Cancer Genetics And The Aftermath

I thought my cancer journey would be over today as far as visiting the Oncologist. It was indicated on my last visit, that if this visit turned out good, then my PCP would do yearly blood tests and if no indications were present, I wouldn't be visiting the cancer clinic anymore.

On review of my case and the fact that genetics are not in my favor, my Oncologist wants me back for testing again in 3 months. If that test shows well with no indications, then I will see him on a yearly basis for life or until there is cause for alarm and then I will go back to more frequent testing.

He said oncologists are taking genetic cancer testing more seriously than ever and his keeping tabs on me is not only a benefit to me but also important for medical science. I must admit that it does give me peace of mind.

While a cure for cancer will never be found, genetics are valuable in prevention and early detection. The fact that DNA can tell doctors what kind of cancer a patient is most likely to get, is valuable because different cancers require different preventions and detections.

 

If you haven't had genetic testing for cancer, get it. With your family history, it is important. I am actually pleased that the oncologist wants to keep me in the loop.

 

NIH was working on a tumor-specific test to monitor cancer. A sample of a tumor was to be sent to them and they would develop a test to monitor that tumor. It was to be filed and your status (of previous tumors) could be monitored by a simple blood test. When I retired form a previous job, there was great hope for this test as it would remove the requirement for follow-up MRIs, CAT scans, etc. It was supposed to be for solid tumors only, so it wouldn't work for leukemias, many lymphomas, etc. There was great hope for this and things seemed to be going well, but I no longer have access to that info. It would be great to check routinely for metastases. The imaging would then only be done for "positive" tests.

 

@Don Alaska I haven't really studied how cancer blood test markers work other than they compare the test taken before cancer is removed or rendered inactive to follow-up test after removal or remission. In my case, since the cancer was localized and all removed, follow-up scans are unnecessary. On chemo/radiation patients, scans are necessary periodically along with blood markers. Over a period of time, if the scans turn out clean they are compared to the blood markers and in time the scans can be discontinued and blood markers alone may be used.

 

Most tumors release tumor markers of some kind and the oncologists use them for follow-up. Generally ,the type and location of the tumor indicates what markers are used. What I was referring to was something new in that it was tailored to each individuals tumor. Do you know what markers are being used for your case?

 

My cancer blood marker tests are tailored for colon and vaginal cancer. He always does CBC, Carcinoembryonic Antigen including CA 125, and Comprehensive Metabolic Panel.

 

It seems there are two topics in this thread; cancer genetics and tumor markers. I had a comprehensive panel of genetic tests and all were negative. According to the American Cancer Society, only about 5% to 10% of all cancers are thought to be strongly related to an inherited gene mutation.

Tumor markers are not routinely monitored for breast cancer except in metastatic patients. Of course I don't know anything about other types of cancer... except the PSA test for prostate.

Here's some info from Mayo Clinic...

Tumor marker tests. Tumor markers are chemicals made by tumor cells that can be detected in your blood. But tumor markers are also produced by some normal cells in your body, and levels may be significantly elevated in noncancerous conditions. This limits the potential for tumor marker tests to help in diagnosing cancer. Only in extremely rare circumstances would such a test be considered enough to make a firm diagnosis of cancer.

The best way to use tumor markers in diagnosing cancer hasn't been determined. And the use of some tumor marker tests is controversial. https://www.mayoclinic.org/diseases-conditions/cancer/in-depth/cancer-diagnosis/art-20046459

 

The cellular test that is mentioned in the Mayo post is related to what I was referring to when I wrote about the "tailored" tumor test, but that sounds like a general purpose test and, as mentioned is not often used. Tumor markers are never used as a screen unless there is a history in a patient that merits their use. PSA is used as a screen somewhat but is frowned upon by some oncologists and urologists. Some women wanted to be screen with the CA-125 marker for a number of years, but I don't know if that is still being requested.

 

My current oncologist uses hematology a bit differently than my former Oncologist. As I mentioned previously, he was going to turn me over to my PCP and Gynocologist for yearly checkups, however, when he did the review before cutting me loose, he decided that he wanted to monitor me closer because of my history and also my genetics. He moved here from Houston and considers himself semi-retired and works online with other scientists as his hobby. On review, he found my case a bit different and wanted to include me in a case study with other women with similar family histories and similar genetics. After my next visit in 3 months, he will write an abstract about any changes or variations he may or may not notice and submit it to this study.

Here is the thing that he finds interesting. All the males in my family on both sides including great grandfathers have had prostate cancer by the time they turned 70. Prostate cancer in males translates to breast cancer in females because of similar genetics. My genetics show NO indication of genetic breast cancer only CV cancer.

 

Honestly I don't know much about it. I asked my oncologist in passing if I'd have any tumor marker testing and he gave an unequivocal "no." He also didn't think I needed the genetic testing (probably due to my age) but I pushed for it; I just wanted to know. Interestingly, my insurance denied the payment claim for those tests and I never received a bill.

On the breast cancer forum, Stage 4 Metastatic patients routinely have the tumor marker tests, I assume to give advanced notice that they might need medication adjustments or whatever.

 

I am guessing the tumor markers aren't necessary in your case because you will be on a routine scan schedule. The scan is the best and most accurate way of detecting most cancers. I am interested in what your follow-up schedule will be. I am guessing you be on the 10-year plan which will probably have a yearly scan, so no specialized blood tumor markers are necessary.

 

Actually, I won't be on any scan schedule and unless "an issue" arises I won't have any more scans. Kind of scary but apparently for patients who responded well to chemo that is SOP.

Since I had IBC, I will be seen by my medical oncologist every 3 months for 2 years, then every 6 months for 2 years, then once a year.

 

If any genetic testing were to be done, @Beth Gallagher it would probably already have been done. It is sometimes used to determine the course of therapy, but may not have been needed in your case. Your oncologist would know best for sure. As to the tumor markers, it would be too soon to be using them anyway. They may already be elevated due to your therapy. Just trust your doc on this one.

 

Don, I had the genetic testing a few months ago (all negative), and my doctor doesn't see any value in tumor markers for me.