Possible Recurrent Lung Cancer

Hi, my father who is 76 years old had a lobectomy performed 7 months ago for a 1.5 cm Squamous Cell Cancer removed.  The operation was successful.  He went for his 1st check up in August and everything appeared clear on the xray.  He has gone now in November and the xray appears to have a white haze over the lower part of his lung.  (The lobectomy was performed on the upper right lung).  Could this be recurrent cancer.  The doctor doesn't think so but wants him to have a CAT Scan done to rule it out.  What are the chances of this type of cancer recurring so quickly?  He was a smoker for 50 years but quit about a year ago after the diagnosis.  He has COPD as well and has a chronic cough and shortness of breath which the doctor says is due to the surgery.   Could this be cancer again?  Please advise.

[bhumi123]

Hi,
The chances are more in favour of an infective process - a pneumonia most probably as your physician also tells you. Though the chances that it being a recurrence cannot be completely ruled out without a scan and maybe a biopsy, they are still rare. The increased duration of smoking years and diagnosed COPD also does put your father in the high risk group. Having said that it would be best to go ahead with the scan and rule out any fear whatsoever. Yes the chronic cough and shortness of breath could be due to COPD and the surgery that he has had.

[Wanna]

Thanks very much.

[Wanna]

I just found that the haze over the xray is a 'fullness in the hylem of the middle lung'.  Do you know what that might mean?

[bhumi123]

Hi,
Fullness in the right 'HILUM' of the lung would mean the haze is in the region of the hilum that is where the bronchus and blood vessels enter the lung. Well it could be explained partially by the enlarged pulmonary artery secondary to the COPD your father has. Has an ECHO ever been done or suggested - if yes what are the pulmonary artery pressures? And were any blood investigations done to rule out an infection?

[Wanna]

I'm not sure what an ECHO is.  He had a blood test done in September and it showed nothing.  My biggest concern is cancer.  Could an enlarged hilum mean turboculosis or emphysema or just his COPD or nothing at all.

[bhumi123]

Hi,
An enlarged hilum could mean either enlarged pulmonary arteries due to COPD, or lymphnodes enlarged at the hilum due to Tuberculosis, sarcoidosis and rarely cacinoma. But a CT scan will help clear whether it is either of the three or nothing at all - yes that is a possibility too. And you should ask your physician about an ECHO and get one done alongwith a CT scan.

[Wanna]

My father went for the CT Scan and the doctor discovered that the cancer had spread to Stage IV.  We (as well as the doctor) are in complete shock.  He thinks it may have gone into the liver.  How could this be in just 3 months time?  My father is now having a bronocscopy scheduled for Dec 10 to determine whether chemo or radiation will help.  The doctor did not sound optimistic and we are all scared.  Any advice.

[DrBhumikaMD]

Hi,
Stage 4 lung cancer with metastasis to the liver has a very poor prognosis. As must have been explained to you by your physician the 2-3 year survival rates are very low. There is a high risk of mortality in such cases usually. Some forms of lung cancer are gradually progressive with very little time for a diagnosis to be established or treatment planned. In any case, lung cancer itself has poor chances of survival. At this point of time you should be mentally prepared to handle the situation at hand. Support and encourage your father to the maximum possible but also simultaneously discuss the details with your physician and family. Goodluck.

[Wanna]

Do you think chemo or radiation will work for him?  He's a pretty strong man with no other illnesses.  I'm just hoping for a miracle I guess.

[DrBhumikaMD]

Hi,
It is difficult to say whether chemo or radiation would help. The bronchoscopy results will tell you what would be the treatment plan. Also discuss the report in detail with your doctor and get a copy of the report for yourself. Just be around for your father because mental strength and support is most important for your father at this stage. Goodluck.