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.

_________________
- 82 year old father may have Stage 4 Lung Cancer
- Refused biopsy and any treatment
- Nov 2006 10mm - Nov 2007 grew to 4cm (was discovered by CT scan with contrast) also six nodules in other lung
- He wasn't told of results of scan (long story) but I called his doctor and he told me (daughter)

You might try posting on the CancerGrace site where a real live doctor will respond with amazing speed. What you have presented here is way over our heads, at least mine.
http://cancergrace.org/

Best of luck - and do respect your Dad's wishes, hard as they might be.

_________________
(photo: me in '61)
Female never smoked, 52 at diagnosis, otherwise healthy
09/08: false cardiac event = finding of 3 cm tumor upper right lobe plus two .5 cm nodes elsewhere on chest x-ray at ER
09/08: CTScan with IV contrast confirms.
10/08: Pulmonary referral for EBUS - bronchoscopy - confirms NSCLC - adenocarcinoma, with bronchoalveolar features
10/08: PetScan - further confirmation, classified T1N0MX (false negative) VATS scheduled.
11/08: full open surgery - revised to T4N2MX with positive spread to 2 lymph nodes, removed upper lobe with 3 cm tumor and partial mid lobe with (1) .5 cm tumor, 3 lymph nodes on trachea - 1 lymph node and margins negative.
5 night hospital stay.
12/08: Port-a-cath implanted
12/08: Brain MRI and hearing test - good other than minor high end loss in left ear
12/08: start (4) 21 day cycles of chemo - day 1 cisplatin and gemcitabine, day 8 gemcitabine alone, day 15 off - tolerated it pretty well - a little hair thinning and follicle inflammation, some ringing in ears and vertigo, much fatigue, and nausea. Kept my taste-buds almost intact.
02/27/09: completed 4 cycles of chemo!
03/03/09: removed port-a-cath
03/27/09: tattooed for radiation
03/30/09: start radiation (IMRT) 5x/wk for 6 weeks - fatigue, moderate esophagitis
5/08/09: completed treatment
6/22/09: NED
9/18/09: Recurrance in the liver and scattered in lungs. No symptoms. Rx Tarceva.
9/25/09: start Tarceva
11/20/09: clear lungs, shrinkage in liver.
2/24/10: still good on Tarceva
6/3/10: graduated to 6 month scan
12/9/10: new 6 cm tumor in liver
12/28/10: stop Tarceva
1/10/11: carbo/alimta/avastin
3/11/11: scan after 3 cycles 72%ish met reduction, stay the course
5/26/11: scan after 6 cycles, stable.
5/31/11: begin Avastin maintenance.
8/17/11: met growth, stop Avastin. Start Alimta.
10/25/11: met growth, stop Alimta. Wondering what to do next?
1/24/11: start hospice

Boy, I don't know what to say. I honestly don't know. I will say that it doesn't sound like Small Cell, as it grows much to quickly and the side affects are obvious...generally...

Maybe your dad will lighten up on the "no biopsy" rule he's made, as that would allow you to know so much more.

Stay strong...
Jen

_________________
[size=75]Loving Daughter, with three siblings, praying for a Dad with SCLC, superior vena cava syndrome.

3/16/06 DX Mass and/or adenopathy within the right hilum..consistent with bronchogenic carcinoma. May also be subcarinal adenopathy. Small right pleural effusion.
3/17/06 MRI head with/out contrast. Biopsi-lung, right middle lobe bronchus. Small Cell Carcinoma of the right lung with SVC syndrome
3/21/06 Bone scan. No evidence for skeletal metastases
3/21/06 Etoposide and Carboplatin chemotherapy (3 days)
4/12/06 Chest XRay - Obvious shrinking of tumor
4/12/06 Etoposide and Carboplatin (3 days)
5/2/06 CScan - again, obvious shrinking of tumor
5/5/06 Meet with Radiologist to determine radiology plan
5/9/06 Day one of Radiation
5/10/06 Chemo (?) (3 days)
6/4/06 In the middle of radiation, going EXTREMELY well, aside from sore eating, and tired, tired, tired. Dad is hopeful, sure that he is coughing up tumor every day, and spirited. Thank you God!
6/18/06 Went into local hospital for infusion. Chest X for possible pneumonia.
6/20/-6 Went to local hospital for infustion. DX with pneumonia in both lungs. O2 levels low, and irregular heart beat. He does not feel heart beating 140 and above. Meds for regulation not working. Made it to Mayo 6/25...back in the hands of the amazing!
6/29 Radiation Graduation! Dad is now home, and regaining strength every day. He is tired, tired, tired, but again, getting stronger every day. Will return to Mayo on 7/30 for all new tests.
7/30 "There is nothing in your noggin but a brain, Keith!" Amazing words to hear! "I would give your chest a clean bill."
8/1 "Keith, you are in remission." We don't consider a cure until you are clear for five years.
8/7 Began 15 rounds PCI brain radiation treatments. This was a difficult decision to make as we were given the side affects, and quite honestly it does sound scary. However, most all SCLC survivors appear to have some form of brain radiation at some time throughout their treatments. Dad figures that mom does the money books, organizes the meds, and keeps the house going already, so what the heck. "I don't want to die from cancer," he says!

