Double Malignancies Research Articles

Dual Gynecological Malignancies: A Case Series from Tertiary Care Center

A literature review on 1,104,269 cancer patients concluded that the prevalence of multiple primary malignancies is between 0.73 and 11.7%. The lifetime risk of developing another de novo primary after being detected with cancer is high. We report synchronous and metachronous double malignancy cases presenting in Radiotherapy Department in the Gynecology Oncology subspeciality in our hospital. A prospective observational study was carried in our Department of Radiation Oncology over a period of 3 years. A total of 25 patients reported with multiple primary cancers from 2015 to 2018. Out of 25 patients, nine patients were with synchronous presentations and the rest were with metachronous presentations. Each had a different line of management, and they were dealt with individually according to their origin of primary cancer and stage. The incidence of multiple primary cancers is on the rise, and the possibility of the same should be considered in the pretreatment evaluation. Screening procedures and careful monitoring should be done to ensure early detection and appropriate management.

A Patient with Synchronous Primary Hepatocellular Carcinoma and Primary Pancreatic Ductal Adenocarcinoma

The incidence of synchronous double primary malignancies is rare. There were only two cases with synchronous hepatocellular carcinoma (HCC) and pancreatic cancer has been reported so far (J Surg Case Rep 2017(9):rjx182, 2017; Indian J Palliat Care 20:53–6, 2014). Whether double primary malignancies to be operable is an interesting and important issue for surgeon. Here, we report a rare case of synchronous double primary malignancies of the liver and pancreas received simultaneous hepatic segmentectomy and pancreaticoduodenectomy.

A Case of Synchronous Primary Gastric Cancer and Primary Hepatocellular Carcinoma

AbstractSynchronous occurrence of primary gastric cancer and hepatocelluar carcinoma is very rare. It is mandatory to differentiate synchronous two primary lesions from metastatic lesion, because treatment modality is different for each disease. We report an interesting case of double malignancy, synchronous primary gastric cancer, and primary hepatocelluar carcinoma, who never had a cirrhosis, family history of cancer as well as hepatitis B or hepatitis C infection. Our patient managed with palliative chemotherapy due to multicentric hepatocelluar carcinoma with primary gastric cancer.

Successful one-stage operation for ipsilateral, synchronous carcinomas of the breast and lung: A case report

Abstract The incidence of double primary malignancies is very low, particularly, a case of synchronous carcinomas of the ipsilateral breast and lung. Determining whether to have a one-stage operation for ipsilateral breast cancer and lung cancer is a challenge for the surgeon. The current study presents a case of a 56-year-old female, with a rigid textured mass measuring approximately 18×20 mm above the areola of the right breast and chest CT showing a mass of 20 × 14 mm at the tip segment of right upper lobe of the lung. A diagnosis of a synchronous dual primary carcinoma of the right lung (cT1N0M0) and right breast (cT1N0M0) was made. The patient underwent a right breast-conserving surgery, sentinel node biopsy, and right upper lobectomy and lymphadenectomy with a video-assisted thoracoscopic technique simultaneously. To our knowledge, in the previous literature, there was no one-stage operation for ipsilateral, synchronous carcinomas of the breast and lung and only one reported case with left breast and right lung cancer underwent a one-stage operation. This report first presents the successful treatment of a case with synchronous primary breast and lung carcinomas on the same side of the body with a one-stage operation and therefore is educational.

Renal Cell Carcinoma and Mucinous Adenocarcinoma of Ureter after Renal Transplantation with Neoplasm of Urethra in Follow up

This paper presents the first case of a kidney graft recipient with double malignancy of the upper urinary system and cancer of the urethra evident four years after transplantation.

