“I discovered a second cancer while undergoing tests to treat the first”: what are synchronous tumors

Simone Barbosa, 67, strove to follow the breast cancer screening recommendations issued by health organizations for three decades.

A World Health Organization study concluded that mammograms for women between the ages of 50 and 64 could reduce deaths from breast cancer, but recommendations vary from country to country. The Breastcancer.org site cites research in the United Kingdom stating that these examinations should begin at 40 years of age. The respected Mayo Clinic in the United States agrees that mammograms at this early age reduce the risk of death from the disease. It is the age at which women in Brazil are also recommended to start having mammograms.

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Knowing that the risk of the disease increases with age, Simone included mammography in her annual checkup for a long time. But in 2020, with several medical services temporarily suspended due to the high demand for care caused by covid-19, he was unable to carry out those exams.

“I was already upset about the situation, so when things got a bit better in 2020, I went for it and soon got checked out,” says Simone.

The mammogram performed at that time indicated a small lump in the breast, which, when biopsied, turned out to be a malignant tumor.

“After this diagnosis, as is usually done, cancer staging is carried out, that is, the evaluation of the possible extension of the disease. In the cases of breast tumors, the most common is that the metastases extend to the liver, bones and lungs, so we first focused on investigating those areas,” explains Leonidas Noronha, a mastologist and oncoplastic surgeon who followed Simone’s case.

The surprise, says the doctor, is that in the chest X-ray, one of the tests requested for staging, a pulmonary nodule was found.

“Because this test is simple, you couldn’t tell just by looking at the image if the mass was from a primary tumor. [otro cáncer, no relacionado con el seno] or a metastasis”.

After a tomographythe specialist received an image of a large tumor, about four centimeters, which indicated that it was primary, something confirmed by a subsequent biopsy.

“In more than 30 years of mastology, Simone was the first patient in whom I saw a breast and lung tumor at the same time.”

The condition of two cancers that are not related to each other, explains Noronha, is called synchronous tumors and is considered quite rare.

“There is no single answer as to why this happens. It could be related to a genetic predisposition, but this could only be confirmed with a DNA sequencing test.”

Simone says the surprise of the two tumors was made even greater by having only one known case of cancer in her family: a sister who had bladder cancer. She, however, was a smoker, and smoking is the main risk factor for this type of tumor.

“I was very blessed”

Simone says she was lucky to discover both tumors, especially the lung one, which is more difficult to treat and its symptoms only manifest when it is already very advanced.

“I’ve been very blessed. I really believe that God gave me breast cancer so I could see lung cancer. I didn’t have any symptoms, so I wouldn’t have been tested if it wasn’t for the first diagnosis.”

When lung cancer begins to show signs such as shortness of breath, coughing, chest pain, and extreme weight loss, it means the disease is already in an advanced stage (and with a high chance of metastasis).

In Simone’s case, neither cancer had spread to other parts of the body.

Simone accompanied by her husband during the treatment. (PERSONAL FILE).

Treatment of two different cancers

The mastologist says that the treatment plan was decided jointly by him, the patient, a clinical oncologist, and a thoracic surgeon.

“Since chemotherapy had already been indicated due to the size of the largest tumor in the lung, we decided to start the treatment in sessions.”

Then came breast surgery and lastly lung surgery.

Using conventional surgical methods, removal of a lung tumor requires a more advanced approach. invasive from the patient’s body, resulting in extensive surgery and a long recovery time.

“As I was going to have two surgeries in a short time, I opted for the robotic lung surgery option, which the doctors explained would cause less pain and a quicker return to my routine,” says Simone.

According to Leonardo Rottili Roede, a thoracic surgeon at the Marcelino Champagnat Hospital in Curitiba, the surgery is minimally invasive and has no cuts, only subtle incisionswhich suits the person concerned about aesthetics.

Traditional surgery to remove a lung tumor (like the one pictured in this file photo) is invasive and leaves scars. (GETTY IMAGES).

What is done in surgery depends on the size of the lesion.

“Since Simone’s tumor was large, we removed one of the lung lobes, the one on the upper left side,” Roede says.

“At first he lost a part of his respiratory capacity, but after the surgery, with rehabilitation and pulmonary physiotherapy, he recovered. Today he has reached a level very close to what he was before.”

Simone’s last surgery turned one year old in November. Her current treatment involves taking an oral hormone blocker that helps reduce the chances of the breast cancer coming back.

“Today she is in remission from her cancer, but, like any patient who has had the disease, she needs follow-up for several years,” says Noronhas, Simone’s doctor.

Treatment for metastatic cancer is more difficult

“When there is a diagnosis of breast cancer, but the staging shows that it is already metastatic, which was not the case with Simone, the way of thinking about treatment changes,” explains the mastologist.

Surgery no longer has an initial impact, since removing a tumor would not kill cancer cells, which they would continue to spread.

“The focus generally becomes systemic treatment such as immunotherapy, chemotherapy and monoclonal antibody drugs. It is a clinical and non-surgical line of treatment.”

The prognosis for metastatic cases is more difficult, but even if it is not possible to go into remission (to be without the disease), patients with this condition often they have a good quality of lifesays Noronhas.

“With the new therapies we have today, patients with grade 4 breast cancer, for example, have active lives for many years, even more than a decade. A few years ago, the prognosis was much shorter.”

This article was adapted from a text published on BBC News Brazil whose Portuguese version you can read here.

Source: Elcomercio