Incidence Of Multiple Primary Cancers Research Articles

Multiple primary tumors in patients with surgically treated pancreatic cancer: a SEER population-based study.

With improving survival after pancreatic cancer (PC) resection, questions emerge concerning risk and patterns of metachronous tumors. We aimed to determine the incidence of multiple primary cancers among postoperative PC survivors. Patients undergoing PC surgery from 1975 to 2020 were identified in the Surveillance, Epidemiology, and End Results (SEER) registry. Standardized incidence ratios (SIRs) compared observed-to-expected cancers based on U.S. population rates. Cumulative incidence of secondary tumors was analyzed with Cox regression and cancer-specific survival with Kaplan-Meier curves. Of 6,100 resected PC patients, 267 (4.38%) developed multiple cancers over 6.2 years median follow-up period. Subsequent malignancies showed a rising cumulative incidence extending beyond 5 years. Lung cancer was the predominant second primary in both males (n=36, SIR 1.87) and females (n=32, SIR 2.17). Prostate (n=33) and breast (n=25) cancers were also common. Risk varied by latency period and gender. Postoperative PC patients face a measurable risk for secondary cancers. Enhanced long-term surveillance has the potential to improve early detection and outcomes in this survivor population. Our data provides real-world evidence which could help inform surveillance guidelines in the future.

Emerging trends in the coexistence of primary lung Cancer and hematologic malignancy: a comprehensive analysis of clinicopathological features and genetic abnormalities

BackgroundThe incidence of multiple primary cancers (MPC), especially involving primary lung cancer (PLC) and primary hematologic malignancies (PHM), is rising. This study aims to analyze clinicopathological features, gene abnormalities, and prognostic outcomes in individuals diagnosed with PLC-PHM MPC.MethodsA retrospective analysis included 89 patients diagnosed with PLC-PHM MPC at the Respiratory or Hematology Departments of Ruijin Hospital from 2003 to 2022 (a total of 842,047 people). Next-generation sequencing (NGS) assessed lung cancer specimens, while Polymerase Chain Reaction (PCR) and NGS were used for hematologic malignancy specimens. Statistical analysis involved survival analysis and Cox regression.ResultsPLC-PHM MPC incidence surged from 1.67 per year (2011–2013) to 16.3 per year (2020–2022). The primary demographic for PLC-PHM MPC consists predominantly of elderly (average age 66 years) males (59.6%), with a high prevalence of metachronous MPC (89.9%). The prevailing histological types were lung adenocarcinoma (70.8%) in lung cancer (LC) and mature B-cell lymphomas (50.6%) in hematologic malignancies (HM). Notably, in a molecular testing cohort of 38 LC patients, 84.2% of lung cancer cases exhibited driver mutations, in which EGFR mutations frequence prevalent was 74.2%. In total group of 85 cases achieved a median overall survival (mOS) of 46.2 months, with a 5-year survival rate of 37.9% and advanced LC patients with LC gene mutations achieved a mOS was 52.6 months, with a 5-year OS rate of 30.6%. The median progression-free survival (PFS) following first-line treatment of 11 advanced patients with lung cancer-associated driver gene mutations is 26.6 months. Multivariate Cox regression revealed a favorable OS associated with surgery for LC, favorable PS score, adenocarcinoma pathology of LC, and the presence of genetic abnormalities associated with HM.ConclusionPLC-PHM MPC incidence is rising, characterized by a significant proportion of lung adenocarcinoma and a high prevalence of positive driver genes, especially in EGFR. Despite suffering from two primary tumors, the PLC-PHM MPC patients had superior data of both PFS and OS, suggesting an inherently intricate background of genetic abnormalities between the two kinds of tumors.

An unusual occurrence of synchronous invasive duct carcinoma and multiple myeloma – A case report

The cancer survival rates continue to increase with the passing day owing to advances in diagnostic modalities, therapeutic strategies and the ongoing research. Simultaneously, there is also an increase in the incidence of multiple primary cancers due to the increased survival, long term effects of chemotherapy and/or radiation therapy, higher diagnostic sensitivity and the persisting effects of behavioural and genetic risk factors. Multiple Primary Malignancies (MPM) was first described in 1879 by Billroth. Multiple primary tumours are defined as synchronous or metachronous tumours presenting in the same individual. The neoplasms may be limited to a single organ or may involve multiple anatomical organs. This article presents a case study of a 72-year old female, who was referred to our institute with a history of lump in the left breast and fracture of left clavicle.

