Think Hearing "You Have Cancer" is Bad? What about "You Have Two."

Understand the importance of searching for a second cancer.

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That 40% of us will at some time hear those three terrible little words, “You Have Cancer,” is frightening enough.  But imagine how much worse it would be to learn that your body is harboring not just one, but two cancers at the same time.  Cancers that are found in the same person at the same time are called “synchronous” malignancies.  But of greater danger to a patient than finding out that they have synchronous cancers is not finding out and treating only one.

Because when that happens (and I have seen it), only when the second, hidden cancer has grown large enough to produce symptoms (or, even more threatening, when the second, hidden cancer has spread elsewhere in the body) does treatment begin.  So, as with all cancers, catching a synchronous, second tumor soon after diagnosing the first malignancy means catching it at an earlier stage.  Nor does a diagnosis of synchronous cancers necessarily alter your likelihood of survival (again, what types and how advanced the cancers are at diagnosis is the key).  So empower yourself and understand the simple steps you should take if you or a loved one is diagnosed with a cancer in order to rule out or find a second tumor.

Two synchronous cancers can develop in the same organ or tissue.  For example, of the 132,700 Americans projected to be diagnosed with colorectal cancer this year (the number two cancer killer), an estimated 3.9% will actually have more than one colorectal cancer at the same time (most commonly two).

  An immediately significant treatment implication is that widely separated intestinal tumors (common with synchronous growths) clearly require a more extensive operation to potentially cure the patient.  Thus if you or a loved one is diagnosed with colorectal cancer during a flexible sigmoidoscopy (which visualizes about the last third of the large intestine), prior to treatment you must undergo a subsequent colonoscopy (which visualizes the entire length of the colon) to look for a synchronous cancer hiding further upstream.

  Fortunately, the overwhelming majority of physicians recognize the need for a full pre-treatment colonoscopy.  And now you know, too.

The reported incidence of simultaneously harboring breast cancer (the most common malignancy in the U.S.) in both breasts varies between 0.8% and 5.0%.  Knowing that you or a loved one actually has synchronous bilateral breast cancers is obviously critical to receiving appropriate treatment.  Fortunately, doctors routinely perform bilateral breast mammography and breast exams.

Thus with exceedingly few exceptions, physicians routinely evaluate their newly diagnosed cancer patients for a second tumor in the same organ or tissue.  But physicians are often laser-focused on the organs and cancers in which they specialize.  Thus it is most important that you understand the second way in which synchronous cancers can develop within you or a loved one:  in different organs.

There are many published reports of individual patients, but getting a handle on the actual incidence of synchronous malignancies in different organs is challenging.

  That said, please allow my personal experience to provide you with some guidance that may just benefit you or a loved one.  The reality is that many, many people fail to follow recommended cancer screening guidelines.  The additional reality is that many recommended cancer screening guidelines are controversial, with some medical societies supporting one screening protocol and other physician groups backing another approach (or believing that screening is of no benefit).  Many of my newly diagnosed colorectal cancer patients had only had their malignancies detected once their tumors caused symptoms.  They had not been screened for colorectal cancer, and often not for breast, prostate, or other cancers.  By requiring that these patients rapidly completed appropriate screening outside of their colon and rectum, we diagnosed several women and men with synchronous cancers in other organs (most often breast and prostate).  Whether the finding of a second cancer altered are attempted curative treatment, or whether the new knowledge led us to avoid putting the patient through aggressive and ultimately unnecessary colorectal cancer treatments, our patients benefitted from the correct synchronous cancer diagnosis.

So if you or a loved one is diagnosed with a cancer, make certain that your physician partners not only evaluate the same organ in which your cancer was diagnosed for a synchronous tumor (which they almost certainly will), don’t let them forget to rapidly screen the rest of you for a synchronous malignancy before you begin treatment.

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