P1.04-018 Occurrence of Triple Multiple Malignancies with Last Lung Squamous Cell Carcinoma - Case Reports

The incidence of multiple primary tumors (MMPNs) ranges from 0.73 to 11.7%. Most often occur double malignancies - 3-5%, much less triples - 0.5%. The aim of the study is to describe the three cases of triple metachronous multiple malignancies, the last of which was a squamous cell carcinoma of lung in all three patients. A retrospective analysis of all medical histories (1163) patients who were hospitalized in the Pulmonary Hospital in Olsztyn, Poland in the period from January 2013 to October 2015, with a diagnosis of at least one neoplasm was performed. We selected only these patients who were diagnosed with histologically confirmed three independent malignancies. The incidence of tumors of triple malignancies was 0.52%. Of all cases of triple malignancies, we selected 3 cases - 2 men and 1 woman, whose last-growing cancer, histopathologically confirmed, was squamous cell lung cancer. Case No. 1 - 54-year-old man with COPD (GOLD 2), who gave up smoking, melanoma of the scalp treated surgically and by chemotherapy (6xDTIC) at the age of 19, Hodgkin NS II at the age of 38 treated with 6xABVD, at the age of 53 years diagnosed with squamous cell carcinoma of the left lung in stage T2N1M0. Due to the low value of spirometry disqualified from surgery, qualified for radiotherapy. Case No. 2 67-year-old man with a history of hypertension, colon cancer at the age of 56, after a laryngectomy because of laryngeal squamous cell carcinoma at the age of 63, diagnosed with asymptomatic squamous cell carcinoma of the right lung in a stage T2N0M0 at the age of 65. Case No. 3 74-year-old woman with atrial fibrillation, stable ischemic heart disease, tongue cancer at the age of 67, and its recurrence in the age of 72, after a right-sided mastectomy and chemotherapy for breast cancer at the age of 69, at the age of 74 diagnosed with squamous cell carcinoma of the left lung. The average age of first cancer was 47, the second 57 years, the third 64 years. 1. Lung cancer often occurs as a subsequent malignancy 2. Another primary malignancy may develop even 30 years later, and therefore the possibility of development the third or another cancer should be considered for all cancer patients. 3. Development of synchronous or metachronous neoplasms should be considered in any case in patients with previous oncological treatment.

A retrospective and prospective study of double malignancies in a tertiary care hospital in south India - a ten years' experience

Background: The occurrence of second malignancies in cancer survivors is not uncommon. Due to advances in diagnostic and therapeutic modalities, the survival of cancer patients has improved and the incidence of second malignancies is also on the rise. The second malignancy may be synchronous or metachronous. Though there are plenty of case reports on double malignancies, original studies are less. The present study aims to analyse the frequency, types of double malignancies and their effect on the morbidity and mortality of the patients. Methods: This is a retrospective and prospective analysis of cancer patients done in a tertiary care hospital. All patients who presented with double malignancies from January 2004 to December 2014 were included. Retrospective data was obtained for cases from January 2004 to October 2011 and prospective data was obtained from November 2011 to December 2014. The study included 32 patients with double malignancies. Results: Gynaecological malignancies were most common in our study, followed by head and neck and gastrointestinal malignancies. Most of the malignancies were synchronous (56.25%). Double malignancies involving the head and neck, female reproductive tract, breast can be explained by common etiological factors like Human papillomma virus (HPV). Field cancerisation explains the synchronous cancers in Head and neck, upper aero digestive tract and reproductive tract. Conclusions: This study emphasises the importance of screening cancer patients for other primary malignancies during initial evaluation as well as during follow up period, in addition to the metastatic workup. It also stresses that timely reduction of risk factors in cancer survivors can prevent further malignancies.

Abstract 4851: BubbleTree: an intuitive visualization to elucidate tumoral aneuploidy and clonality in somatic mosaicism using copy number ratio and allele frequency

