Incidence Of Multiple Primary Tumors Research Articles

Multiple Simultaneous Primary Squamous Cell Carcinomas in the Oral Cavity

The incidence of multiple primary tumors confined to the oral cavity is 1.4%, more often affecting women without smoking habits. A 67-year-old woman presented with a painful tongue lesion that had not healed for 4 months. She denied smoking and alcoholism. An intraoral examination showed an ulcer with raised borders measuring 2 × 2 cm on the tongue's right border, reddish gingiva with white irregular plaques between teeth 46 and 47, whitish striations with reddish background on the right buccal mucosa, and a 0.5 cm reddish area on anterior lower gingiva. The main diagnostic hypothesis was squamous cell carcinoma; incisional biopsies were performed in all lesions. The histopathological examination confirmed the diagnosis, except on the anterior gingiva with moderate epithelial dysplasia. The patient was referred to the head and neck department for surgical treatment. The possibility of multiple, simultaneous primary oral squamous cell carcinomas should be considered, even in patients without risk factors.

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.

Second Primary Tumors in Patients with Head and Neck Cancer

This is a review on second primary tumors in patients with head and neck cancer. These patients have a high risk of developing other cancers simultaneously or subsequently. The incidence of multiple primary tumors in this population can be as high as 27%. Recurrences are the most common cause of treatment failure within the first 2years of follow-up. After the third year the diagnosis of a second primary tumor becomes the most important cause of morbimortality in head and neck cancer patients, especially in those treated for cancers early diagnosed. Most second primary tumors occur in the upper aerodigestive tract (40%-59%), lung (31%-37.5%), and esophagus (9%-44%). Patients who develop second primary tumor have a significant reduction of survival expectancy.

Increased risk of larynx cancer in heterozygous carriers of the I171V mutation of the NBS1 gene

The high incidence of multiple primary tumors (MPT) is a significant problem in head and neck tumor treatment. Recent studies suggest that carriers of heterozygous mutations in the NBS1 gene have an increased risk of malignant tumor development. The aim of our research was to assess the frequency of NBS1 mutations in patients with larynx cancer only (LC) and with MPT. The MPT group consisted of patients with one cancer localized to the larynx (primary or second) and another at another site. DNA from 175 patients with LC and 93 patients with MPT was analyzed using the single-strand conformation polymorphism method and direct sequencing. We found nine carriers of the I171V mutation among these 268 cancer patients and only one carrier among 500 population controls (0.2%). Four carriers of the I171V mutation were detected among 175 LC patients (2.3%) and five among 93 patients with MPT (5.4%). The frequencies of the I171V mutation carriers in LC and MPT patients were significantly higher than in controls (odds ratio [OR] = 11.7, confidence interval [CI] 1.3-105.2, P = 0.0175 and OR = 28.35, CI 3.27-245.7, P = 0.0005, respectively). In one individual with LC, a novel molecular variant, c.1222 A > G (p.K408E), was identified. No carriers of R215W or 657del5 NBS1 mutations were found in the present study. These findings imply that heterozygous carriers of the I171V mutation are prone to the development of larynx cancer and may, in addition, display an increased risk of second tumors at other sites.

The impact of genetic factors on the incidence of multiple primary tumors (MPT) of the head and neck

One of the most troublesome failures in head and neck tumors treatment is the incidence of multiple primary tumors (MPT). The aim of the study was to identity the genetic factors associated with the predisposition of second cancer occurrence. The polymorphisms of genes involved in carcinogen metabolic activation ( CYP1A1, CYP2E1), detoxication ( GSTM1, GSTT1, GSTM3, NAT2,) and DNA repair ( XPD /A35931C-exon 23 and C22541A-exon 6/, XRCC1 /G28152A-exon 10 and C26304T-exon 6/, XRCC3/C18067T/) were studied by PCR-based techniques to analyze genotypes and allele distribution in 84 patients with MPT correlated with 182 subjects with a single tumor of head and neck and 143 cancer-free male volunteers recruited from healthy smokers. Out of 11 polymorphisms examined significant differences between studied groups in CYP1A1, GSTM1, NAT2 genes, but not at the CYP2E1, GSTT1, GSTM3, XPD (exon 23 and 6), XRCC1 (exon 10 and 6) and XRCC3 were established. Further, the coexistence of some genotypes/alleles associated with a higher cancer risk, so called ‘risk genotypes’ was established as an added genetic factor to MPT development. The interpretation of our data indicates that the same group of low-penetration genes is involved in the development of single and multiple primary head and neck cancer but their association with MPT is significantly stronger.

Multiple primary tumors in patients diagnosed with hypopharyngeal cancer.

There have been few series to report on the incidence of multiple primary tumors associated with hypopharyngeal cancer. A unique consecutive patient group in a closed community who were treated by a single surgeon was available. The incidence and effect of multiple primary tumors were unknown. We sought to assess (1) the incidence of multiple primary tumors among patients with hypopharyngeal cancer who were treated at a tertiary center, (2) the incidence of synchronous and metachronous tumors, and (3) the location of these multiple primary tumors and their effect on patient survival. We conducted a retrospective study of case notes of 150 consecutive patients with hypopharyngeal malignancy treated by a single surgeon between 1983 and 1998. Information was compiled from the patients' medical records and death data from the Family Health Services Authority. Thirty-four patients had multiple primary tumors (22.6%). There were 22 men and 12 women; piriform fossa tumor was seen in 21 men and 6 women, and postcricoid space tumor was seen in 6 women and 1 man. Second primary tumors were synchronous in 7 patients, subsequent to hypopharyngeal tumor in 5 patients, and antecedent to hypopharyngeal tumor in 14 patients. Eight patients had 2 primary tumors, of which 4 were synchronous, 4 were subsequent, and 8 were antecedent to hypopharyngeal malignancy. On the last review (2001), 3 patients were alive, and 31 had died: 17 had died from primary malignancy, 11 from another malignancy, and 3 from unrelated causes. The presence of second primary tumors in hypopharyngeal cancer is higher than previously reported, and their presence had a significant effect on the patients' survival.