Preliminary study on the molecular features of mutation in multiple primary oral cancer by whole exome sequencing.

Multiple primary cancers (MPCs) refer to cancers that occur simultaneously or metachronously in the same individual. The incidence of MPC has increased recently, as the survival time of malignant tumor patients has been greatly prolonged. It is difficult to differentiate MPC from primary cancers (PCs) in the same anatomical region from the clinical manifestation alone. However, their biological behaviors appear to be distinct. In this study, we show that the prognosis of multiple primary oral cancers (MP-OCs) is worse than primary oral cancers (P-OCs). To better understand the molecular mechanisms of MP-OC, we used whole exome sequencing (WES) to analyze samples from 9 patients with MP-OC and 21 patients with P-OC. We found more somatic mutations in MP-OC than in P-OC. MP-OC had more complicated mutation signatures, which were associated with age-related and Apolipoprotein B mRNA Editing Catalytic Polypeptide-like (APOBEC) activity-related signatures. Tumor mutational burden (TMB) and mutant-allele tumor heterogeneity (MATH) of MP-OC trended higher compared to P-OC. KEGG and GO analysis showed the differential pathways of MP-OC versus P-OC. In addition, MP-OC took amplification, not loss, as the main pattern of copy number variation (CNV), while P-OC took both. Lastly, we did not find significantly different mutant germline genes, but MSH-6 mutation may be a potential MP-OC driver. In short, our preliminary results show that MP-OC and P-OC have different molecular characteristics.

The analysis of multiple primary cancers in Ege University hospital database

Amaç: Ege Üniversitesi Hastanesi (EÜH) kanser veri tabanında birden çok sayıda kanserleri olanÇoklu Primer Kanser (ÇPK)’li olguların sayıca artışı dikkat çekici bulunmuş, bu artışın istatistik olarakanalizi planlanmıştır.Gereç ve Yöntem: EÜH’de EÜKAM tarafından CANREG-4 özel bilgisayar programına kayıt edilenkanser verileri WHO ve Surveillance, Epidemiology, and End Results (SEER) sistemleri temelindegruplanarak analizler yapılmıştır. İstatistik analizlerde Ki-kare, General Linear Model, Kaplan Meiersağkalım analizleri uygulanmıştır. Kaplan Meier Sağkalım analizinde Log Rank (Mantel-Cox), Breslow(Generalized Wilcoxon) ve Tarone-Ware istatistikleri kullanılmış, istatistik analizlerde p <0,05istatistiksel olarak anlamlı kabul edilmiştir.Bulgular: EÜH veri tabanında 1992-2018 yılları arasında kaydedilmiş 124.321 kanser olgusunun6.311’inde birden çok kanser (%5,1) saptanmıştır. ÇPK görülüşü erkeklerde daha belirgindir(p<0,0001). ÇPK’de yıllara göre bir artış saptanmıştır (p<0,0001). Her iki cinste en sık görülenGastrointestinal sistem (GİS) kanserlerinde ÇPK genellikle yine GİS ile ilgili olmakta, bunu ürogenitalsistem (ÜGS) kanserleri izlemektedir. Akciğer kanseri ile beraber görülen ÇPK’lerin başında diğersolunum sistemi kanserleri gelmekte, bunu mesane kanserleri izlemektedir. Meme kanserini izleyenÇPK’ler endometrium ve over kanseridir. ÇPK’lerde sağkalım tek primer kanserlilere göre daha kötüve çoklu ÇPK sayısı arttıkça sağkalımlar daha kötü olmaktadır (p<0,001). Olguların %18,2’si senkron,%81,8’i metakron olup sağkalım açısından istatistiksel olarak aradaki fark anlamlı değildir (p=0,506).Sonuç: EÜH Hastanesi veri tabanında %5,1 ÇPK saptanmış olup yıllara göre bir artış eğilimi vardır.Senkron veya metakron gelişen ÇPK’lar da sağkalım farkı bulunmamıştır. Çoklu primer kanserlerdesağkalım tekli kanserlere göre daha kötü olup ÇPK sayısı arttıkça GSK’lar daha kötü olmaktadır.