Abstract Background Tumors are characterized by properties of instability, heterogeneity, and significant oligoclonality. Elucidating these patterns of tumor clonal evolution is critical to our understanding of neoplastic development, which can ultimately improve diagnosis and treatment decisions in cancer therapy. Methods BubbleTree is an intuitive tree-like graph used to simultaneously illustrate tumor cell prevalence, allele-specific copy number, and clonality in human tumor specimens. This method evaluates somatic copy number alterations (SCNAs) at the focal genomic segment level to determine allele-specific copy number and elucidate the clonal hierarchy within tumors. Further, BubbleTree can longitudinally track genetic alterations in clonality during tumor progression and/or recurrence. Two models, a Bayesian and finite mixture distribution-based method, were developed to automate the interpretation of the BubbleTree graph. Both whole genome and whole exome sequencing (WGS and WES, respectively) data from three case studies are presented using the BubbleTree method: paired primary tumors in the lung and ovary from a patient, matched primary and recurrent liver tumors from a hepatocellular carcinoma (HCC) patient, and matched primary liver and metastatic lung tumors in a second HCC patient. Results BubbleTree accurately identified both inherited and altered karyotypes, as well as their prevalence between primary and recurrent liver tumors in two HCC patients, which suggests that the recurrent HCC malignancy post orthotopic liver transplantation originated from the primary tumor, with novel subclonal expansion during metastasis. Furthermore, BubbleTree accurately reveals the dominant clone and instable subclones in the lung tumor of a patient with synchronous double malignancies; these results were validated by fluorescent in situ hybridization. Conclusions Our model is robust for both WGS and WES data, with consistency demonstrated on both data types from the same tumor biopsy. The BubbleTree diagram and model presented here is a powerful approach to provide a comprehensive spectrum of the heterogeneous tumor karyotype in tumors. Further, this tool is a free R package available for download at Bioconductor. Citation Format: Wei Zhu, Mike Kuziora, Chris Morehouse, Tianwei Zhang, Yinong Sebastian, Zheng Liu, Dong Shen, Jiaqi Huang, Zhengwei Dong, Yi Gu, Feng Xue, Liyan Jiang, Yihong Yao, Brandon W. Higgs. BubbleTree: an intuitive visualization to elucidate tumoral aneuploidy and clonality in somatic mosaicism using copy number ratio and allele frequency. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4851. doi:10.1158/1538-7445.AM2015-4851

Dual malignancies: Do they have a worse prognosis than their individual counterparts

Background: The incidence of multiple primary cancers is reported to be between 0.734% and 11.7%. The occurrence of another malignancy of different organ in patients with known malignant tumor is known as double malignancy and is categorized into synchronous; in which the cancer occurs at the same time or within 6 months and metachronous; in which cancer follows in sequence more than 6 months apart. We review the presentation and management of synchronous malignancies in two different organs. Patients and Methods: All the patients who underwent surgery for malignancy between July 2009 and July 2013 were reviewed and the patients who had synchronous malignancies were identified. Their clinical presentation, treatment and outcome were evaluated. Results: Out of a total of 286 patients with malignancies treated in our institute, four had synchronous primary malignancies (1.39%). Three of them underwent surgery simultaneously for both the malignancies and were given adjuvant chemotherapy. One patient presented with colonic obstruction due to sigmoid carcinoma which was operated in an emergency setting and was later in the postoperative period found to have a synchronous periampullary carcinoma. Two of the patients who were managed with surgery followed by chemotherapy are doing well. Whereas the other two patients have died. Conclusion: Treatment strategies in cases of double malignancy depend on treating the malignancy that is more advanced first, or sometimes both malignancies could be treated simultaneously. If both are amenable to surgical resection as in two of our cases both the malignancies may be dealt with at the same time. The prognosis of the patients with dual malignancies depends on the aggressiveness and the stage of presentation of the more advanced tumor.

Abstract 4280: Integrative analyses of multi-omics sequencing data to guide treatment decisions in a patient with double malignancy

