THREE METACHRONOUS PRIMARY LUNG CANCERS IN A CHRONIC SMOKER: A CASE REPORT

Abstract

SESSION TITLE: Fellows Lung Cancer Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Lung cancer is the worldwide leading cause of cancer-related deaths. Patients once treated curatively for lung cancer can develop subsequent primary lung cancer. Smoking is the major risk factor for the development of lung cancer and contributes to a higher risk of developing a second lung cancer in patients who continue to smoke after diagnosis and treatment of the initial cancer. The subsequent primary lung cancer can be treated successfully, however, both treatment regimen and prognosis depend on whether it is synchronous or metachronous. CASE PRESENTATION: A 60-year-old smoker with 55 pack-year history, presented with cough and hemoptysis. His physical exam was remarkable for clubbing. His pulmonary function testing revealed moderately severe chronic obstructive pulmonary disease (COPD). A Computerized Tomographic (CT) scan revealed a right upper lobe spiculated mass. Positron emission tomography (PET) scan showed standard uptake value (SUV) of 4.5 in the primary tumor and ipsilateral hilar and paratracheal nodes in metastatic range. Histopathologic examination of a transthoracic needle biopsy showed poorly differentiated adenocarcinoma (ADC) of the lung, stage IIIA. The patient was curatively treated with chemotherapy and radiation. After nine years he developed a new posterior left upper lobe spiculated nodule. PET/CT showed it to have an SUV of 4. The patient underwent apical wedge resection of the left upper lobe. Histopathological examination showed moderately differentiated keratinizing squamous cell carcinoma (SCC), stage IA1. He was given extensive counseling on smoking cessation, but he was still not able to quit. Six months later, CT of the chest showed increased soft tissue density and adenopathy of the right hilum with perilymphatic nodules in the right upper and lower lobes consistent with lymphangitic carcinomatosis. The patient underwent transbronchial biopsy reporting a small cell carcinoma (SCLC). Due to poor performance status, he was not a candidate for systemic chemotherapy, and he decided to go into hospice care. DISCUSSION: We reviewed the clinical and pathological features of synchronous and metachronous lung cancers in previously described patients. These patients were below the average age at which first lung cancer diagnosis is made in most patients, had long smoking histories, and histological type occurred in random order. The patients with metachronous cancers continued to smoke after the first or second cancer diagnosis which placed them at a higher risk for subsequent cancer(s). CONCLUSIONS: We recommend that patients with lung cancer diagnosis must quit smoking to reduce the risk of a second primary cancer, and those who do not quit should remain on long-term surveillance. Reference #1: de Groot PM, Wu CC, Carter BW, Munden RF. The epidemiology of lung cancer. Transl Lung Cancer Res. 2018;7(3):220-233. Reference #2: Han SS, Rivera GA, Tammemagi MC, et al. Risk Stratification for Second Primary Lung Cancer. J Clin Oncol. 2017;35(25):2893-2899. Reference #3: Smith RA, Andrews KS, Brooks D, et al. Cancer screening in the United States, 2018: A review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 2018;68(4):297-316 DISCLOSURES: No relevant relationships by Boris Betancourt, source=Web Response No relevant relationships by Lillian Chow, source=Web Response No relevant relationships by Dushyant Damania, source=Web Response No relevant relationships by Raavi Gupta, source=Web Response no disclosure on file for M Haseeb; no disclosure on file for Absia Jabbar; No relevant relationships by James Mahoney, source=Admin input No relevant relationships by gurinder sidhu, source=Web Response