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Forum Name: Esophageal Cancer

Question: Spot on lung for esophogeal cancer "survivor"


 sunny82 - Tue Jul 24, 2007 2:54 pm

My father age 55, was diagnosed with Stage IV esophogeal cancer in Aug. 2005. Starting Sep. 05, underwent chemo/radiation treatment at the Cleveland Clinic. In Nov. 05, test came back clear, no cancer, subsequent test in Jan., Mar. Jun., and Sep. 06 also came back clear. My father moved to AZ from Cleve. OH in June of 2006, and flew back for the Sep. 06 tests. (while there, visited with family sat around campfire, helped son with fixing up attic). Right after the test and visiting with family in Sept., he got severly ill for two weeks with flu-like symptoms. When returned to AZ he was tested for Valley fever (results negative) and got a chest X-ray. Chest X-ray showed spot on lung. Went to new Drs. here in AZ and they said it was cancer returned (no biopsy done - just CT and PET in Jan. 07) and has has been on Carbo/Taxol Chemo since Jan. 07. Chemo has lowered SUV counts since Jan. report, but still "lit up" in spot on lung and original esopho spot (this will most likely always light up, was my impression from docs). Chest X-ray has never been looked at by any of his onc. docs. Last month, sister-in-law in Cleveland was diagnosed with histoplasmosis, after dealing with pain, fatigue, soreness, for a long time. Could my father also have gotten histoplasmosis (spores kicked up from hanging around campfire, etc.?), and is being treated incorrectly for return of cancer? Also, researched internet and "granulomatosis" (sp?) was another diagnosis that fit his symptoms. My understanding is that these things can only be dx by specific test, however, would that spot "light up" if it wasn't cancer?
 Dr. Chan Lowe - Tue Jul 31, 2007 4:15 pm

User avatar Hi Sunny82,

It is appropriate that your father was tested for valley fever (coccidiomycosis). To formally exclude cocci, if the first blood test was negative it should be repeated in 6-8 weeks to see if it has become positive. If it is still negative, cocci is unlikely.

Histoplasmosis can act identically to cocci and is found very commonly in the Ohio river valley area.

It may be that your father's oncologists are following tumor markers in his blood. If they are elevated it is almost certainly going to be a cancer recurrence. Cocci or Histo would not be expected to increase specific tumor marker levels.

To formally determine exactly what the spot is your father probably needs a biopsy of the area. It may be that your father's oncologists have enough information from other studies that they feel the risk of the biopsy is not needed.

I would recommend your father talk with his doctor about doing some testing for Histo and repeat cocci testing if it hasn't been done. He should also inquire about the need for a biopsy (and the risks/benefits of doing so).

Best wishes.

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