The Colon Club

My DH had his scans yesterday and we got the dreaded phone call from the oncologist this morning. A bit of recent history (full history in signature): About 4 months ago DH started noticing shortness of breath upon exertion, and some wheezing. He mentioned this to his oncologist who ordered a scan and sent him to pulmonologist. The pulmonologist ordered a 3 month follow up CT which happened yesterday. So the nurse practitioner who called this morning began the conversation by asking me if DH had been experiencing any symptoms of a respiratory infection recently (I guess she didn't look at his recent notes...). Anyhow, I explained everything and she said the CT scans showed both lungs had an area of high density that they want to treat with an antibiotic...while they begin the authorization process for a PET scan. My first thought is "How can they possibly not tell the difference between a lung infection and metastasis?" Also, "Why did they say area of density and not a nodule or mass?" Luckily he has his long scheduled appointment Monday and also sees the pulmonologist Tuesday so we will get some kind of answer sooner than later. In the meantime, I would appreciate I if anyone can share their thoughts with me. Thank you in advance!

Areas of increased density on a lung scan don't necessarily mean metastasis. They can be caused by any process that fills the alveoli with fluid, pus, blood, cells (including tumor cells) or other substances resulting in lobar, diffuse or multifocal ill-defined opacities. An infection can easily do that, especially since he's been having symptoms like wheezing and shortness of breath.

If it reassures you any, I had lung mets and never had any symptoms - no pain, no shortness of breath, no wheezing, nothing. So the odds are good he just has an infection and the antibiotics will take care of it. It's good you're seeing the pulmonologist next week though, just in case.

Hope this helps!
Juliej

My first cat scan after finished treatment showed scarring and inflammation of the lungs. My oncologist said it could be caused by chemotherapy or may be something else. I was referred to a pulmonologist. After doing a repeat scan with no change my pulmonologist started testing me for an autoimmune disorder (sjogrens, scleroderma, lupus, and rheumatoid arthritis) as these can cause lung scarring and inflammation. One of the blood tests did come back abnormal but not conclusive as I don't have any other symptoms. So now I am monitored by a pulmonologist and rheumatologist every 6 months doing breathing tests and walking tests to check lungs. A year ago a 4mm nodule appeared, so repeat ct scans were ordered 3 months and 6 months later. Both my pulmonologist and oncologist did not believe it was a met, but the pulmonologist did say it could be a new lung cancer and wanted to check to see if it grows. It has remained stable the past year and now is attributed to the scarring and inflammation in the lungs, even though we will keep watching. There are many things that can appear in ct scans, and any infection can cause changes in the lungs. Alot of times waiting and watching for changes is the best way to determine what is actually going on. But, I do understand the anxiety.

Like Julie, I had NO symptoms from my lung met. Neither my onc nor my thoracic surgeon thought this was in any way abnormal. Of course you and your doc need to keep on top of this, but in my (non-medical) opinion, there is significant likelihood that it has nothing to do with cancer. Good luck.

PET scan results arrived today. Most bizarre, there was nothing of interest noted on lungs. Before the PET, both the oncologist and pulmonologist stated they would be shocked if this was cancer. However, 3 para aortic lymph nodes lit up near the kidney, as well as T11 on the spine and his left femur. NOT A THING on his liver or lungs. His dr is on vacation, so I spoke with a nurse today. She said this is an extremely bizarre pattern of spread for colon cancer. So I am holding out hope that this is a false positive and he has sarcoidosis. Its all I have. That is where my mind is right now. Biopsy next week. They are saying nodes will be very tricky to biopsy, and not able to be removed. They might not even be able to biopsy nodes and will have to do bones instead. Of course if they are cancer, we will seek 2nd opinion. So, if anyone has any words of wisdom, I would appreciate hearing them. Thanks.

Just being completely honest. My oncologist is one of the top guys in the area, really knows his stuff and has seen a lot.

I too had a weird pattern of spreading and have had unusual PET scan results.

My original diagnosis was Colon Cancer and the first PET scan showed enlarged nodes: retroperitoneal, left superclavicular, left prevascular, mesenteric, and aortic bifurcation.

After 10 months of chemo I was NED and five months later the nodes were lighting up. Since then I had Pet scans where the radiologist thought it spread to the bones but two different oncologists didn't think so (Looks like oncologists were right) there was a high uptake in the liver suggesting spread there but there was no lesions seen and it hasn't spread there yet. But I've had one long nodule turn into four nodules and now two of them are close to being masses.

So Pet scans can be all over the place and spreads can be unpredictable. I was stage 4 from my original diagnosis and it was three years before it spread to another major organ (lungs).

Asa far as second opinion if they are cancer, that's fine, but don't expect another doctor to say it's not cancer. If they do a biopsy and it says its cancer, then the second opinion is really about a different possible treatment option. I take it the CT scan didn't include the are by the femur but did include the t-11. Was it with contrast. Did they note anything with the spine?

I would seek a second opinion about removing the lymph nodes, if indeed only the lymph nodes were cancer. The CT, with contrast, said nothing about the bones, in fact it noted, no skeletal abnormalities. He has no bone pain at all, it wasn't even a consideration. The CT states there are lymph nodes enlarged above left kidney, but the radiologist felt they were reactive to whatever infection was in his lungs.I don't even thing a PET would have been ordered if he didn't have the "micronodular densities" show up on his lungs in the CT, but not the PET scan. Not a thing about the lungs in mentioned in the PET.