P1.07-054 Second Primary Small Cell Carcinoma of Lung in Previously Treated Carcinoma Breast

Abstract

Breast cancer is the major cause of cancer among women worldwide. Some of the patients are treated with surgery followed by adjuvant chemotherapy and radiation therapy. It is presumed that the radiation of surrounding tissues during breast radiotherapy may cause cancer in other areas of body. A 40 year old woman presented with chest pain and breathing difficulties for four months. She was diagnosed as infiltrating duct cell carcinoma of right breast and undergone modified radical mastectomy. Her 1 of 20 lymph nodes showed tumor metastases with perinodal extension. Triple marker (oestrogen receptor, progesterone receptor, her 2 neu receptor) was negative. She was given four cycles of CEF regimen cyclophosphamide, epirubicin, 5-FU) and four cycles of paclitaxel. She had also received 25 fraction of radiotherapy completed over one year before. There were no other co-morbid conditions, family history was not significant. She had average body built and nutrition. On general examination mild pallor was only positive finding, no peripheral lymphadenopathy or clubbing. Contrast enhanced computed tomogram of chest revealed bilateral lung nodular infiltrates more predominantly in left lower lobe, mediastinal lymphadenopathy with left lower lobe collapse. Ultrasound abdomen detected no significant abnormality. Bronchoscopy showed multiple nodules present over carina, infiltration in right lower lobe segmental opening, left main bronchus lumen narrowed due to diffuse infiltrative growth. The endobrochial biopsies were taken from this area. Endobronchial biopsy revealed tumor cells were strongly and diffusely positive for synaptophysin and negative for chromogranin and TTF1. The diagnosis of small cell carcinoma lung was made. MRI of brain showed ring enhancing lesions in right cerebellar hemisphere suggestive of metastases. Staging of the tumor came to T4N2M1a according to 8th edition of IASLC TNM classification for lung cancer. Her performance status improved to ECOG 2. She was given cisplatin and etoposide in addition to brain radiation therapy. The second primary malignancy refers to a different type of cancer in a person who has survived an earlier cancer. There are series of non-small cell lung cancer (NSCLC) reported as second primary after breast cancer. To our knowledge, this is the first case presented as small cell lung cancer as second malignancies in lung in a fully treated breast cancer patient. This may be related risk of second malignancies associated with radiotherapy exposure to lung applied for breast cancer or due to adjuvant treatment as in this case.