Blood tests for yearly exam

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5/29/2011 5:14pm
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Replies: 8

I'm 5 years post stage 1b and will be having my yearly derm exam in July. I've changed doctors so I'm not sure which blood tests are used in addition to the exam. I don't see an oncologist any longer since the SNB was negative and my primary care doctor will fill out the lab request form but she was puzzled as to what tests to order. What blood tests are used to monitor for signs of recurrance or changes in a post melanoma patient?  I'm not sure I'm asking this right, so in other words what blood tests should my PCP order?

Thanks!

There are two tests that I am aware of, but I really do not think you should concern yourself with that at stage 1b, which I am as well.

One is called the TA-90 test which looks for early blood glycoprotein markers in the blood serum, which may indicate that there is an immune response to metastasis undetected by a SLNB following WLE surgery. However, the test has about a 76% accuracy rate, with both false positives & negatives recorded. Please be aware of that.

The other is called the LDH test. This is a blood test that measures the amount of an enzyme in the blood called "lactate dehydrogenase" (LDH). Chemically, LDH is involved in the conversion of pyruvate and lactate in the body. For example, the accumulation of lactate is the cause of sore muscles after a heavy workout.

The LDH level is measured in order to check for tissue damage, especially to the heart, liver, kidney, skeletal muscle, brain, and lungs, which elevates the normally low LDH level in the blood. For patients with melanoma, it is used to determine if the cancer has metastasizes (spread) to organs beyond the skin or lymph nodes, usually to the liver or lungs. Although LDH is not specific for melanoma, it may be useful at diagnosis or to monitor post-surgery adjuvant treatment.

Be aware that this is also mainly used for stage four patients, and normal LDH levels also vary with age, and if you go this route it could open up a whole different set of issues as greater than normal LDH levels could also suggest :

Heart attack

Hemolytic anemia

Hypotension (low blood pressure)

Hypothyroidism (thyroid doesn't produce enough hormones)

Infectious mononucleosis

Intestinal ischemia (blood deficiency) and infarction (tissue death)

Liver problems or disease such as hepatitis

Muscle injury

Muscular dystrophy

Pancreatitis

Lung tissue death

Stroke

Ischemic cardiomyopathy

Many different types of cells in the body contain this enzyme. Some of the organs relatively rich in LDH are the heart, kidney, liver, and muscle. As cells die, their LDH is released and finds its way into the blood. Normal LDH levels vary with age. Because the LDH enzyme is so widely distributed throughout the body, cellular damage causes an elevation of the total serum LDH. There are five fractions that determine the diagnostic usefulness of this enzyme in the determination to comprise the LDH. These fractions are called isoenzymes and sometimes are better indicators of disease than is the total LDH.

LDH-1 (4H) - in the heart

LDH-2 (3H1M) - in the reticuloendothelial system

LDH-3 (2H2M) - in the lungs

LDH-4 (1H3M) - in the kidneys

LDH-5 (4M) - in the liver and striated muscle

Nearly every type of cancer, as well as many other diseases, can cause LDH levels to be elevated. LDH levels can be used to monitor treatment of some cancers, including testicular cancer, Ewing's sarcoma, non-Hodgkin's lymphoma, and some types of leukemia. Elevated LDH levels can also be caused by a number of non-cancerous conditions, including heart failure, hypothyroidism, anemia, and lung or liver problems.

Hope this helps some,

Michael

This information is for general patient educational & information purposes only. It should not be used for diagnosing/treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your healthcare provider.

Thanks Michael, I don't see an oncologist any longer, just the yearly skin checks. It was the oncologist that ordered the SNB because my melanoma was staged between 1 and 2. He also stated that I needed a yearly chest x-ray and blood work. My primary care physician has ordered the blood work in the past but I changed doctors and need to coach this one on what I need to have done. The derm told me that they are looking for changes via bloodwork.  Last year when I brought her the blood test results she told me that they missed the test she was looking for. Just trying to get all my paperwork in order before the appt in July.  thanks again.

nicoli - (5/29/2011 - 8:44pm)

Summer of 2010: I read that red wine is very anti-cancer. Although I do and did not drink at all, I thought I would drink 4oz each day. When I did this, my LDH levels went sky high, which of course freaked out my onc. My scans were clear so I did some research myself and found that alcohol can greatly effect LDH levels.

I wish my onc would have figured that out, but that's seems to be how it goes. She is my former onc now.

Nicki

Be strong and take heart, all you who HOPE in the Lord. Ps. 31:24

BTW, congrats on being five years out! I still have about 2 years and four months to go until I hit that mark!

Michael 1b

This information is for general patient educational & information purposes only. It should not be used for diagnosing/treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your healthcare provider.

It was very emotional hitting that 5 yr mark, make sure you celebrate. I tend to get all wound up the weeks leading up to my derm visit.  But I did celebrate each milestone...for example when I was able to go every 6 months instead of every 3 months, that was a big deal for me. Every time I got for a derm visit I either have AKs removed or basals removed. I never get to leave that office without some kind of wound! But it's ok, get all those barnacles scraped off.

Janner - (5/29/2011 - 11:34pm)

Stage IB here also - never have blood work done.  3 primaries and 19 years out from the first one.  There are no blood tests for melanoma, and the ones that Michael stated are just so nebulous for early stages that they don't seem practical.  LDH changes just aren't that indicative of anything - there are people here who have had liver mets and their LDH levels haven't changed!  My cutaneous onc doesn't see much point in them and my research didn't see any point either.  I don't do the chest X-Ray either.  Being 5 years out, your highest risk for recurrence years are past you.  It's unlikely that anything in your bloodwork will ever indicate melanoma mets - the most likely avenue of recurrence will be either you see something at the original site, or feel something in the regional lymph nodes.  I've actually never heard of any stage I individual having bloodwork done and then finding mets because of the results.

Best wishes,

Janner

Thanks, 3 different derms, 1 oncologist and 2 primary care physicians all asked for blood work and a yearly chest x-ray when following me as a patient. The only changes that occured were from every three month derm visits to every 6 mths after the first 3 years, then yearly visits after the 5 yr mark was hit. I myself have chosen to have the chest x-ray every 3 years, not every year.   I also chose not to continue with an oncologist, all basals are dx after removal by derm and sent to pathology (I've had a lot of those and too many to keep count of AKs removed.)

 

Thanks!

Beth

Gene_S - (5/30/2011 - 3:34pm)

Possibly CoQ10 ?

see:   http://naturalstandard.com/news/news200602007.asp

Best wishes,

Gene

Live 4 today. Thank God for all he has done for us. Looking forward to enjoying tomorrow.