Diagnosis Of Multiple Primary Cancers Research Articles

Suicide and Cardiovascular Death Among Patients With Multiple Primary Cancers in the United States.

BackgroundPrevious studies have demonstrated that patients with a cancer diagnosis have an elevated risk of suicide and cardiovascular death. However, the effects of the diagnosis of multiple primary cancers (MPCs) on the risk of suicide and cardiovascular death remain unclear. This study aimed to identify the risk of suicide and cardiovascular death among patients with MPCs in the United States.MethodsPatients with a single or MPC(s) between 1975 and 2016 were selected from the Surveillance, Epidemiology, and End Results database in a retrospective cohort study. Mortality rates and standardized mortality ratios (SMRs) of suicides and cardiovascular diseases among patients with MPCs were estimated.ResultsOf the 645,818 patients diagnosed with MPCs included in this analysis, 760 and 36,209 deaths from suicides and cardiovascular diseases were observed, respectively. The suicide and cardiovascular-disease mortality rates were 1.89- (95% CI, 1.76–2.02) and 1.65-times (95% CI, 1.63–1.67), respectively, that of the general population. The cumulative mortality rate from both suicides and cardiovascular diseases among patients with MPCs were significantly higher than those of patients with a single primary cancer (Both p < 0.001). In patients with MPCs diagnosed asynchronously, the cumulative incidence rates of suicides and cardiovascular deaths were higher than those diagnosed synchronously. Among all MPCs, cancers of the pancreas and esophagus had the highest SMRs of suicide (5.98 and 5.67, respectively), while acute myeloid leukemia and brain cancer had the highest SMRs of cardiovascular diseases (3.87 and 3.62, respectively). The SMR of suicide was highest within 1 year after diagnosis, while that of cardiovascular diseases was highest 5 years after diagnosis.ConclusionsThis study showed that the mortality rates from suicides and cardiovascular diseases among patients with MPCs were higher than those with a single primary cancer. Therefore, our results underscore the need for psychological assessment and targeted preventive interventions for suicides and cardiovascular diseases among patients with MPCs.

The impact of selected factors on early diagnosis of multiple primary cancers in patients with uveal melanoma

Aim of the studyTo find differences between a group of patients with intraocular melanoma and another primary cancer and a group of patients with no identifiable second primary cancer.Material and methodsThe analysis involved 240 participants, selected from patients who were treated for uveal melanoma at the Department of Ophthalmology and Ocular Oncology of the Jagiellonian University Medical College between the year 1998 and 2007. Among those patients 97 were diagnosed with one or more independent primary cancers. Those patients were subject to a comparative analysis with a second group of 143 patients who had uveal melanoma with no identifiable second primary cancer.ResultsStatistically significant differences between the group of patients with intraocular melanoma and another primary cancer, and the group of patients with uveal melanoma (but without another diagnosed primary neoplasm) were as follows: more common family history of cancer, better education, living in cities (especially with a population over 500 thousand), previous surgery except for uveal melanoma, and two or less than two pregnancies in the case of women.ConclusionsThis analysis revealed that more common family history of cancer, better education, living in cities (especially with a population over 500 thousand), previous surgery, except for uveal melanoma, and two or less than two pregnancies in the case of women, were associated with a higher rate of detection of multiple primary cancers.

Multiple primary cancers of separate organ sites: implications for research and cancer control (Australia)

To identify cancers which occur as second primaries following the diagnosis of cancers of other sites, as a basis for formulating causal hypotheses and planning medical surveillance. Analyses of fifteen common cancer sites were undertaken to examine the occurrence of multiple primaries. These cancers were notified to the South Australian Cancer Registry during 1977-2001. Historic cohort models were used where standardised incidence ratios (95 confidence limits) were calculated to indicate the risk of second primary cancers. New associations detected included an increased risk of cancers of the bladder, colon, rectum, kidney and melanomas following a diagnosis of prostate cancer and an increased risk of leukaemia following both lung and rectal cancer. Many previously identified combinations of multiple primaries were confirmed. From the wide range of associations identified, some such as leukaemias occurring as second primaries after the diagnosis of ovarian cancers and lymphomas may be a treatment effect. The diagnosis of multiple primary cancers in the same month (e.g. bladder-prostate cancers and ovarian-uterine cancers) may reflect patterns of medical testing and the long preclinical phases of some cancers.

