CA27 29 & metastisis

[gingerhruz]

My mother had a very slow growing breast tumor removed in 1997.  I don't remember what the name of it was.  It was very small and they said they got it all and it hadn't spread to the lymph nodes but they removed a few anyway.   Her breast cancer numbers were never really what they should have been so the surgeon and oncologist says.  Everyone is baffled.  I'm not sure what the 27-29 means but hers have always been in the low thirties and have gradually escalated over the last 6 or 8 years to around 92.  The oncologist is sure there is a metastisis somewhere but she has been through every test imagineable and they have found nothing.  The last about 3 or 4 years the numbers have gone from the mid 60's to around 92 just recently.  Why can't this metastisis be found.  

This woman is 88 years old and has a hard time getting around and gets scared when she has to take all these tests.  She is getting dementia.  I hate to put her through this again.  She has had CTscans, PETscans and a lot of other testing a few years ago but the numbers keep rising.  The doctor is asking me now what I should do.  I hate to put her through all these tests again.  They may not be able to do anything about it anyway.  Her oncologist is going to try another drug now.  I don't know the name of it.  She has been taking Femara but it doesn't seem to make a difference. The Femara has been holding it at bay but all her doctors said it will show up sooner or later.  This is torture to me also to always be wondering.  

My actual question is: Why isn't this metastisis showing up somewhere after all these years with her numbers rising each year ?  

Thank you very much,
Ginger Hruz  

[Cleveland Clinic]

Dear Ginger Hruz:  CA27.29 is a nonspecific marker for breast cancer.  The use of CA27.29 to detect breast cancer recurrence at present is controversial.  Increased levels could be due to a variety of reasons. In general, a new elevation of this tumor marker would prompt further evaluation. We do not routinely use the CA27.29 at our institution for follow-up of individuals with stage I cancer.

The other thing to consider is what you will do with the information.  If no metastasis is found, then one is treating a number.  Even if a metastasis is found, is your mother well enough to take chemotherapy?   As with any illness, risk versus benefit must be considered.  You may benefit from a discussion with the oncologist regarding goals of  care and what testing would be most appropriate for your mother's situation.

[gingerhruz]

Thank you very much for your quick response.  I was told that her numbers should be around 27 to 29.  As I said they haven't found anything yet but with the number 92 the oncologist said he is sure something is there.  He also said what you mentioned about her age and what we wanted to put her through.  I was never told that there could be a variety of reasons.  What tests do you use to follow up on breast cancer ?  Her oncologist made the comment "she's almost 90 years old, what should we put her through over and over again".  The surgeon is the one that is always scheduleing tests.  He is very compassionate but also very much a perfectionist about how he handles things.  I guess I have the decisions to make for her.  She's not capable.

Thanks again for your help..