Could Fluctuating ESR Levels Indicate Cancer in Ankylosing Spondylitis?

Could my ESR condition be caused by cancer?

Hello Doctor, I am a patient with ankylosing spondylitis, 22 years old, and I have been diagnosed for 2 years and 3 months.
About 2 years ago, blood tests and MRI confirmed my diagnosis of ankylosing spondylitis.
During my first blood test 2 years ago, my CRP was 0.5 mg/dL and my ESR was 34 mm/hr.
Over the past 2 years, I have had a total of 10 blood tests, with ESR levels ranging from 14 to 38, and a median of 35.
I feel that despite receiving treatment, my ESR levels have been quite unstable.
A year ago, I also underwent protein electrophoresis analysis, and the doctor said it was normal.
During these 2 years, I have regularly had blood and urine tests during follow-up visits, all of which have shown no abnormalities.
Currently, aside from occasional pain in my buttocks, I have no other symptoms.
I would like to ask the doctor, given that my ESR was already elevated at 34 two years ago and has fluctuated significantly over the past 2 years, if this ESR condition could be caused by cancer, is it possible that after 2 years, I still have not experienced any related symptoms of cancer? (I want to confirm that the likelihood of having cancer is low so that I can continue my treatment for ankylosing spondylitis with peace of mind.) Thank you, Doctor.

Zhengzhong, 20~29 year old female. Ask Date: 2022/12/02

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Indeed, there are other reasons that can cause an elevated ESR, including cancer.
However, the diagnosis of cancer is not based solely on ESR; it should be considered alongside other related symptoms and regular health check-ups.
You are still quite young, so I believe you shouldn't be overly concerned about cancer.
However, since your ankylosing spondylitis has been treated for such a long time and your ESR remains elevated, it would be advisable to discuss possible reasons with your physician.
The Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, cares about you.

Reply Date: 2022/12/02

More Info

Fluctuating ESR (Erythrocyte Sedimentation Rate) levels can indeed raise concerns about underlying conditions, including cancer. However, it is essential to understand that ESR is a non-specific marker of inflammation and can be elevated due to various reasons, including autoimmune diseases like ankylosing spondylitis (AS), infections, and malignancies. In your case, as a 22-year-old diagnosed with ankylosing spondylitis, the elevated ESR levels you have experienced over the past two years are more likely related to your underlying condition rather than indicating cancer.

Ankylosing spondylitis is a type of inflammatory arthritis that primarily affects the spine and the sacroiliac joints in the pelvis. It is characterized by chronic inflammation, which can lead to pain and stiffness. The inflammation associated with AS can cause elevated ESR levels, reflecting the ongoing inflammatory process. Your ESR levels, ranging from 14 to 38 mm/hr, suggest that there is still some level of inflammation present, which is not uncommon in patients with AS, even when they are undergoing treatment.

Regarding your concern about cancer, it is important to note that the absence of other symptoms typically associated with malignancies—such as unexplained weight loss, persistent fatigue, night sweats, or significant changes in appetite—can be reassuring. The fact that you have undergone regular blood tests and routine check-ups without any abnormal findings further supports the notion that your fluctuating ESR levels are more likely tied to your ankylosing spondylitis rather than an indication of cancer.

In general, cancer-related symptoms often manifest more prominently and are accompanied by other clinical signs. If cancer were a significant concern, it is likely that you would have experienced additional symptoms or abnormal findings in your routine evaluations. Moreover, the stability of your other blood tests, including normal protein electrophoresis results, suggests that there are no alarming indicators present.

It is also worth mentioning that while elevated ESR can be associated with cancer, it is not a definitive diagnostic tool. Oncologists and rheumatologists typically consider a combination of clinical history, physical examination, imaging studies, and specific tumor markers when evaluating a patient for cancer. If there were any significant concerns regarding cancer, your healthcare provider would likely recommend further investigations, such as imaging studies or biopsies, to rule out malignancy.

In conclusion, while fluctuating ESR levels can be concerning, in your case, they are more likely a reflection of your ankylosing spondylitis rather than an indication of cancer. It is crucial to maintain open communication with your healthcare provider, discuss your concerns, and continue with your treatment plan for AS. Regular monitoring and follow-up appointments will help ensure that any changes in your condition are addressed promptly. If you have persistent worries about cancer, consider discussing them with your doctor, who may recommend additional evaluations to provide you with peace of mind.

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