Multiple primary cancers of oral cavity and pharynx

Multiple primary cancers were found in 23 of 68 patients (34%) with an index cancer in the oral cavity or pharyngeal area treated in our institute from June 1995 to July 1998. Four cases had triple primary cancers. All 68 cases underwent upper and lower gastrointestinal endoscopy as well as ultrasonography of the liver. Lung CT was performed in cases with abnormal findings on chest roentgenograms. Multiple cancers were found in 5 of 25 oral cavity cases (20%), 6 of 14 mesopharynx cases (43%) and 12 of 29 hypopharynx cases (41%). Nine of 23 cases (39%) were synchronous and 14 (61%) were metachronous. Eighteen of 27 (69%) secondary cancers occurred in the upper aerodigestive tract with an especially high incidence (22%) in the esophagus. Gastroendoscopy also revealed 7 neoplastic lesions, aside from cancers, with the total abnormal rate of 24% (24/68). Thus, gastroendoscopy is useful for the diagnosis of multiple primary cancers. The frequency of multiple primary cancers in males (33%) was not different from that in females (35%). The average age of multiple primary cancer patients (65.1 years) was a little higher than that of single cancer patient (62.7 years). Smoking or drinking was not related to the incidence of multiple cancers. The interval between the first and the second cancer in metachronous cancer cases was 25.5 months on average, and within 4 years in 71% (10/14) of the cases. This result suggests that close follow-up including endoscopy should be required for at least 4 years after treatment of oral or pharyngeal cancer. Radical treatment for each of the multiple cancer lesions was performed in 22 of 23 cases, and the mortality rate of multiple primary cancer cases was not significantly different from that of single cancer cases. Among 7 cases who died of disease, 5 cases died of distant metastasis, suggesting that control of distant metastasis is an important issue in the treatment of multiple primary cancers.

Synchronous and metachronous diagnosis of multiple primary cancers.

In the time period near to the diagnosis of a new cancer, other tumors (synchronous cancers), especially slow-growing tumors, may be detected because several diagnostic examinations are performed. The frequency of synchronous in comparison with metachronous carcinomas has been evaluated in a population-based series of multiple primary cancers. The case series of multiple primary cancers of the Tuscany Tumor Registry, incident during the period 1985-1991 was analyzed. For each site of a second independent tumor, the proportions of synchronous (diagnosed within 2 months of the first primary) and metachronous cancers were compared with the mean distribution (all sites except the specific one). During 1985-1991, 1095 patients had two independent tumors diagnosed; 216 were synchronous. The proportion of synchronous compared to metachronous cancers was significantly higher for bladder, prostate and renal cell carcinomas; it was significantly lower for lung cancer. When cancers following skin epitheliomas were evaluated, only the proportion of synchronous skin cancers was significantly increased. Silent slow-growing tumors are suspected to be more frequent in patients with prostate, bladder or renal cell carcinomas. In fact, they were most frequently diagnosed during ascertainment for another cancer. When few examinations were performed, as after the diagnosis of a skin epithelioma, no difference between metachronous and synchronous cancers was evident, except for skin.

Multiple Heteromorphologic Malignant Tumors of the Uterus

IN spite of the fact that mortality statistics rank malignancy as one of the leading causes of death, the incidence of multiple malignant tumors in the same individual is comparatively rare. Cases in which three morphologically dissimilar tumors occur are regarded as curiosities. The case herewith presented illustrates the occurrence of three such malignant tumors of the uterus. Billroth (1) is credited with the first report on multiple primary malignant growths in the same individual. He emphasized the importance of certain basic criteria before the diagnosis of such a condition could be established. His postulates are as follows: (1) each tumor must have an independent histologic appearance; (2) the tumors must arise in different situations, and (3) each tumor must produce its own metastasis. Mercanton added a fourth prerequisite—that there be no recurrence of the tumors following their removal. The demand for the fulfillment of the third postulate of Billroth, as well as that of Mercanton, is quite as unreasonable in the diagnosis of multiple primary malignancy as in that of a single carcinoma. In the latter case, to diagnose malignancy only in the presence of metastasis would create a deplorable situation. Hurt and Broders (9) and Hanlon (8) felt that the criteria advocated by Goetze are reasonable, and were fulfilled in their cases. They are: (1) the tumors must have the macroscopic and microscopic appearance of the usual tumors of the organs involved; (2) exclusion of metastases must be certain, and (3) diagnosis may be confirmed by the character of the individual metastasis. Burke (2) believed that the reasonable criteria for the diagnosis of multiple primary cancers are: (1) each tumor must be distinct in morphology ; (2) must present a definite histologic picture of malignancy, and (3) must not represent a metastasis. There is considerable difference of opinion as to the incidence of multiple primary malignant tumors in the general cancer population. The work of Warren and Gates (14) is particularly noteworthy in this respect. They collected 1,259 such cases, including 40 of their own. Based on statistics of all the reviewed cases, they found that the frequency of multiple malignancy in cancer patients was 1.84 per cent; on the basis of American statistics it was 3.9 per cent, and in a series of 1,078 autopsies at their clinic the incidence was 3.7 per cent. Counseller and Butsch (4) reviewed the incidence of multiple primary malignant tumors in various series of cases reported and found that the percentage varied from 0.5 to 5.2. Burke (2) reported a series of 46 cases of multiple malignancy, with an incidence of 7.8 per cent—the highest reported in the literature. If we are to place much reliance on the socalled “general cancer-producing factors,” we might consider that an individual affected with one malignant tumor would be fertile soil for the development of other dissimilar tumors.