August 25, 2006 Mom and Dad return after PCI. Dad feels great, has a tan, bald head, and got out onto the boat on day 1 of his return! Thank you God!

11/29/06 3 month Check Up...Still in remission. Lung scarring from radiation occuring. Dad feels great. Depression and low activity are going away!

2/25/07 Another check up shows no progression...however a slight pleural effusion that has grown since November. Could be one of three things...1. Infection 2. Scar Tissue 3. Cancer. Must go back to Mayo next week to have it drained and checked.

3/1/07 Drained pleural effusion yesterday. However, when they got in there, there wasn't enough fluid to drain and check...this means it probably wasn't cancer, and more than likely was the tail end of some kind of infection. She decides she wants him back in two months instead of three, just to be safe. Heart doc gives dad the clean bill of health. Go home, enjoy life!

5/11/07 Dad had a standard chest CT, which showed nothing new. He feels great and again was given a clean bill! Yeah! Doc will do a "big" check-up in August...complete with chest CT, bone scan, and brain scan...all because at that point he will be one year in remission! Yeah...I pray every day for these years to be granted!
8/21/07 Dad had a full body scan yesterday and results today were very "boring!" We LOVE boring. There was one nodule, in the lung area, that she could see, but it is smaller than small, and leaves no reason to be concerned. Dad will return for a check-up after Christmas. When mom said, "So, do we not need to be worried anymore" she answered with, "Your new normal will be that you are always worried." Yuck...but oh so true. Thank you God for the gift of healing, and may you continue with that wonderful gift. I pray in thanksgiving.

1/21/08 "I am going to call you my miracle man! Keith, I still don't see any evidence of cancer in your body." Wow! Blessed again!

5/19/08 "Keith there is no change. I see no evidence of any cancer." Wow! We are so blessed to be given another clean report. "Every day is a gift," my dad said. Isn't that the truth!

Sept. 08 Still Cancer Free

4/8/09 All evidence of the small cell is still gone. She believes Dad is cured. However, a dot on the CT almost a year ago has turned into an eraser sizes spot. This could just be a product of his recent bronchitis or could be when he breathed during the scan. She DOES NOT think we have anything to worry about. Scans will be in 3 months now, instead of 6 months...I am happy for that!

7/20/09 CT shows growth in spot on opposite lung than original cancer. They do not want to leave it alone. Will have PET and surgical consult next week with the hopes for simple removal.

8/2009 Removed spot. Biopsy showed trace of NSCLC. No SCLC found.

11/2009 All clear
3/2010 All clear
7/2010 All clear
11/2010 All clear. We really are so very blessed to continue to be cancer free. Thank you God.
8/23/11 - Still clear. Thank God!



Picture at left is my husband and I, October 2007. Below is Dad crossing the line during the survivor lap at the Relay. The other pic is just one of my faves!

[img]http://lchelp.org/picfiles/jen2.jpg[/img][img]http://lchelp.org/picfiles/ztweb3.jpg[/img]
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Hi SharRob.

Obviously, no non-professional can pass judgment on the CT-scan report, but my concern is what your goal is. If your father has no symptoms, then I take it he's feeling fine, right? If so, and if he wants no treatment (which really only claims to alleviate symptoms, i.e. be 'palliative', anyway), then why worry about what's happening in his lungs? I wonder because I'm in a similar situation -- I was dx with Stage 4 NSCLC and want no treatment and have no symptoms. I see the onc once a month (will now be once every 6 wks) and she always asks if I want a CT-scan and my response is always, 'What for?' She laughs and says "Right. See ya next month.' So my advice to you is what I would want for myself in his situation: let him be, let him live his life with as few hassles and as much pleasure as possible.

Ellen

_________________
-66-yr-old woman
-Dx 12/26/07 at age 63
-Stage 4 NSCLC, adenocarcinoma, with mets to local lymph nodes, salivary gland, and pelvis, later vertebra.
-Have chosen to do no chemo or chest radiation -- have had radiation to pelvis and spine to lessen discomfort and, mainly, to lessen likelihood of stress fractures and nerve root damage. Successful!