Can you get two crabs at the same time?

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October 7, 2022
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October 7, 2022

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Jennifer Schmid had just found out that she had pancreatic cancer and that she needed surgery to remove part of her pancreas, stomach and intestines. Schmid’s oncologist recommended that she get a CT scan to look for cancer elsewhere on her body.

This is how the doctors found the spot on her lungs.

To Schmid, 61, from Newhall, California, the news sounded as bad as it could be. Pancreatic cancer must be so advanced it’s already spread to her lungs, she thought. But that was not the case.

Schmid’s oncologist ordered gene sequencing of both the lung tumor and pancreatic tumor. This is a test to read each tumor’s unique DNA. It turned out that the two tumors were completely different. Schmid did not have a single advanced cancer that had spread from her pancreas to her lungs. She had two different early-stage cancers: lung cancer and pancreatic cancer. This made the difference in Schmid’s treatment and long-term prognosis.

“It was a stroke of luck that they found this spot on my lung and found out that it wasn’t a metastasis,” says Schmid.

Two separate primary cancers require different treatment, as opposed to one that has spread to multiple parts of the body, and in many cases can be associated with a far better outlook than a single metastatic cancer. And it happens more often than you think.

How common is it?

While it may seem like a rare case of being struck twice, it’s not very uncommon for a person to get two primary cancers — even at the same time.

Researchers estimate that about 1 in 20 people with cancer have another cancer at the same time. They define “simultaneously” as two tumors occurring less than 6 months apart. It’s even more common to have two different types of cancer at different times – that is, a second cancer more than 6 months after the first. This happens in up to 1 in 5 people who have had cancer.

Lauren Stevens from Louisville, OH was one of those 1 of 5. She had lived with a brain tumor from 2004 to 2019. Her doctor monitored him with routine scans and until he grew they chose not to operate. However, a scan in 2019 showed it had started to grow — and fast.

Stevens, now 50, underwent surgery to remove most of the tumor, followed by radiation and chemotherapy. She then resumed routine scans to monitor the remaining tumor that the surgeon was unable to remove.

Stevens continued to live with an inoperable brain tumor and began seeing blood in her stool. A colonoscopy and biopsy revealed that she had colon cancer. Stevens was soon back on chemotherapy and radiation followed by surgery to treat this second cancer while still living with the first.

Understandably, living with cancer since she was 32 has been discouraging for Stevens. There were times when she wanted to give up and stop following recommended care. But 7 years ago she got a new reason to live.

“I have a grandson now,” she says. “He just turned seven years old. When I was growing up, I didn’t know my grandparents. I want my grandson to remember me. We’re very close. I think the sun just rises and sets over him.”

Who Gets Cancer Twice?

Anyone who has had any type of cancer can get a second cancer of any type. However, research shows that those who have had bladder cancer or non-Hodgkin lymphoma are at the greatest risk of developing second cancers. Lung cancer appears to be the most common second primary cancer.

There are a number of reasons why a person can develop two different primary cancers in their lifetime.

Chance. Everyone is at risk of developing cancer at any time. For example, you have a lifetime risk of lung cancer and a separate risk of, say, colon cancer. Although it’s less common than having just one of these cancers, it’s possible that you could get both.

Genetics. You can inherit genes from your parents that increase your risk of certain types of cancer. For example, mutations in the BRCA1 and BRCA2 genes that you inherit from a parent increase your risk of breast cancer (as well as ovarian and pancreatic cancer). You can also inherit a gene that increases your risk of colon cancer. This genetic predisposition is known as Lynch syndrome.

“For this reason, it’s important to have genetic testing done to check for any of these syndromes if you have two primary cancers,” says Joleen Hubbard, MD, an oncologist at the Mayo Clinic. “There are many that we can test for, but there are also probably many cancer syndromes that we don’t know about yet.”

Common Risk Factors. Many factors that increase your risk of one cancer also increase your risk of others. Smoking and tobacco use, for example, cause at least 14 different types of cancer. Obesity, alcohol consumption and an unhealthy diet are other risk factors for various types of cancer. Exposure to pollutants in the environment can also increase the risk of more than one type of cancer.

Previous cancer treatment. Radiation and chemotherapy for one cancer can increase the risk of another cancer down the line. However, doctors do not usually refer to these cancers as secondary primary cancers. They are radiation-induced or chemotherapy-induced secondary cancers.

How do doctors diagnose two different types of cancer?

For many types of cancer, when you receive a diagnosis, the doctor will order imaging of your chest, abdomen, and pelvis to see if the cancer has spread beyond where it started. For cancers that often spread to the brain, such as lung cancer, tests may also include brain imaging.

If other tumors show up in these images, they could provide clues as to whether they arose from the same cancer or a different one.

“If you have a patient who has two separate masses and they look different on a PET scan – one glowing more than the other – this raises our suspicion that they may not be the same malignancy, which would require that we examine both areas. says Arsen Osipov, MD, the oncologist who led Schmid’s treatment at Cedars-Sinai Cancer in Los Angeles. He heads the multidisciplinary clinic for pancreatic cancer.

A biopsy and genetic sequencing of both tumors, like Schmid had, can definitely tell doctors whether they’re looking at one type of cancer or two.

“It’s crucial to find out whether a person has two primary cancers or a single cancer that has metastasized,” says Osipov. “It could have been assumed that she had metastatic pancreatic cancer, but in fact she had two different types of cancer, each of which could definitely be treated with the intent of a cure. You deal with one thing before the other, and these cancers haven’t progressed as far as a single cancer with metastasis would have.”

What is the treatment for two different types of cancer?

When two different types of cancer occur at the same time, doctors have to decide: Which cancer should they treat first?

In unusual cases, the two cancers may share common features that would cause them to respond to the same targeted drug or chemotherapy regimen.

“That would be an ideal scenario, but it’s very rare,” says Osipov.

When two co-occurring primary tumors require two different treatments, Hubbard says, “Either treat the most life-threatening cancer first, or sometimes it’s best to treat the easiest-to-treat first.”

Schmid first had abdominal surgery for pancreatic cancer and then radiation and chemotherapy for her lung cancer. The chemotherapy is still ongoing.

what if it happens to you

If you get a diagnosis of metastatic cancer, make sure you get a biopsy of the metastases to make sure you don’t have two different types of cancer.

“Most centers already do this,” says Hubbard, “and that’s why your doctor has to biopsy a metastatic site.”

Osipov recommends that people with two concurrent primary cancers be treated at a cancer center where they can work with a multidisciplinary team that includes oncologists, surgeons, radiologists, and pathologists, who can all work together on your case. Keep in mind that oncologists tend to specialize in specific types of cancer. So if you have more than one type of cancer, you want a team of oncologists at a cancer center to determine which cancer to treat first.

At the very least, Hubbard adds, patients with two types of cancer should get a second opinion on their diagnosis and treatment.

“This not only helps the patient, but also the primary oncologist to get a better idea of ​​what tumors they are dealing with, what treatment options are available and in which order the cancers are best treated.”

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Can you get two crabs at the same time?
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