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colon cancer metastasis to lungs and not liver?
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colon cancer metastasis to lungs and not liver?

My apologies for the long post, and for cross-posting, I am new here and did not know there was a specific Colon Cancer group, originally posted in the general Cancer group.

My 72 year-old father was diagnosed with colon cancer about 6 months ago.  It is currently 5cm diameter (from 4.5cm at time of diagnosis, both measurements by CT), located in the sigmoid region, protruding into the lumen as well as infiltrating an adjacent section of wall of the small intestine.  His bowel structures are disorganized due to resection of 18" of small intestine 3 years ago and subsequent herniation through the mid-line incision site.  The hernia was never repaired and is literally the size of a basketball.  The tumor is in the area of the margin of the hernia, surrounded by scar tissue.  The hernia and small bowel resection were due to an exploratory surgery that discovered and repaired a torsion and necrosis of part of the small bowel.  He has adamantly refused further surgery for either hernia repair or cancer resection because of several life threatening complications after the original surgery and fear that he will not survive further sugery (contrary to surgeons' opinions and recomendations).  He has done nothing to treat the cancer other than adjust his diet (described later).

After painful and bloody bowel movements the cancer was diagnosed by colonoscopy and CT 6 months ago.  6 weeks ago he had another painful episode and another CT.  This latest CT showed "two new masses in the right lung, both about 8cm in size", and the colon tumor grew from 4.5cm (at diagnosis) to 5cm.  His CEA level taken at that time was only 4.2.  

He has done nothing that I know of to identify the nature of the "masses" in the lung, or to treat them.  A little over 2 weeks ago he reported coughing up a little blood (described as a small smear) about once a day/every few days. I do not know if it has resolved or worsened since then .  This is all the information he will give me as he vehemently refuses to discuss his health conditions.  Pertinent past medical history: he had pneumonia in the right lung after the original surgery 3 years ago, and he also had an embolism at that time, but I don't know if it was pulmonary or otherwise.  He has not reported any other respiratory symptoms since the CT 6 weeks ago and I did not notice him coughing when I visited for Christmas less than a week before the CT.  

My question is: are the lung masses likely to be metastases?  I know that colon cancer usually spreads to the liver via the portal system, then to the lungs.  The liver was clear in the last CT 6 weeks ago when the lung masses were detected.  Could the vasculature be diverting the metastases to the lung due to the prior surgery and herniation in the abdominal cavity?  How likely is it that there are two metastatic masses in the lung, both already 8cm, when the colon tumor hasn't grown a lot?  What else could they be?  

Other PMH: He smoked for about 10 years in his youth, but hasn't smoked in 40 years and has never been diagnosed with any chronic lung problems (but he's not one to see the doctor much, obviously). Cardiovascular: 8 months ago he had a stroke, and a heart arythmia was subsequently detected that was causing I believe some early signs of congestive heart failure (edema and discoloration of the lower extremities). The arythmia was repaired by ablation about 8 months ago and he is now in good cardiovascular health (the cardiologist is the only doctor he will see and the only news he will tell me since it is good news), the edema and discolorations have resolved.  He is 6'5" and was over 300lb when the cancer was diagnosed and has since lost 70 lbs in 6 months and improved his cardiovascular health due to a mostly vegan diet with the exception of some shellfish.  This is despite lack of exercise other than intermitent physical therapy, being confined to wheelchair and walker since the stroke.  I'm not sure how balanced his vegetarian diet is, it is a miracle cancer cure detox thing he found in a book by a quack who has been arrested in 3 US states and Mexico who thinks intestinal flukes cause all cancers.  I'm glad he has lost the weight but sad that this is his medical resource and source of hope despite his access to high quality health care.  I know the diet includes a wide variety of juiced raw fruits, berries, and greens, and lightly steamed vegetables, and boiled potatoes.  I advised him to add nuts and legumes, flax for omega-3/6, and vitamin supplements such as B complex, but I don't know if he has taken this advice.  

I just also want to say that his initial prognosis before the weight loss was that he had 1.5-2 years to live before he would die of bowel obstruction complications or metastasis if he did not undergo surgical resection and chemo (which has been his choice to refuse these, especially surgery).  That was 6 months ago so he is now down to about 1-1.5 years left, but he has also lost a lot of weight so I don’t know if that improves things much.  If the lung masses are metastases, how might this affect his prognosis without surgery?

Sorry for being so long-winded, I wanted to include as much info as possible. I appreciate any information and opinion.  Thank you very much for reading and considering my father's situation.

~ Jamian Reed
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Avatar_m_tn
Jamian, your father's case is complicated.  Obviously he should seek medical attention but it appears he's refusing to do so.  Did he have a chest CT 6 months ago or just abdomen/pelvis?  Would be unusual to develop 2 large lung mets in 6mos, but possible.  Colon CA does metastasize to liver most often, then lung, but it's not necessarily a stepwise progression.  You can have lung mets without liver mets.  He doesn't sound like a very good surgical candidate, especially given his surgical history and complex abdomen.  Chemo would likely be best option for him; should discuss what his wishes are regarding that, and also what he would want done should he develop obstructive symptoms.  Best wishes.
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