Q: After Whipples resection I underwent 6-weeks radiation. After 3 months I went for a review checkup and I was asked to get my blood test done. Every thing else was normal but the alkaline phosphatase level was high (380). I am 49 years old now the doctor asked me to get the ultra-sound of my upper abdomen done. This also gave me a clear chit; so what is my problem?

A:After a Whipples resection there is a protocol used by the surgeon/ oncologist for the follow-up of patients. The protocol usually includes regular visits for checkup (initially every 6 weeks, then every 3 months, much later 6 monthly visits); blood tests, such as liver functions, particularly alkaline phosphatase: these are usually carried out at every visit. Blood tests for tumour markers, such as CA-19.9: every 3 months, in general ultrasound tests every visit CT scan after 6 months, or yearly.The exact protocol may vary between surgeons. The mild elevation of your alkaline phosphatase is of little significance in light of your treatment so far. At present I would declare you to be free from disease. You do, however, need to adhere to the follow-up protocol advised by your doctor.