60-yr-old woman with tumours in breast and kidney at the same time successfully treated at Sahyadri Hospital in Hadapsar; such a condition is rare, presenting a conundrum to doctors .
In a rare feat, doctors at a Hadapsarbased hospital in the city successfully treated a 60-year-old patient suffering from a double malignancy at the same time, battling both breast and kidney tumours. Such malignancies pose a diagnostic and therapeutic problem for oncologists, making it difficult for them to figure out which tumour is to be treated first. With very few guidelines available for their management, the decision on treatment solely depends on the doctors — who were successful in this instance.
The woman, a Kondhwa resident, first came to Sahyadri Hospital around four months ago, complaining of a lump in her left breast. During examination, it was found to be affecting the overlying skin and had spread to the armpit. As part of routine tests, she underwent a biopsy of the lump, which proved to be breast cancer.
A chest and abdomen CT scan was performed to rule out spread of the cancer to other organs. However here, a left-sided kidney tumour was detected — reported to be second cancer. This put the treating doctors — director of medical oncology at Sahyadri Dr. Shona Nag and oncosurgeon Dr. Joy Ghose — in quite a dilemma, as the treatment for both these cancers are along very different lines.
Said Nag, “It was a tricky decision to start — from which one to treat first to which of the two is more life-threatening for the patient. There are very few guidelines for the management of such double malignancies. As her breast cancer was at an advanced stage, she required chemotherapy first. But kidney cancer is resistant to chemotherapy agents, and if left untreated, would continue to grow.”
Added Ghose, “A multi-disciplinary tumour board discussion in our hospital led to a plan being formulated — laparoscopic surgery for the kidney cancer allowing quick recovery, then chemotherapy for the breast cancer, to be followed by surgery for this tumour. As planned, then patient has completed treatment without any setbacks, and is now on the road to recovery. She has been discharged.”
The son of the patient, preferring to stay unnamed, said, “We had earlier gone to a Mumbai hospital for treatment and later came to Pune. We were unaware of the second tumour. It was a big shock for all of us when found. With very little hope, the treatment began. Fortunately, everything went well. We are happy that the treatment was successful and my mother is almost on her way to recovery.”
While a patient presenting two different cancers at the same time is a rare clinical condition, there are some circumstances that may predispose simultaneously developing cancers affecting more than one organ system, possibly due to genetic causes.
Weighing in on the latest case, Dr Gajanan Kanitkar, consultant surgical oncologist at Ruby Hall Clinic, Pune, said, “Cases of double malignances are not found routinely. The line of treatment is decided individually cancerwise, based on severity. Treatment differs from regular tumour cases. The one which is more aggressive should be targeted first.” Dr Rakesh Neve, senior onco-consultant at Sterling Multi-Speciality Hospital, Pune, shared, “The line of treatment for both tumours is different, which is a challenging task. If both are operable, doctors could also opt for a surgery of both at the same time. Chemotherapy is required for the breast tumour and oral medication for the one in the kidney. If diagnosed in time, it is curable.”