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.

Abstract 4157: Idenitificaiton of pathogenic germline variants of patients with double primary cancer of stomach and colon

Abstract Purpose: The incidence of multiple primary cancers has increased as survival of cancer patients has improved. The most common type of multiple primary cancers is the combination of stomach and colon cancer in Korea. Patients affected by two primary cancers at early age would be mainly related to their own genetic risk, however, germline variant of patients with double primary cancer have not been well evaluated. Methods: Patient who is with pathologically confirmed cancers in both stomach and colon in Severance hospital between January, 2000 and December, 2016 were enrolled in this study. The patients were classified into two groups: early-age group was defined as both cancers were diagnosed before 55-years, and others were considered as late-age group. The overall early-age group (n=19) and randomly selected a fourth of late-age group (n=36) were enrolled in this study. The DNA was extracted from an archived formalin fixed paraffin embedded normal mucosa that was retrospectively reviewed. Target sequencing analysis focused on 65 genes that are known to be related to hereditary cancer was conducted. The characteristics of both cancers and family history were also evaluated. Results: Overall 11 pathogenic/likely pathogenic germline variants (PGVs) were detected in nine patients (16.4%, 9/55, MLH1 [n=7], BLM [n=1], BRCA1 [n=1], MSH6 [n=1], and MSH2 [n=1]). The incidence of PGVs was 36.8% (7/19) and 5.6% (2/36) in early and late-age group, respectively (p<0.001). The early-age (Odds ratio[OR]: 9.92, 95% confidence interval [CI]: 1.81-54.49, p=0.008), Amsterdam_II criteria (OR: 24.29, 95% CI: 2.45-241.36, p=0.006), multiple lesions either gastric and colon cancer (OR: 13.13, 95% CI: 2.48-69.55, p=0.002) and mucinous/poorly differentiated histology of colon cancer (OR: 10.75, 95% CI: 1.48-78.06, p=0.019) were significant risk factors of PGVs in patients with double primary cancer at stomach and colon. Conclusions: The Lynch syndrome related PGVs were identified in patients with double primary cancer at stomach and colon. Patients with double primary cancers at stomach and colon related to early age, multiple lesions, family history especially Amsterdam_II criteria, and poorly differentiated histology of colon cancer would be good candidate for genetic evaluation. Citation Format: Yoon Young Choi, Ji Soo Park, Seung-Tae Lee, Su-Jin Shin, Jae Eun Lee, Jeong-Hyeon Jo, Eun Ji Nam, Taeil Son, Hyoung-Il Kim, Woo Jin Hyung, Sung Hoon Noh, Jae-Ho Cheong. Idenitificaiton of pathogenic germline variants of patients with double primary cancer of stomach and colon [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4157.

Multiple primary cancers associated with endometrial and ovarian cancers: An analysis based upon the Japan Autopsy Annual Database from 2002 to 2010.

A thorough analysis of multiple primary cancers (MPC) could provide important information as to the pathogenesis of human malignancies. Analysis of MPC using clinical databases has been performed, but little has been done using autopsy cases. Therefore, in this study, we first retrospectively analyzed MPC associated with endometrial and ovarian cancers using the Japan Autopsy Annual Database. The Japan Autopsy Annual Database from 2002 to 2010 was established by the Japanese Society of Pathology, Tokyo, Japan. Among the 164 211 autopsy cases registered, 9142 were cases of primary cancers. The patients with endometrial cancer-associated MPC did have a lower risk of harboring colorectal cancer (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.45-0.89) but had a higher risk of ovarian cancer (OR, 3.15; 95% CI, 2.11-4.71). Those with ovarian cancer-associated MPC had a lower risk of harboring gallbladder cancer including bile ductal cancer (OR, 0.47; 95% CI, 0.27-0.80) but a higher risk of harboring breast (OR, 1.69; 95% CI, 1.20-2.38) and endometrial cancers (OR, 3.48; 95% CI, 2.33-5.20). Both endogenous and exogenous factors are associated with the incidence of MPC. Results of our present study based on Japanese Autopsy Base first demonstrated that female hormones had a strong influence on the incidence of MPC. This study also demonstrated that the analysis of MPC using an autopsy database could have advantages over clinical database analysis.

