Multiple primary cancer: Thirty patients with three or more primary cancers

Abstract

Many types of cancer, when treated early and aggressively, can be cured. The potential, however, for cancer to occur independently a second time, or more often, in the same patient remains an ever present risk. In 1964, Mersheimer, Ringel and Eisenberg [1] analyzed the records of 140,000 cancer patients that were made available through the End Results Evaluation Program of the National Cancer Institute. Multiple primary lesions were found in 4,461 or 3.2 per cent. Of these patients, 4,230 or 95 per cent had two independent malignant lesions; 221 or 4.5 per cent had three independent lesions; the remaining 10 or 0.5 per cent had four or more primary cancers. In 1963, Pickren [2] studied an autopsy series of 2,094 subjects who had had cancer and found the incidence of multiple primary tumors, including occult lesions, to be 11 per cent. Pickren also cited similar autopsy studies [3,4] in which the incidence of multiple primary cancers varied from 1.8 to 7.8 per cent. In the study of patients with multiple primary cancer, suspected primary lesions must be established as truly independent and not metastatic growths. Billroth in 1869 was the first to propose criteria for establishing a true new primary lesion [I]. He proposed that (1) each tumor must have an independent histologic appearance; (2) the tumors must be separate and situated in different organs; (3) each tumor must produce its own metastases. Warren and Gates [5] in 1932 liberalized these criteria. They proposed that each suspected primary