Elena Castro, oncologist: “The most common synchronous cancers are breast and prostate”
We spoke with the oncologist about Navratilova’s case: “It is relatively common to detect breast cancer by chance, at the same time as another”
Breast and prostate tumors “are not uncommon as synchronous cancers: primary tumors that are discovered incidentally”
Age, genetic predisposition, or the fact that there is a common cause for two types of cancer are risk factors for developing synchronous cancers.
A Martina Navratilova has just been diagnosed with two cancers at the same time: throat and breast. The news jumped a few days ago. The tennis player, of 66 yearswas diagnosed with cancer of the throat in phase 1, very incipient. When further tests were done regarding this tumor, they discovered another, breast and unrelated to the throat.
It’s what oncologists call “synchronous cancer”: two primary tumors at the same time, two simultaneous cancers in time but independent. Amazing? Not for oncologists. “What surprised me was that it was on the news,” he confesses. Elena Castro, oncologist and researcher at the CRIS Foundation Against Cancer.
Castro is an expert in prostate cancer, and works at the Hospital 12 de Octubre in Madrid. And she explains why she was not surprised by the Navratilova case. “Breast and prostate are very frequent tumors in the general population. You may be studying a tumor of something else and, when doing tests, you also find a breast or prostate tumor. And the diagnosis will coincide in time.
Explain that, with these two types of cancer, “it is not so rare” to detect them like this, casually, at the same time as others. “Breast and prostate are not uncommon as synchronous cancers, we see it relatively frequently,” she says. “And she is of age, besides”, he underlines, referring to Navratilova. Why age is a risk factor in synchronous cancersalthough not the only one.
Asymptomatic cancers discovered incidentally
Navratilova already had breast cancer years ago, in 2010. It was detected at a very early stage and resolved with radiotherapy. This one right now it can be a relapse of that one, what oncologists call “recurrence”, or a new, independent one. Castro assures that, without having more information about his history or about the tests that have been done on him, it is difficult to know. Although he warns: “It could be another primary tumor. A person who has had a previous breast cancer has a higher risk of having a second.”
But, be it one thing or the other, an independent breast tumor or a recurrence of the previous one, what has happened to the tennis player is not so strange. And it happens with other types of cancer. too. “For example, in bladder cancerwhen the patient is operated on, it is removed also the prostate, and it is very frequent that he had a tumor there. Or in a patient they are studying for a lung cancerwhen doing the analysis the PSA level comes out high and it turns out that there is another tumor located in the prostate. They are primary tumors that are discovered incidentally.explains Castro.
“When doing very sensitive tests, such as PET, a lesion can appear in another place that, when going to study it, you can see that it is a primary tumor.” It occurs, above all, with the breast and prostate, although Colon cancer is also very frequent in the population. Why doesn’t it happen as much with that one?
“Breast, prostate and colon cancers are the most frequent, but in breast and prostate many are asymptomatic. The colon does usually give symptoms. Therefore, the first two are more likely to be found at the same time as others, by chance. They are the most frequent synchronousCastro explains. “Y also the leather ones“, Add.
Risk factors: age, genetics, a common cause…
The age is a risk factor in synchronous cancers, because “both breast cancer and prostate cancer are more common in older people. Cancer, in general, is, because it is linked to the aging of the organism. The older you get, the more likely some of this is going to show up.”he warns. “Unless you have some genetic predispositionhereditary, which then can happen to you very young”.
“There are inherited mutations that greatly increase the risk of certain tumors. For example, in the BRCA gene. When both (1 and 2) are mutated, greatly increases the risk of breast and ovarian cancer. It may be that, when studying a case, both tumors are seen developing at the same time”. This is the case, for example, of the actress Angelina Jolie, who has undergone preventive surgeries to avoid them.
and there is also causal factors, which predispose to develop two or more types of cancer. Tumors that have a common cause. For example, tobacco greatly increases the risk of lung cancerbut also of the head and neck, that is, in the respiratory tract: throat, larynx…”, explains Castro. Or bladder. And he gives an example: “It is possible that a person who sees a nodule in a lung, when doing the study, sees a lesion in the throat and that it is a tumor.” Although in many cases, a question arises: Is it metastasis?
Metastasis or two primary tumors?
Know if the second tumor found Is it a metastasis of the first or is it a primary, independent tumor, it is not always easy. “You have to biopsy them to find out. And see what kind of tumors they are.” Oncologists do a series of tests with which they can end up concluding whether it is a synchronous cancer or not.
“Sometimes we know it because of the aggressiveness of the tumor,” explains the oncologist. For example, a patient with a large and aggressive lung cancer, of a specific cell type, has another tumor in the prostate, but it is small, not very aggressive and with different types of cells. “In that case it’s easy, we see that they are not connected.” But Castro gives another, more difficult example.
“If you are a smoker with a tumor in the lung and another in the throat, both of which are epidermoid (with the same type of cells), sometimes it’s hard to know. We will know by the mutations it has. If you have the same ones, it has to be the same tumor”.
Other times, he explains, they know “by tumor markers,” such as PSA levels, marker of prostate cancer. “We analyze tumor markers, mutations, histology (the cell type of the tumor), and in most cases we are able to conclude if it is metastasis or if they are two primary tumors”.
How are they treated?
And what is the best treatment, in these cases? “Whatever you think may have the best result for the patient. If you doubt, if you can not be clear if it is a synchronous cancer or a metastasisand the patient is able to undergo surgery, normally what benefits the patient the most is remove them and treat them as if they were two primary tumors. But you have to study each case.”
Returning to the of Navratilova, Castro believes that “throat seems localized and in an initial stage, I suppose that they will operate it ”. and believe that “The one that will condition the prognosis the most is that of the breast”. Why? Because she already had it. And, even if it were two primary tumors, “there is more risk” when it appears again. But the oncologist is optimistic: “It can be operated, and it will surely go well.”
Castro highlights one thing, above all else. “What this case of Navratilova makes clear is that early detection is key, it is very important”. In the case of the tennis player, it seems that the two tumors -breast and throat- are treatable, and for this It has been key to detect them in time.