Contribution of genotoxic anticancer treatments to the development of multiple primary tumours in the context of germline TP53 mutations

IntroductionLi-Fraumeni syndrome (LFS), due to TP53 germline mutations, is characterised by a remarkably high incidence of multiple primary cancers (MPCs), and the key role of p53 in response to DNA damage questions the contribution of anticancer treatments to MPCs development. Materials and methodsWe first evaluated genotoxicity of X-rays and different classes of conventional chemotherapies, thanks to genotoxicity assays, based on the measurement of transcriptional response to DNA damage and performed in murine splenocytes, either exposed ex vivo or extracted from exposed mice. We then exposed a total of 208 Trp53Δ/Δ, wt/Δ or wt/wt mice to clinical doses of X-rays or genotoxic or non-genotoxic chemotherapies. Tumour development was monitored using whole-body magnetic resonance imaging and pathological examination at death. Results:X-rays and conventional chemotherapies, except mitotic spindle poisons, were found to be genotoxic in both p53 genotoxicity assays. Exposition to X-rays and the topoisomerase inhibitor etoposide, analysed as genotoxic anticancer treatment, drastically increase the tumour development risk in Trp53Δ/Δ and wt/Δ mice (hazard ration [HR] = 4.4, 95% confidence interval [CI] [2.2–8.8], p < 0.001*** and HR = 4.7, 95% CI [2.4–9.3], p < 0.001***, respectively). In contrast, exposure to the non-genotoxic mitotic spindle poison, docetaxel, had no impact on tumour development. ConclusionsThis study shows that radiotherapy and genotoxic chemotherapies significantly increase the risk of tumour development in a LFS mice model. These results strongly support the contribution of genotoxic anticancer treatments to MPC development in LFS patients. Therefore, to reduce the risk of MPCs in germline TP53 mutation carriers, radiotherapy should be avoided whenever possible, surgical treatment prioritised, and non-genotoxic treatments considered.

351P - Stage I/II oropharyngeal carcinoma treated with surgery or RT at the Japan National Cancer Center Hospital East

Background: According to the National Comprehensive Cancer Network guideline (ver. 1.2016), stage I/II oropharyngeal carcinoma (OPC) should be treated with surgery or definitive radiotherapy (RT). However, the appropriatetherapeutic strategy for OPC has not been elucidated yet. In addition, the optimal long-term therapeutic strategyshould be identified because head and neck cancers, including OPC, often have multiple primary cancers (simultaneous or metachronous) at high frequency. Methods: We retrospectively analyzed 81 cases of stage I/II OPC (limited to squamous cell carcinoma) treated with surgery or RT between January 2000 and December 2011 at the Japan National Cancer Center Hospital East. Results: The patients included 68 men and 13 women, whose median age was 68 years (range, 35–92 years). The median follow-up time was 1825 days. The cancer was stage I in 28 patients and stage II in 53 patients. The tumorinvolved the lateral wall in 43 patients, the anterior wall in 12, the superior wall in 19, and the posterior wall in 7. Surgery was performed for 62 patients; and RT, for 19 patients. Of the patients who underwent surgery, 44 underwent transoral surgery and 18 underwent open resection. Nine of the 18 patients who underwent open resection received a free flap. Only 1 of the patients treated with RT received proton beam therapy. The 5-year overall survival rates were 74.0% and 47.7%(p = 0.0199); the 5-year disease-specific survival rates,83.4% and 61.7% (p = 0.1158); and the 5-year local control rates, 70.7% and 57.4% (p = 0.1170) for the surgery and RT groups, respectively. Of the 81 cases, 43 (53.1%) were multiple primary cancers, of which 22 (27.2%) were in the head and neck region and all were metachronous. Conclusions: Initial surgery for stage I/II OPC is a useful therapeutic strategy considering the high incidence of multiple primary cancers. Legal entity responsible for the study: Japan National Cancer Center Hospital East. Funding: None Disclosure: All authors have declared no conflicts of interest.

