Rising ALP in bloodwork

Melbo
Melbo Member Posts: 346
edited April 2021 in Not Diagnosed With a Recurrence or Metastases but Concerned

I was diagnosed last July - stage 2a or 2B depending on whether you count the lymph node or not. lumpectomy showed a PCR after chemo. I finished rads two weeks ago, and at this moment I am getting an infusion of kanjinti and Perjeta.

my MO does blood work before all of my infusions. 6 weeks ago my ALP was 117 (normal range per the chart is 46-116). It was barely elevated, but MO said we would watch it. 3 weeks ago it was 127. I did some research, and thought it might be from the fast food I had that day. For the last two weeks I have kept my diet clean, hoping the number would be normal today. Instead it was 131.

I’m still assuming this could be nothing — bodies are weird and tests don’t always tell the whole story. I have a message in with my MO to see what he thinks, but I’m curious about any thoughts you guys might have.


I had a bone scan when I was first diagnosed, which was obviously clean at that time, but haven’t had any middle of the body imaging. My other blood work numbers are all normal and I don’t have any bone pain anywhere. I occasionally think I might have liver pain, but that could be my mind playing tricks on me.

I’m not freaking out, but it would be nice to have a nice benign reason for the elevated number

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  • LaughingGull
    LaughingGull Member Posts: 560
    edited April 2021

    Hi there,

    It is not uncommon for ALP to rise after chemo. When I was diagnosed my ALP was 60. During 5 months of chemo, first AC, then Taxotere (plus Herceptin plus Perjeta) was still under the limit, but kind of trending up. I had surgery, then radiation plus oophorectomy, and started hormone therapy. For like 8 months after I started hormone treatment, my ALP was over the limit, reached as high as 180, during that period I went from osteopenia to osteoporosis. Then my regular doctor checked my VitD and it was very low, way in the defficiency zone. Started calcium and VitD supplementation and ALP came back to the normal range. A few months ago was a little bit over the limit, a few months later it was back in the normal range. I know all this because I plotted my ALP over time in a graph, overlapping with the treatment I was under.

    My oncologist during chemo, or my current oncologist didnt think this was relevant. They say effect of chemo or shedding bone after starting hormone treatment. I had X rays of a (temporary) area of (light) pain in my back, and I also had a bone scan recently, no signs of mets.

    I would say watch it carefully and get the tests that apply to the situation. If you think you have liver pain, say so and ask your doctor what they think. I was told by my current MO that my somehow elevated ALP doesnt point to a liver problem bc all other liver enzymes are in the normal range. And that if the ALP was a sign of mets, she would expect to see a higher level and also pain. Still she sent me for a bone scan that came back clear.

    Did you get a bone density scan? Got your VitD checked? Do you have osteopenia or osteoporosis?

    LaughingGull

    image


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  • Melbo
    Melbo Member Posts: 346
    edited April 2021

    interesting! I like the “when in doubt blame chemo" plan. :)How long after chemo did it start rising? I finished chemo in late November, but ALP was normal until March.

    I figure liver is a tiny chance, since all of my other numbers are normal, which is why I assume my mind is playing tricks on me with pain. I also assume bone involvement would include a lot of pain, which I definitely don't have.

    I have not had a bone density test yet. But I will keep that in mind. I also haven’t had any bone problems or diagnosis at this point. My vitamin d hasn’t been tested recently, but I have some fasting blood work scheduled to get that checked

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