LOS ANGELES – Duncan Avery thought his son was imitating his big sister when he said his head was hurting.
Avery's other child, 6-year-old Kalea, was diagnosed with a brain tumor a week ago. She had just had an operation to remove the mass.
Now Noah, 4, pointed to a point between his eyebrows, the same place Kalea had complained of pain.
Then Noah vomited. He began to walk strangely, his little body tilting to the right.
On June 21, an MRI showed that Noah also had brain cancer. There was a tumor that looked exactly like his sister's, in the same part of the brain.
"We've burst into tears," said Avery, who lives in Torrance. "How could two children have the same tumor in 1
There seems to be no precedent for the twin diagnoses. Doctors say they are drugged that both children develop symptoms within a few days.
There are rare reports of sibling developing brain tumors, even the same type of brain tumor, but not simultaneously.
"We've probably never seen any of that," Dr. Sonia Partap, a professor at Stanford University who works on childhood brain tumors.
At the end of May, Kalea surrendered on a Sunday morning. She seemed to be good otherwise, so her parents wrote it as stomach upset.
It was Memorial Day weekend. She played with her cousins on a family barbecue. She strapped on her yellow helmet and went skateboarding with her father, cleverly leading her around a U-shaped halfpipe.
But later that week, Kalea began to say, her head hurt. Her mother, Nohea, took her to the emergency room.
There physicians discovered a mass in the girl's brain.
Doctors said it was a medulloblastoma, an aggressive tumor in the back of the brain. About 500 children in the US are diagnosed with one each year, although it is unclear what causes them.
The diagnosis was heartbreaking.
The treatment typically involves surgery to remove the tumor, followed by radiation and chemotherapy to ensure the cancer does not come back. Every step of the treatment carries serious risks.
Kalea underwent a four-hour operation on June 11th. In just a few weeks "we're going by a healthy baby, a skateboarder and a footballer who just loves life" Duncan, 36.
Duncan, who is a surf coach at Redondo Union High School, and made nohea, a nurse soon worried about Noah.
Just two years later, Noah and Kalea often played together. They are both shy, with the same broad foreheads and round cheeks.
Her parents noticed that while Kalea was in the hospital, Noah napped every day, pointing at his head, and walking a little strangely.  Duncan thought Noah was depressed. He understood; He was sad too. His eldest child, with whom he had started teaching last summer, was ill. He could not say her name without tearing.
But Duncan brought Noah to the pediatrician just in case.
Dr. Lauren Nguyen examined Noah. She already knew what was going on with Kalea.
She also knew that medulloblastomas grow near the cerebellum, the part of the brain that controls balance and movement. Although Kalea did not have such symptoms, a shaky gait can be a sign of this type of tumor.
"When I saw Noah walking down the hall, my heart fell," Nguyen said. "But of course the lightning could hit twice?"
Tests showed that Noah's medulloblastoma was even bigger than his sister's.
"It's very unusual," Nguyen said. "It could be coincidental, but probably not."
Doctors say the siblings probably have something in their genes that makes them vulnerable to this type of cancer. It is unlikely that the trigger comes from the environment.
"It's not in the water in LA," said Partap.
Scientists have identified mutations in several genes that increase the risk of cancer, the most prominent of which is the BRCA gene associated with breast cancer. It is possible that a genetic mutation that predisposes children to medulloblastoma has not been detected.
"Perhaps the reason why we are being brought to this earth so that we can find the gene that causes medulloblastoma," said Duncan
The timing of the Avery children's symptoms is remarkable, experts say.
There are about 10 cases of medulloblastoma in siblings in the scientific literature. In a 1990 publication, a brother and sister were described who developed the tumors within 12 months, but most examples report tumors that differed over years
. Dr. Ramin Javahery, MD of pediatric neurosurgery at Miller Children's and Women's Hospital in Long Beach, had already operated on Kalea when he received a call for a new brain tumor patient.
"I thought," Huh, same surname, how weird, "said Javahery," It just was not so within my thought processes that you could let her siblings come. I assumed it was someone else. Then I was told by the oncologist what was going on, and I said, "Oh, my God."
Javahery operated on Noah on Monday. He was able to completely remove Noah and Kalea's tumors. None of the masses seems to have spread to other parts of the children's brains or bodies.
The chance of surviving five years for both children is about 80 percent, he said. After clearing the five-year mark, it is unlikely that the cancer will return, he said.
However, the radiation and chemotherapy included in the treatment could damage your brain. Radiation is not good for anyone, but especially not for growing brains.
"With radiant young children, you can significantly influence every part of the brain, but the way it manifests is, above all, cognitive, it significantly delays cognitive development," Dr. Anthony Wang, who examines pediatric brain tumors at UCLA.
Kalea and Noah may need years of speech therapy, occupational therapy and physiotherapy, experts say.
"It's not just that you talk about your child's life, they also talk about their future, so, will my child survive, but how will they survive?" Said Javahery.
Duncan said he knew that his family had a long way to go.
Soon, they plan to go to the Children's Hospital of Los Angeles, he said. He wants to bring the kids together, so wait a few days for Noah to recover from his surgery.
"Everyone says his kids are best friends, but our kids are 100 percent best friends," Duncan said. "We'll look after them and they'll say, 'Go away, Mom, go away, Dad, we're just playing.'"
When Noah was hospitalized last week, he was sent to the same ward as his sister. It was a floor for cancer patients. Their rooms were side by side.
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