Examining the relationship between multiple primary cancers and psychological distress: A review of current literature.

The incidence of multiple primary cancers (MPCs) is increasing, but little is known about psychological distress in this population. The purpose of this study is to review and synthesize the literature regarding what is known about psychological distress in adults who have experienced MPC diagnoses. All potentially eligible studies identified in PubMed and CINAHL were reviewed by 2 independent evaluators, and each relevant article was assessed for methodological quality. Data were extracted, organized, and recorded using a coding log, PRISMA flow diagram, and a standardized table of evidence. Effect size (ES) values were calculated using Cohen's d. Five of the 562 potentially relevant articles were selected for final analysis. MPC survivors, when compared with single cancer survivors, had lower global quality of life (d=0.32-0.37), poorer emotional role function and stress (d=0.08-0.20), greater and more frequent distress (d=0.11-0.37), and greater subclinical anxiety (d=0.15). Depressive symptoms were variable (d=0.01-0.22), and no differences between MPC and single cancer groups were identified for sleep and suicidal ideation. There is a substantial lack of evidence focused on psychological distress among the growing MPC survivor population. ES noted in the 5 studies reflect small but potentially significant increases in psychological distress in survivors of MPC compared with survivors of a single cancer. Clinicians should be aware of this at-risk population when screening for distress in cancer survivors. Suggestions for future research are provided.

Examining the relationship between multiple primary cancers and psychological distress: A systematic literature review.

214 Background: The incidence of multiple primary cancers (MPC) in cancer survivors is increasing. However, little is known about the psychological effects of MPCs on cancer survivors. The purpose of this systematic review was to synthesize the evidence regarding the impact of MPC on psychological distress in cancer survivors. Methods: Relevant studies were identified in PubMed database (up to June 2015). Non-English articles were excluded. Two independent evaluators reviewed articles for relevancy and data extraction. Data was organized and recorded using a coding log with exclusionary rationale, a PRISMA flow diagram, and a standardized table of evidence. Effect sizes (ES) were calculated using Cohen’s d to measure relationship magnitude and direction. Results: Of the 543 potentially relevant articles identified, four articles met criteria and were retained for analysis. Different quality of life (QOL) measures were used to assess psychological distress across studies, so ES were calculated for individual studies. There were consistently small but significant ES found for the impact of MPC on distress. When compared to survivors of a single cancer: one study found lower global QOL and higher total stress (ES, 0.1430 and 0.3653); one study reported that those with MPC were more likely to experience frequent mental distress and sleep problems (ES, 0.1404 and 0.2235); and one study found that those with MPC had lower global QOL and emotional function and greater anxiety and depressive symptoms (ES range, 0.1026 - 0.3215). Finally, the one study that evaluated suicidal ideation in survivors of childhood cancers did not find a higher incidence among those with MPC. Conclusions: The ES noted in the four studies suggest a small but significant increase in psychological distress in survivors of MPC compared to survivors of a single cancer. Clinicians should be aware of this at-risk population when screening for distress in cancer survivors. Additional studies that control for care transition points known to increase distress are warranted to explore the impact of MPC on psychological distress over time. Additionally, as the science in this area grows, it will be necessary to reevaluate the literature.

Multiple primary cancers: An enigma.

Background:Incidence of multiple primary cancers though uncommon, is being frequently reported now-a-days owing to better diagnostic techniques, the prolonged life span and the increased incidence of long-term survival of cancer patients.Materials and Methods:This is a retrospective study. Cases of multiple malignancies diagnosed histopathologically were retrieved from the archives of department of surgical oncology. Clinical data were obtained from the medical records. They were categorized as synchronous malignancies if the interval between them was less or equal to 6 months and metachronous, if the interval was more than 6 months.Results:A total of 13 cases were encountered in the 5 year study period. Out of them two were in the metachronous category and the rest were synchronous as the 2nd malignancy was detected mostly during clinical evaluation of the patients for the primary malignancy. There was female predominance with age range being 43-68 years. Majority of the cases were in the 7th decade. The most common organ involved was breast, followed by cervix. Apart from bilateral breast malignancies, there were combinations like breast with uterine endometrial carcinoma, cervical carcinoma and even papillary thyroid carcinoma.Conclusion:Detection of multiple primary malignancies is becoming increasingly common in day-to-day practice. Greater awareness of this is required among both cancer patients and their treating clinicians.

