibility to cancer.

[TammyCross in reply to CatLady2022]

When I first had breast cancer in 2008 (no recurrence until 2019), I asked my breast surgeon, who was much more attentive than oncologist, and she said anyone can get it now, and it is widespread, because of the degradation of our environment, not our specific risk behaviors. It is a very American thing (or maybe Western) to blame the individual rather than the environment or context. To attribute causes of anything internally rather than externally. It takes two hands for me to count all the environmental hazards to which I have been exposed in my life time. And now add chocolate. I guess the question then is why some of us are more susceptible. My rheumatologist said that genes are mutating all the time, all the time, and randomly, some mutations take hold, are cancerous. (Not sure I am using the right language there.) If a mutation is successful, it will replicate - because it can.

That means we have less control over our fate than we would like. We prefer to think if we do everything right, we are protected, we have taken care of it. It is apparent that it is not so. The oncology nurse practitioner told me she has as many patients who never smoked, never drank, were vegetarian and have mbc as those (like me) who smoked and ate too much sugar.

[Winter-Flowers in reply to Silver126]

My MBC was diagnosed after I insisted on a PET scan. I had been in pain for 6 months and my Alkaline Phosphatase had been rising steadily for over a year. So mad at the onc, it's just SO EASY to figure out and they ignored all the basic symptoms. We pay doctors a lot of money, but nothing replaces checking blood work ourselves and objectively assessing your own body. After 3 months on Ibrance and Letrozole, Alkaline Phosphatase dropped from 125 to 69, then right back up to 89, and now 1 year later at 60.

[Justme153]

Hi i think the same way i dont smoke i dont drink i wasnt over weight ! No history of breast cancer in my family ! So why do i have breast cancer!!!!?????I have two older sisters neither of them smoke but both are over weight and they drink a lot. They dont have breast cancer. Go Figure!!!! Ive just decided cancer can be more prevelent when a history is there but still not an absolute!!!!! And that cancer can and does happen to anyone and no two people are the same in response to treatments!!! Explaining why cancer is so hard for scientists to figure out!!! I have decided worrying about the future just robbs me of the pleasures of today!!! Worry will not change the inevitable but can cause more illnesses!!!! So Enjoy today live for tomorrow and let the future take care of itself!!!

[13plus]

I found myself thinking the same way about my 2 older sisters, well one in particular, when I got diagnosed at 40 yrs. Now they’re like 69 and 71 , roughly 10 yrs older then me and neither of them have cancer . Luck of the random draw of life!

And yes to everything else you said too! Fear is not healthy at all, and only effects things negatively.

[CatLady2022]

I’m an only child of my mother and father. I have three half siblings who have different mothers and who are young enough to be my grandchildren. My cousins and I were raised like siblings. I cannot tell you how many of those cousins have told me ‘why you?’ They drank, they smoked, they partied, they still smoke, they still drink, they don’t watch what they eat, Their overweight and some morbidly overweight, etc. I am of average size, not skinny but not overweight either. Im not a goody two shoes but I’ve lived my life in a mostly healthy way so everyone around me is asking that question. For me the inheritance angle is strong tho because we have colon cancer a lot in my family which is why I’ve always lived a somewhat healthy life. Mother, grandmother, great aunt etc have all had colon cancer but they lived to ripe old ages (92 being the oldest). My mother is 77 and still kicking. I’m confused as to why they cannot find a corresponding defective gene to confirm my cancer being inherited SOMEWHERE.

My mom had six siblings, one died of pancreatic cancer, one had ovarian cancer caught early still living, one had lung cancer still living, and of course my mother with colorectal cancer still living. My dad had 5 siblings who all had many children. One sister lost three kids at about my current age to lung cancer. One is currently fighting blood cancer.

I think I inherited this crap! But why can’t they find a gene to confirm it???? I’ve done regular genetics testing for the normal ones for breast cancer. I’ve done extensive genetics testing with caris. And I’ve also joined 23andMe and they also tested my genes. Nada! Can’t find anything. Well then shouldn’t I be as healthy as a horse…..

[fancydog]

My Onc has a monthly BMP and CBC done. I only had a rise in Alkaline Phos when first diagnosed Metastatic. There are many things that can cause a temporary rise in Alk Phos, such as a simple stomach virus, a single episode of vomiting, a fever, etc. It alone does not indicate anything. Re. Cancer mutations, I was checked a few years ago for what I beleive was the 47 most common mutations and was negative for any of these. I believe new studies will begin to show additional mutations. I have a first cousin who had Lobular, triple negative diagnosed early, had a bilateral Mastectomy and has had no reoccurrence. I am HR+, Her2 neg and was ductal. I did take a very low level of HRT during perimenopausal period knowing that it increased the risk of breast ca, will probably never know if that had anything to do with having BC.

[CatLady2022]

I’ve gone back to all reports beginning on April 2020 and my alk phosph was

4-30-20 —— 92

9-24-20 —-102. I was scanned (MRI, CT) thoroughly because I had a fractured rib.

3-26-21 —- 101

My alk phosph was never higher than normal until after my bout with Covid which included the time I had a fractured rib in 2020. It rose after my bout with Covid and continued to climb higher until two months after I began treatment with verzenio/letrizole. I’ve had blood work done every year since my first cancer diagnosis in 2014. I’ve kept records from those days and will be checking the levels on my old reports to see how high my alk phosph rose during chemo/radiation treatments.

[CatLady2022]

Well I’m totally convinced! Covid is the only time in my life dating back to 2006 (As far back as my personal medical records can verify) that my alk phos levels were ever documented to be elevated. That includes blood work done for chemo, radiation, biopsied x3, lumpectomy, radical hysterectomy, colonoscopies, and every other minor illnesses I’ve encountered in my life. 34 alk phos tests and only 3 were ever high, the one immediately following a positive Covid, and then two after starting verzenio and letrizole.