My husband had a mass removed last year from his colon and was diagnosed stage 4 colon cancer at age 49. The stage 4 was because the CT scans showed questionable spots to his liver and lung. Since then PET scans have shown nothing on his liver and after almost a year of trying to convince his oncologist to have his lungs biopsied, he agreed to it and the pulmonary doctor found that my husband has chronic bronchitis and diagnosed him with COPD. He has since started medication for that and is no longer taking chemotherapy, after 9 months of it. The biopsies taken of his airways were benign and the oncologist expected it to came back positive for malignancies. The Pulmonologist said that the "tumor" that has been of most concern, in the hilar region of left lung, could be a mucus plug form the COPD and that it could show up on a PET scan as a hot spot just as cancer does. I guess my question is can COPD be mis-diagnosed as cancer in the lung, especially with the given criteria that he did have a malignancy in his colon removed with 19/23 lymph nodes positive? Please advise.
COPD and metastatic cancer to the lung are two very different diseases and, with rare exceptions, should be readily distinguishable. A number of criteria can be used to distinguish between the two, including apparent progression or the lack thereof and the natural history of each disease. Spread of cancer to the lungs would not be unlikely given the finding of 19 of 23 nodes positive for cancer.
Interpretation of the lung biopsy would require an estimate of the likelihood that the part of the lung in question (the hilar region of the left lung) was actually biopsied rather than the biopsy being from adjacent, coexistent COPD. This will require evidence-based judgment on the part of his physicians.
As to what should be done at this time, it would not be unreasonable to request that the Oncologist and the Pulmonologist have an in-depth discussion of all the available evidence and what the next step should be. That step could involve further diagnostic studies or simply optimum therapy of the COPD with careful close observation. If agreement cannot be reached by these physicians, it might be prudent to request consultation with one or more previously uninvolved lung cancer specialists; pulmonologists and/or oncologists with a special interest and expertise in the optimum approach to this dilemma.
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