Germline BAP1 mutation in a family with high incidence of multiple primary cancers and a potential gene–environment interaction

We report a high-risk cancer family with multiple mesotheliomas, cutaneous melanomas, basal cell carcinomas, and meningiomas segregating with a germline nonsense mutation in BAP1 (c.1938T>A; p.Y646X). Notably, most (four of five) mesotheliomas were peritoneal rather than the usually more common pleural form of the disease, and all five mesothelioma patients also developed second or third primary cancers, including two with meningiomas. Another family member developed both cutaneous melanoma and breast cancer. Two family members had basal cell carcinomas, and six others had melanocytic tumors, including four cutaneous melanomas, one uveal melanoma, and one benign melanocytic tumor. The family resides in a subtropical area, and several members had suspected exposure to asbestos either occupationally or in the home. We hypothesize that the concurrence of a genetic predisposing factor and environmental exposure to asbestos and UV irradiation contributed to the high incidence of multiple cancers seen in this family, specifically mesothelioma and various uveal/skin tumors, respectively.

Clinical characteristics of multiple primary cancer associated with esophageal squamous carcinoma

To examine the characteristics of esophageal squamous cancers with multiple primary cancers in another organ. Between January 2012 and December 2014, 3 104 patients with esophageal squamous cell carcinoma treated in Cancer Institute and Hospital, Chinese Academy of Medical Sciences, were reviewed for the presence of an additional primary cancer retrospectively. The patients were divided into two groups according to whether they had multiple primary cancer. Totally 369 (11.9%) patients were found multiple primary cancer in the other organs. Among these patients, 72.4% was found synchronously, another primary cancer was found in the head and neck region in 211 (6.8%), in the stomach in 140 (4.2%), and in the lung, colon, breast, and other locations in the remaining patients. Of the 211 patients with another primary cancer in the head and neck region, 156 (73.2%) had hypopharyngeal cancer. Furthermore, the incidence of intraesophageal multiple cancerous lesion in the patients with primary cancer in the head and neck region was significantly higher than that in those whose other primary cancers were gastric cancer or in those with non-multiple primary cancer (P<0.01). There is a high incidence of multiple primary cancers in patients with esophageal squamous carcinoma, mostly found synchronously. The leading multiple primary cancers were head and neck cancer and stomach cancer. Intraesophageal multiple cancerous lesion is an indicator for a second primary cancer in head and neck. A better knowledge of the relationships between esophageal carcinoma and cancers in other organs may lead to earlier detection of other primary cancers and improved therapeutic results.

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.

Incidence of multiple primary cancers and interval between first and second primary cancers.

In this retrospective study, we aimed to clarify the risk of developing a second primary cancer and to determine the periods of high risk of second primary cancers. Subjects were all patients who had been diagnosed with a first primary cancer and registered with the Nagasaki Prefecture Cancer Registry between 1985 and 2007. We calculated the standardized incidence ratio (SIR) of second primary cancer according to site and years after diagnosis of the first primary cancer. A second primary cancer developed in 14 167 of 174 477 subjects (8.1%) during a median follow-up of 1.8 years. The SIR of all cancer was 1.10 (95% confidence interval, 1.08–1.11). Some specific relationships were observed between sites with risk factors in common, such as smoking, drinking, and hormone status. The SIRs were relatively high after approximately 10 years for all sites, and trends differ among cancer sites. We showed that cancer patients are at higher risk of a second primary cancer than the general population. In respect of the risk of a second primary cancer, physicians should be alert for cancers that have risk factors in common with the first primary cancer.

Clinical characteristics of colorectal cancer patients with a second primary cancer.