Abstract Multiple primary malignancies are becoming common. The number of second or higher-order cancers is burgeoning and accounted for about 16% of incident cancers. Double malignancy cases pose the problem of finding the best treatment for the patient. Next generation sequencing (NGS) was used in this study to characterize the genetic and genomic composition in a patient with multiple cancer syndromes. A lung adenocarcinoma brain metastasis sample (FFPE) naïve to any tumor therapy, and relapsed primary lung adenocarcinoma and ovarian serous carcinoma tumor biopsies (fresh frozen) were procured from a 51-year old Chinese female never-smoker. The primary lung and ovarian cancer samples were post to the treatments with both first line and EGFR-TKI targeted therapy. Multiple NGS approaches were conducted on the patient biopsies, including DNA whole genome/exome sequencing, RNA sequencing, and microRNA sequencing. Integrative analyses of the comprehensive NGS data indicated EGFR exon 19 deletions in-frame, which encode part of the kinase domain presented in both primary lung cancer and its brain metastases. EGFR T790M mutation which accounts for the resistance of lung tumor to the EGFR-TKI therapy was identified in the relapsed lung sample but not in the brain malignancy. These results were well aligned with the clinical response to EGFR-TKI treatment in the patient. Furthermore, we uncovered frequent occurrences of somatic copy number variations in both lung and ovarian tumors. A somatic non-sense mutation (COSMIC ID: 307331) in TP53 was uniquely identified in the ovarian tumor biopsy, suggesting a different mechanism driving tumorigenesis than that in the lung. Besides, we also identified a heterozygous insertion in DUSP16 and a stop code gained mutation in MAP3K15 in the patient's germline DNA, a potential predisposition of multiple cancer syndromes and early onset of tumor in this patient. Finally, structural variation and gene fusion, gene interaction, pathway analysis of the affected genes were integrated and evaluated. Overall, NGS approaches shed insights into the molecular phenotypes of tumors and thus have the potential to provide the physician key scientific rationale to design targeted therapeutic approaches in the treatment course. Citation Format: Wei Zhu, Jiaqi Huang, Brandon W. Higgs, Philip Brohawn, Shujun Dai, Laura Richman, Bahija Jallal, Liyan Jiang, Yihong Yao. Integrative analyses of multi-omics sequencing data to guide treatment decisions in a patient with double malignancy. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4280. doi:10.1158/1538-7445.AM2014-4280

A rare case report: Carcinoma pancreas with hepatocellular carcinoma

Synchronous double malignancies involving different organs are relatively rare and uncommon finding. We report an interesting case of double malignancy in which a patient exhibited synchronous two separate carcinomas, pancreatic and hepatocellular carcinoma (HCC). Patient was a 64-year-old male who presented primarily with symptoms pertaining to the biliary obstruction and ultrasound of abdomen revealing pancreatic head mass. HCC was detected incidentally during the investigations for carcinoma pancreas.

Synchronous Detection of Dual Neoplastic Malignant Disease: Adenocarcinoma of the Caecum and Renal Cell Carcinoma

Background: Primary cancer may occur synchronously in two different organs.The presence of a renal primary cancer discovered by chance during staging prior to surgery of another cancer (caecum-colon) is not as rare an event as is believed. In this case report the authors report an interesting case of double malignancy in which a patient was struck by two separate carcinomas, carcinoma of the caecum and renal cell carcinoma. Case report: A 59-year-old male underwent screening with faecal occult blood test (FOBT) for colorectal cancer. The resulting positive test of which required a colonoscopy indicated the malignancy of the caecum-colon. Renal cell carcinoma was detected incidentally through Computed Tomography (CT) during preliminary investigations for the staging of the disease prior to surgery. The patient subsequently underwent simultaneous, radical, right nephrectomy and hemicolectomy. Both tumours were confirmed in pathologic evaluation, revealing chromophobe renal cell carcinoma and caecum- right colon adenocarcinoma. Conclusion: In conclusion, the elevated frequency of coexisting synchronous renal and colonic carcinomas, recommends routine use of preoperative imaging studies, in order to rule out coexistent, asymptomatic malignant lesions in patients with colorectal cancer.

Metachronous double malignancy involving the kidney and the breast: A case report

The occurrence of multiple primary cancers is rare; it can be missed as a disease progression. The etiology remains controversial. We report a case of a 55-year-old female with metastatic renal cell carcinoma treated with sutent followed by left sided nephrectomy. Follow-up CT showed increase in the size of the right axillary lymph nodes which was proven after biopsy to be metastatic adenocarcinoma of the breast. Any suspicious disease progression in a single site not compatible with disease history should be biopsied for confirmation. The relationship between renal cell carcinoma and breast cancer is still unclear, and more case reports are required to determine this relationship.

