‘I discovered a second cancer while undergoing tests to treat the first one’: what synchronous tumors look like

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

In Brazil, it is recommended that women start mammography exams at age 40, even if there are no cases of cancer in the family, according to entities such as the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo) and the Brazilian Society of Mastology (SBM). The National Cancer Institute (Inca) and the Ministry of Health point out that the milestone should be from 50 years old.

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

“I was already bothered by the situation, so when things got a little better in 2020, I went after it and soon went through the check-up”, says Simone.

The mammogram performed at the time indicated a small lump in the breast, which, when undergoing the biopsy, was informed to be a malignant tumor.

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

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

“Since this exam is simple, you couldn’t tell just by looking at the image if the mass was from a primary tumor [outro câncer, sem relação com o de mama] or a metastasis.”

After a tomography, the specialist received an image of the tumor, large, about four centimeters, which pointed to the case of a primary tumor – which was later confirmed by 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 unrelated 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 that the surprise of the two tumors was even greater for having only one known case of cancer in her family: a sister who faced the disease in the bladder. 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 the two tumors, especially the lung one — more difficult to treat because it only shows symptoms in an advanced stage.

“I was very blessed. I truly believe God gave me breast cancer so I could see lung cancer. I didn’t have any symptoms so I wouldn’t get tested if it wasn’t for the first finding.”

When lung cancer shows signs such as shortness of breath, cough, chest pain and extreme weight loss it means that the disease is already in an advanced stage (and with a high possibility of metastasis).

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

Treatment for two different cancers

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

“As she already had an indication for chemotherapy due to the size of the larger tumor in her lung, we chose to start the treatment in sessions.”

Then came breast surgery, and finally, lung surgery.

By conventional surgical methods, removing a tumor from the lung requires a more invasive approach to the patient’s body, which results 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 routine”, says Simone.

According to Leonardo Rottili Roede, thoracic surgeon at Hospital Marcelino Champagnat, in Curitiba, the surgery is minimally invasive and has no cuts, just subtle incisions, which helps anyone who is concerned with aesthetics.

The price, says the surgeon, is still high for the majority of the Brazilian population — it is between R$15,000 and R$20,000 for patients who, like Simone, have a health plan and benefit from covering part of the expenses. .

“But the price tends to drop over the years and the evolution of technologies. About two years ago it cost R$ 50,000.”

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

“As Simone’s tumor was extensive, we removed one of the lung lobes, the one on the upper left side”, points out Roede.

“At first, she lost a portion of her breathing capacity, but after the surgery, with rehabilitation and pulmonary physiotherapy, she recovered. Today, she has reached a level very close to what she had before.”

Simone’s last surgery completed one year in November. Today her treatment consists of taking an oral hormone blocker that helps to lower the chances of breast cancer coming back.

“Today she is in remission from her cancer, but, like any patient who has had the disease, she needs to be followed 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 the treatment changes”, explains the mastologist.

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

“The focus becomes, usually, a systemic treatment such as immunotherapy, chemotherapy and drugs with monoclonal antibodies. 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 (being without the disease), patients with this condition often manage to have a good quality of life, says Noronhas.

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

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