Is it possible for a cancer patient receiving chemo/ rad to develop cancer in an unrelated area? my 64 yr old father has esophageal cancer. in preparing for surgery he had a ct scan done and a 'spot' on his lung has been detected. biopsy is scheduled, but

The : The short answer to your question is yes. Different types of cancer respond differently to different chemotherapy regimes, and even if it is the same type of cancer ( hypothetically, squamous cell carcinoma) it is possible to have resisitant cell lines and second primary cancers develop. Radiation therapy was directed to the esophagus and is generally used as a form of local treatment and wouldn't be protective for the lung. I'm assuming there probably is a significant smoking history, and there would be reason for concern with a new spot in the lung with the history you provided. I'm sure your father is in good hands, and his physician is doing the right thing in pursuing a tissue diagnosis. Wishing you the best.

I : I hope your father is recovering well from his treatment and that the lung spot is nothing as many of us will have spots on ct scans. Unfortunately, however, esophageal cancer often travels (e.g. Metastasizes) to the lung. Sometimes we can help determine the need for a biopsy with a pet/ct scan which is usually part of the standard pre-surgery or pre-chemo/radiation work up for patients with esophagus cancer. The way you describe things, it sounds like the spot in the lung was found before surgery and that his doctors decided to do chemotherapy and radiation either instead of surgery or before it to try to shrink the tumor before they do an operation. If the esophagus cancer has spread to the lung, chemotherapy by itself is the best treatment. Surgery to remove the esophagus cancer is not helpful and radiation to the esophageal tumor should probably only be done if the tumor is causing symptoms that the chemotherapy is unlikely to make better on its own. In this case a short course of radiation over about 2-3 weeks would be given to try to shrink the tumor and relieve the symptoms it is causing. This is because the cancer has spread and trying to remove it from the esophagus or kill every last cell in the esophagus tumor with high-dose radiation will probably not help the patient live longer nor help him/her have a better quality of life. Therefore, if a suspicious 'spot' is found in the lung before surgery or chemotherapy and radiation, we usually biopsy it before starting treatment to make sure we don't give someone too aggressive a treatment that is unlikely to help them much. Very, very rarely, an otherwise healthy patient with esophageal cancer might have what we call "oligometastatic" disease. This means that the cancer has spread to only a few (usually 1-3) other organs or spots in the body. In this rare case, it might be reasonable to give a full course of chemotherapy and radiation to the esophagus tumor as long as the lung spot could be treated with a full dose of radiation at the same time. I've also seen patients who have unfortunately had a tumor that started in the lung (lung cancer) and one that started in the esophagus (esophageal cancer) diagnosed at the same time. In this rare case, if neither of the tumors have spread to other parts of the body, it might be reasonable to treat them both with the goal of a cure.