Double jeopardy? Renal sparing management of simultaneous ipsilateral renal cell carcinoma and urothelial carcinoma

The occurrence of renal cell carcinoma (RCC) and urothelial carcinoma (UC) synchronously in the same kidney is exceedingly rare. All reported cases have been managed with either nephroureterectomy or nephrectomy. We report on a patient who required renal-sparing management of his double malignancy, including open partial nephrectomy of his pT1a RCC and endoscopic laser ablation of his low-grade Ta renal pelvis UC. After 4 years, the patient is in good health and disease-free under strict surveillance. It, therefore, would appear justified to combine partial nephrectomy for RCC and endoscopic management of UC in the same kidney of an appropriately selected patient.

Gall bladder carcinoma with ampullary carcinoma: A rare case of double malignancy

Simultaneous double cancers in the biliary system are rare. Most are associated with pancreaticobiliary maljunction (PBM). However, it can occur in patients without PBM. Differentiation between these events is important since these two mechanistic origins imply different stages of disease, as well as different subsequent treatments and prognoses. Herein, we report a case of ampullary carcinoma associated with gall bladder carcinoma diagnosed nonoperatively and palliated with biliary metal stenting.

A case of synchronous double malignancy: Invasive bladder cancer and Leiomyosarcoma of extremity and review of literature

A case of synchronous double malignancy: Invasive bladder cancer and Leiomyosarcoma of extremity and review of literature

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

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.

Non-familial double malignancy of the colon and ampulla of vater: A case report and review of literature

Apart from their association in familial and hereditary cancer syndromes, sporadic double malignancies of the gastrointestinal tract involving the ampulla of Vater and colon are extremely rare. Although synchronous resection of the two by adding a colectomy to a pancreaticoduodenctomy can be accomplished with minimal increase in the surgical morbidity, a few patients, however, are best managed by a staged resection. We report a case of sporadic double malignancy of the ampulla of Vater and right colon who despite the best attempts continued to bleed and remained malnourished and was successfully managed by staged right hemicolectomy followed by a pancreaticoduodenectomy.

Clinical analysis of 47 cases of synchronous double primary carcinomas of esophagus and cardia

To explore the clinical features and prognosis of the patients with synchronous double primary malignancy of esophagus and cardia. The clinical data of patients with synchronous primary esophageal and cardiac carcinomas undergoing surgery at our hospital between April 1988 and April 2009 were retrospectively reviewed. All data were analyzed by the SPSS 15.0 software. The overall survival rates (OS) were calculated and compared with the Kaplan-Meier method and the Log-rank test. The prognostic factors were identified by Cox's hazard regression model. Among all 47 cases, esophageal carcinoma was missed preoperatively in 1 patients and cardiac carcinoma in 12. The 1-, 3- and 5-year overall survival rates (OS) of the whole group were 81.5%, 49.1% and 34.3% respectively. And the median survival time was 33 months. The univariate analysis of prognostic factors showed that radical resection, N stage of esophageal carcinoma (2009), N stage of cardiac carcinoma (2009) and TNM stage of cardiac carcinoma (both 2002 and 2009) might influence the long-term survival. However, according to the multivariate analysis, only radical resection and N stage of cardiac carcinoma (2009) were independent prognostic factors. With preoperative combined examination of esophagography and esophagoscopy and thorough intraoperative detection, the clinicians may reduce the rate of missed diagnosis for synchronous double primary esophageal and cardiac carcinomas. Radical resection of primary lesions and thorough dissection of locoregional lymph nodes may improve the patient survival.

Triple malignancy in a single patient including a cervical carcinoma, a basal cell carcinoma of the skin and a neuroendocrine carcinoma from an unknown primary site: A case report and review of the literature

IntroductionThe occurrence of multiple primary cancers is rare. Only a few cases and patient reviews of an association of triple malignancy have been reported.Case presentationWe report here a case of a 78-year-old Moroccan woman presenting initially with a synchronous double malignancy, the first in her cervix and the second in her skin. Our patient was treated with radiation therapy for both tumors and remained in good control for 17 years, when she developed a metastatic disease from a neuroendocrine carcinoma of an unknown primary site.ConclusionsAlthough the association of multiple primary cancers can be considered a rare occurrence, improving survival in cancer patients has made this situation more frequent.