Multiple Primary Cancer as Observed at the State Institute for the Study of Malignant Disease

Abstract

Experience over a period of twenty years has taught us that the occurrence of multiple primary cancer is much more frequent than we have been inclined to believe. Most pathologists are agreed that the initial lesion of cancer is generally solitary. During the past fifty years, however, they have become more cognizant of the fact that more than one primary germ center may occur in a given system or organ. Such occurrences are now recognized as primary multiplicity of malignant lesions. Many writers on the subject have called attention to the rarity of this condition, but as more data are accumulated in hospitals, especially those devoted to the study of cancer, many more instances of multiple malignancy are encountered. The occurrence of primary multiple malignant lesions is most common in the skin. These tumors of the skin often supervene on dermatitis, such as chronic seborrhea or psoriasis, or follow prolonged exposure to inclement weather conditions, injuries, thermal and chemical irritation, or the well known roentgen dermatitis. Mulsow (1) reports a case of spindle-cell fibrosarcoma on the index finger of a physician, followed one year later by a typical roentgen-ray carcinoma of the middle finger of the same hand. Malignant tumors of the skin concomitant with mucous membrane malignancies involving the lips, mouth, pharynx, esophagus, vulva, vagina, or cervix, are not rare. Primary multiple malignant neoplasms of the internal viscera are probably less frequent, Congenital malignant tumors are known to occur bilaterally in the kidney, testicle, and ovary. Bilateral primary cancer of the breast is not infrequent. Almost all combinations in different systems, as well as different types of malignant disease, have been encountered in our study of 307 cases in which primary multiple malignancy existed during the period of observation. Other interesting phenomena were observed in this study, such as combinations of different types of malignancy in the same specimen. These combinations will be mentioned in more detail later in the course of this paper.