Lymphangiosarcoma in late‐onset hereditary lymphedema: Case report and nosological implications

Hereditary lymphedemas that are not associated with other malformations usually affect the lower limbs and are inherited in an autosomal dominant fashion. These non-syndromic hereditary lymphedemas are categorized by their age of onset, being either congenital (Milroy disease) or having an onset in childhood or around puberty (Meige disease). We describe a family in which three individuals in three generations had unusually late onset of lymphedema in their mid-twenties or thirties. The proband additionally developed a very rare lymphangiosarcoma. This tumor, usually associated with post-mastectomy lymphedema, has not been described in late-onset hereditary lymphedema. Because of an unusually high incidence of multiple primary tumors in association with lymphangiosarcoma in the literature (approximately 10%) and the proband's own familial cancer background, we speculate that an inherited predisposition to malignancy may underlie the development of lymphedema-associated lymphangiosarcoma.

Multiple primary cancer: Thirty patients with three or more primary cancers

Many types of cancer, when treated early and aggressively, can be cured. The potential, however, for cancer to occur independently a second time, or more often, in the same patient remains an ever present risk. In 1964, Mersheimer, Ringel and Eisenberg [1] analyzed the records of 140,000 cancer patients that were made available through the End Results Evaluation Program of the National Cancer Institute. Multiple primary lesions were found in 4,461 or 3.2 per cent. Of these patients, 4,230 or 95 per cent had two independent malignant lesions; 221 or 4.5 per cent had three independent lesions; the remaining 10 or 0.5 per cent had four or more primary cancers. In 1963, Pickren [2] studied an autopsy series of 2,094 subjects who had had cancer and found the incidence of multiple primary tumors, including occult lesions, to be 11 per cent. Pickren also cited similar autopsy studies [3,4] in which the incidence of multiple primary cancers varied from 1.8 to 7.8 per cent. In the study of patients with multiple primary cancer, suspected primary lesions must be established as truly independent and not metastatic growths. Billroth in 1869 was the first to propose criteria for establishing a true new primary lesion [I]. He proposed that (1) each tumor must have an independent histologic appearance; (2) the tumors must be separate and situated in different organs; (3) each tumor must produce its own metastases. Warren and Gates [5] in 1932 liberalized these criteria. They proposed that each suspected primary

MULTIPLE PRIMARY TUMORS WITH FIBROSARCOMA AND COEXISTING CARCINOMA OF THE LUNG

THE INCIDENCE of multiple primary tumors is low. Slaughter, 1 confirming the impression of Warren and Gates, 2 stated that cases of multiple primary malignant growths represent 3.9 per cent of all cases of cancer. Primary sarcoma of the lung constituting one of these tumors is even less common. Primary carcinoma of the lung, on the other hand, is by no means an uncommon disease—constituting about 10 per cent of all cases of cancer seen at necropsy—and is occasionally seen in instances in which two primary cancers coexist in the same person. The occurrence of a primary carcinoma of the lung in a patient who has a primary sarcoma of that organ with another benign tumor of the contralateral lung is extremely rare. It is even rarer to find such a state further complicated by several benign tumors in other organs. 3 The case to be reported is an example

Incidence of Multiple Primary Tumors and the Problem of Acquired Cancer Immunity

While multiple tumors of identical type are frequently encountered in the same person, as for instance in all cases of multicentric skin lesions and of metastasis, we are justified in speaking of multiple primary tumors only when we are reasonably sure that such tumors have developed independently and have no ascertainable direct or indirect connection with each other. This lack of connection is obvious in the case of combinations of tumor types entirely dissimilar morphologically and clinically, as for example tumors arising from embryologically different layers, as connective tissue and epithelium, and in the case of manifestly benign tumors and definitely malignant neoplasms. On the other hand, the differential diagnosis may become extremely difficult or even impossible if we are confronted with a combination of morphologically or clinically similar tumors. To exclude metastases, Billroth formulated the following postulates, which he believed should be fulfilled before a diagnosis of multiple primary tumors can be given: 1. That the tumors have a different anatomical structure. 2. That each tumor be histogenetically derived from the tissues of the organ in which it is primarily found. 3. That each malignant growth have its own metastases. These requirements appear too strict. It is impossible to insist on metastasis as a diagnostic sine qua non in every case of malignant neoplasm. In addition, it is well possible that, because of a variety of factors, a tumor may be modified in structure and character to such a degree as almost completely to lose its original type and identity. Etiologically, tumor multiplicity may be explained as the effect of multiple cell implantation, of multiple stimuli, or of multiple primordial cell nests (Geschwulst-Anlagen). Lubarsch interprets the occurrence of multiple tumors as evidence of a general tumor diathesis, while Walter thinks that in the majority of cases it signifies nothing more than a coincidence. Among 3,700 consecutive autopsies performed by the Department of Pathology of the University of Colorado Medical School from 1925 to 1940, 42 examples of multiple primary tumors were recorded. An analysis of these cases shows that in 38 instances two tumors were found in the same person, while in 4 cases the patient harbored three tumors. A combination of benign tumors only was seen but twice. The most frequent combination was that of a benign and a malignant tumor. This combination was seen in 27 patients. The combination of two benign tumors and one malignant tumor occurred in 3 cases. In 9 cases, two independent malignant tumors were observed simultaneously, while in still another case two primary malignant tumors were seen together with a benign tumor.