Lung Cancer

[SharRog]

Would you please give me your opinion on the CAT Scan described below? I have no one else to turn to because my father adamantly refuses a biopsy. His primary doctor told me 15 months ago, that he believed with certainty he has Stage 4 Lung Cancer. Now, the doctor has changed his opinion, he believes he has a Lung Fungus because my father shows no symptoms of lung cancer So I requested the CAT Scan to get another opinion.

CT SCAN with CONTRAST
There is a 3.79 x 3.45cm mass within the posterior segment of the right upper lobe with the mass extending below the carina by approximately 1 cm. There are at least six small metastatic lung nodules noted within the posterior segment right upper lobe. There is a small metastatic lung nodule noted in the anterior segment of the left upper lobe. The rest of the visualized lung fields are essentially clear. There is no mediastinal, hilar, or axillary adenopathy noted. Thee are atherosclerotic changes of the origin of the left subclavian artery, of the thoracic aorta, LAD coronary artery, and circumflex coronary artery.

History:
1. 2006 / Nov – 10mm (X-ray)
2. 2007 / Nov – Grew to 4cm (CAT scan with contrast)
3. Dad: 82-yr-old (quit smoking 30 years ago) (refuses biopsy and treatments-adamant about this)

Lung Fungus?? (the 4cm mass in lungs)
- Lifetime resident upstate NY
- Dad had driven from Chicago to California (50 years ago)
- Dad had visited Arizona and Nevada for one month (30 years ago)

Questions:
- From examining the CAT Scan, do you think he has Lung Cancer?
- Can a person have lung cancer starting 10mm (Nov 2006) grow to 4cm (Nov 2007) – and have no symptoms as of this date Feb 2009?
- If not, and you think it is a lung fungus, can lung fungus show up on a CAT Scan 30-50 years from possible exposure?
- If Lung Fungus, are there any life threatening issues?

Thank you for your time and I appreciate any advice/information you can give me.

[Davy9]

A few thoughts.

If this is fungal the likely candidate would be coccidiomycosis AKA Valley Fever. It is common to the southwest. There is a reactive skin test which can be done for this but the definitive diagnosis is again by biopsy. Regardless, a fungal infection such as this would still need treatment. If it is cocci or not it is still a pneumonia and lung tissue is being damaged. Cocci can also spread outside of the lungs.

Cancers cannot be accurately staged unless they are fully worked up. If this is lung cancer the adjacent lymph nodes may not be involved as noted on this scan but both lungs are now involved. The radiologist (also an MD) who read the scan clearly feels that there is cancer in the lungs.

Have they tried to obtain any deep sputum to study for either cancer or fungus, or or diseases? Have they done any blood screens looking for fungal infections or cancer substrates?

Whichever it is, it is active and it is growing and where it should not be. It needs to be diagnosed and a treatment plan defined in either situation.

[SharRog]

Dear Davy9,

Thank you for taking the time to respond, but if I may ask you one more question. If you could tell me specifically in the CAT Scan what it was why you believe the MD “feels that there is cancer in the lungs.” I would really appreciate it. Thank you

[Davy9]

The term 'metastatic' can be used in reference to the spread of any type of infection but it is often used in regard to the spread of tumor cells.

[SharRog]

I apologize for asking yet another question but you haven’t said that this mass could be a benign tumor. Is that possible? And if so, do benign tumors grow (I did read this on the internet that benign tumors can grow slowly).

Also, another person said that in the one year time span that the mass was growing rapidly. Is this true? (Nov 2006 10mm to Nov 2007 4cm).

Thank you again for any information you can give me. I ask because I want to gather as much info as I can, I can’t ask his doctor because I’ve lost faith in him. He told me 15 months ago, with almost certainty that he had Stage V LC and I’ve had to deal with that all this time and then now he says Lung Fungus. Why didn’t he say that that was a possibility 15 months ago, and also, if it could be a benign tumor. Thank you for any information.

[Davy9]

At the juncture of the latest CAT scan there was more than a single tumor. There is a larger tumor in the midline of the chest and several small tumors noted in the right upper lung lobe and another in the left upper lung lobe. Clearly the information shows growth in the main site and perhaps spreading to these other areas.

I am no specialist in lung cancers. I suggest that you get your father assessed by an oncologist or a pulmonologist to get a second opinion on how to proceed. If it is a fungal infection that also needs attention, and the sooner, the better.