Second Primary Malignant Neoplasms: A Clinicopathological Analysis from a Cancer Centre in India

Narendra Hulikal,Joseph Thomas,Satadru Ray,Donald J Fernandes

doi:10.7314/apjcp.2012.13.12.6087

Abstract

Patients diagnosed with a cancer have a life time risk of developing another de novo malignancy depending on various inherited, environmental and iatrogenic risk factors. Of late the detection of new primary has increased mainly due to refinement in both diagnostic and treatment modalities. Cancer victims are surviving longer and thus are more likely to develop a new metachronous malignancy. To report our observed trend of increase in prevalence of both synchronous and metachronous second malignant neoplasms among cancer victims and to review the relevant literature. A hospital based retrospective collection of prospective data of patients diagnosed with second denovo malignancy. The study was conducted over a 5 year period from July 2008 to June 2012. All patients diagnosed with a histologically proven second malignancy as per Warren Gate's criteria were included. Various details regarding sex, age at presentation, synchronous or metachronous, treatment and outcome were recorded. The occurrence of multiple primary malignancies is not rare. Awareness of the possibility alerts the clinician in evaluation of patients with a known malignancy presenting with unusual sites of metastasis. Individualizing the treatment according to the stages of the primaries will result in durable cancer control particularly in synchronous double malignancy.

Highlights

The occurrence of multiple neoplasms is not rare
The Second primary malignancy (SPM) is a second denovo malignant neoplasm occurring in a patient with known cancer
With respect to metachronous head and neck cancers, a diagnosis of SPM was considered only when the second cancer was of non-squamous cell histology, or it developed in a different subsite or when the second cancer was of squamous cell histology and developed in the same region as the index cancer, it was considered so if the time interval is more than 5 years without any evidence of metastatic disease

Summary

Introduction

The occurrence of multiple neoplasms is not rare. The reported incidence ranges from 0.734-11.3 % depending on whether the study is ante mortem or postmortem (Spratt and Hoag, 1966; Hadju and Hadju, 1968; Berge et al, 1969; Haddow et al, 1972; Berg and Schottenfeld , 1977; Bordin et al, 1977; Newell and Krementz, 1977; Lee et al, 1982; Watanabe et al, 1984; Flannery et al, 1985; Storm et al, 1985; Teppo et al, 1985; Engin, 1994; Aydiner et al, 2000). The Second primary malignancy (SPM) is a second denovo malignant neoplasm occurring in a patient with known cancer. A SPM can arise either synchronously or metachronously. The criteria used for the diagnosis of multiple primary cancers were first given by Warren and Gates (Table 1) and refined later Each of the tumors must be malignancy confirmed by histology

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