PurposeThe incidence of colorectal cancer is increasing due to a westernized dietary lifestyle, and improvements in treatment and diagnostic tools have resulted in more patients being confirmed of having multiple primary cancers. However, studies regarding multiple primary cancers are insufficient. In this study, the clinical aspects of patients with primary multiple cancers, including colorectal cancers, were investigated, and the results were compared to those of patients with primary colorectal cancer only.MethodsSeven hundred eighteen patients who received surgery for colorectal cancer between March 2003 and September 2012 in CHA Medical Center were enrolled. A retrograde cohort was done for comparison of the two groups: those with and those without multiple primary cancer. The analysis was done according to sex, age, tumor location, tumor size, metastatic regional lymph-node number, vascular/lymphatic microinvasion, staging, tumor markers, microsatellite instability, and C/T subgroup of polymorphism in methylenetetrahydrofolate reductase.ResultsOf the 718 subjects, 33 (4.6%) had multiple primary cancers: 12 (36.4%) synchronous and 21 (63.6%) metachronous. The malignancy most frequently accompanying colorectal cancer was gastric cancer, followed by thyroid, prostate, and esophageal malignancies in that order. In the comparison between groups, mean age, tumor location, and microsatellite instability showed statistically significant differences; others parameters did not.ConclusionThe incidence of multiple primary cancers, including colorectal cancer, is increasing. Therefore, defining the characteristics of patients with multiple primary cancers is crucial, and those characteristics need to be acknowledged in the follow-up of colorectal cancer patients.

Multiple primary malignancies in patients with prostate cancer: increased risk of secondary malignancies after radiotherapy

New treatment strategies for prostate cancer have recently been developed, but multiple malignancies remain a major concern. The aim of this study was to evaluate the characteristics of multiple malignancies and to analyze the risk of secondary malignancies after radiotherapy for prostate cancer. From 2000 to 2011, 150 patients with prostate cancer were treated with curative radiotherapy in our department. Patient age range was 54-92years (median, 70years), and the follow-up period was 4-142months (median, 48months). The incidence of multiple primary cancers was compared with the estimated incidence. A total of 147 patients (98%) survived more than 12months (12-142months; median, 48months); 20/150 patients (13%) died within 10years. Cause of death was recurrent prostate cancer in 11 patients, other primary malignancies in 7 patients, and cardiovascular disease in 2 patients. Multiple primary cancers were present in 26 of 150 patients (17%), including 16 subsequent malignancies (11%) with latent periods of 13-83months (median, 43months). The subsequent non-prostate malignancies were lung cancer in 4 patients, urinary bladder or ureter cancer in 4, stomach cancer in 3, malignant lymphoma in 2, and other in 3. Analysis of the observed incidence of secondary malignancies compared with the estimated incidence in the general population revealed a higher incidence of ureter cancer and malignant lymphoma. Close attention should be paid to secondary malignancies after radiotherapy for prostate cancer, including malignancies occurring within 5years, which could be attributable to radiotherapy.

Clinical study of multiple primary and double cancers including oral squamous cell carcinoma

ObjectiveIn recent years, there has been an increase in the incidence of multiple and double cancers involving the oral cavity. In this study, we clinically reviewed patients with multiple or double cancers. Patients and methodsThe subjects were 696 patients with multiple oral squamous cell carcinomas who had visited the Department of Oral and Maxillofacial Surgery, Tokyo Dental College during the 26-year period between 1982 and 2008 and 497 patients with double cancers treated during the 16-year period from 1992, when endoscopy was started, to 2008. ResultsThe incidence of multiple primary cancers was 26 (3.7%) in 696 patients. The most common primary site of multiple cancers was the mandibular gingiva (42.3%). The maximum number of multiple cancers per patient was seven. On the other hand, the incidence of double cancers was 43 (8.7%) in 497 patients, with esophageal cancer being the most frequent (58.1%). The most common primary site of oral cancers in double cancer patients was the oral floor (32.6%). ConclusionsAbout 10% of all patients developed double cancers. Therefore, follow-up is necessary not only for recurrence and metastasis, but also for the development of a primary cancer elsewhere through strengthening endoscopy in close cooperation with the endoscopist.