Multiple Primary Malignant Tumors Research Articles

Localized scleroderma in a woman irradiated at two sites for endometrial and breast carcinoma: A case history and a review of the literature

Localized scleroderma is an uncommon side-effect of radiotherapy. We report a unique case with multiple asynchronous primary malignant tumors, which developed localized scleroderma after radiotherapy. A 67-year-old healthy woman received external irradiation for endometrial cancer. Three years later she underwent partial mastectomy and postoperative radiotherapy because of breast cancer. A progressive fibrosis developed in the breast. Within 12 months similar skin reactions were also seen in the irradiated abdominal wall and on both lower extremities. Biopsies revealed scleroderma lesions of breast and abdominal wall and scleroderma-like lesions on the legs. The lesions dissolved partially without generalization. This case, in contrast to most of the cases previously reported in the literature, illustrates not only lesions outside of radiation ports, but also that radiotherapy given to one cancer site can affect distant skin at a previously irradiated cancer site. When a localized scleroderma is diagnosed, further curative radiotherapy should be cautiously prescribed irrespective of cancer site.

Carcinoma of the lung and multiple primary malignant tumors

To evaluate the incidence of multiple primary malignancies combined with lung and other organs and their relationship. All patients who consecutively treated for lung cancer from December 1964 to December 1992, were retrospectively analyzed regarding the recurrence of a synchronous primary tumor elsewhere in the body. Of total 1019 patients reviewed, 21 (2.1%) had associated carcinoma of other organs. In these 21 patients, the incidence of associated aerodigestive tract cancer was 71.4% (15/21) and that of other organs was 28.6% (6/21). Five patients had simultaneous cancer with the lung cancer and 16 had metachronous cancer. Multiple primary tumors in patients with carcinoma of the lungs is not a rare phenomenon. Surveillance programs for detection of second primary tumors should focus on these patients.

Simultaneous operations in thoraco-abdominal clinical oncology.

To increase radical operability of cases with synchronous multiple primary malignant tumours (SMPTM) of the thorax and abdomen, and of cancer patients with concomitant severe heart disease simultaneous operations are implemented in the clinical practice. Twenty-seven simultaneous operations for SMPMT (17) and for cancers of different sites and concomitant cardiac disease (10) were performed at the Surgical Department of Thoraco-Abdominal Oncology, N.N. Blokhin Memorial Cancer Research Centre. All SMPMT cases had lung cancer. The second tumours were gastric cancer (6), oesophageal cancer (7), laryngeal cancer (3) and opposite lung cancer (1). Coronary artery bypass grafting for ischaemic heart disease was made in nine cases simultaneously with lung resection (4), tracheal resection (1), resection of the stomach or gastrectomy (4). Mitral valve commissurotomy and left pneumonectomy for lung cancer was made in one case. Two patients died from therapeutic complications early postoperatively. Median survival after simultaneous operations for SMPMT was 26 months. One patient undergoing simultaneous operation for cardiac disease and lung cancer died from cancer progression at 1 year following surgery. The remaining patients were followed up for 2 years free from evidence of cancer or heart disease. Simultaneous operations increase resectability, radicality and functional operability and therefore promise improvement of follow-up results in the most serious category of cancer patients in question.

Multiple primary neoplasms at a single institution: differences between synchronous and metachronous neoplasms.

During the 10-year period (1987-1996) of our study, 26,255 patients with cancer were admitted to our clinic and, of these, 271 (1%) patients had multiple primary malignant tumors. Ninety-two (34%) patients had synchronous tumors (synchronous group), and 179 (66%) patients had metachronous tumors (metachronous group). The mean age at first diagnosis was higher in the former group. The ratio of men to women was 1.36 in the synchronous group and 0.74 in the metachronous group (p = 0.018). Smokers and drinkers were more common in the synchronous group. Breast cancer and lung cancer were most prevalent, and associations between head/neck and lung cancer and between breast and breast cancer were the most frequent associations in both the synchronous and the metachronous group. The frequency of aerodigestive tumors was higher and that of mesenchymal tumors was lower in the synchronous group than in the metachronous group. Localization in the medial region and in the head/neck was more frequent in the synchronous group than in the case of metachronous secondary tumors.

Retrospective analysis of multiple primary malignant tumors (MPMT): General characteristics andprincipal associations

International Journal of Gynecology & ObstetricsVolume 70, Issue S3 p. C82-C82 Panel cervixs Retrospective analysis of multiple primary malignant tumors (MPMT): General characteristics andprincipal associations M.A. Gonçalves, M.A. GonçalvesSearch for more papers by this authorA.L. Pinto, A.L. PintoSearch for more papers by this authorF. Savoy, F. SavoySearch for more papers by this authorF. Laginha, F. LaginhaSearch for more papers by this author M.A. Gonçalves, M.A. GonçalvesSearch for more papers by this authorA.L. Pinto, A.L. PintoSearch for more papers by this authorF. Savoy, F. SavoySearch for more papers by this authorF. Laginha, F. LaginhaSearch for more papers by this author First published: 10 December 2003 https://doi.org/10.1016/S0020-7292(00)80577-9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume70, IssueS32000Pages C82-C82 RelatedInformation

Multiple primary malignant tumors in patients with oral and pharyngeal carcinoma

Multiple primary malignant tumors in patients with oral and pharyngeal carcinoma

The incidence of other primary tumours in patients with oral cancer in Scotland

Objective: To find out the incidence of second or multiple primary malignant tumours in patients with oral cancer in Scotland and identify the sites at most risk. Design: Retrospective cohort study of data from the Cancer Registry. Subjects: 1891 patients registered with oral cancer in Scotland between 1 January 1980 and 31 December 1986. Main outcome measures: Relative risks of subsequent cancers in patients with oral cancer. Identification of the sites at most risk of second cancers. Results: Of the 1891 patients, 228 (12%) developed a second primary cancer. The mean follow-up period was 3.2 years. Fourteen patients had 3, and 2 patients had 4 primary cancers. The overall risk of second primary cancers was 2.03 (95% confidence intervals (Cl) 1.77 to 2.39) times greater than expected in the general population. The relative risk for male patients was 1.95 (95% Cl 1.65 to 2.24) and for female patients 2.29 (95% Cl 1.7 to 2.9). Conclusions: Men with cancer of the lip in Scotland have an increased risk of developing second cancers of the lip and skin (excluding melanoma), whilst women with cancer of the lip have an increased risk of developing skin cancer only. Both men and women with intra-oral cancers have increased risks of developing second cancers of the oral cavity, pharynx, and trachea, bronchus, and lung, while men alone have an increased risk of developing second cancers in the oesophagus.

Multiple primary malignant tumors in patients with head and neck cancer: results of a prospective study and future perspectives.

Multiple primary tumors are a known phenomenon in head and neck cancer. They are partially responsible for the limited improvement in survival of head and neck cancer during the past 20 years. Only a few prospective data have been published about the incidence of metachronous tumors. The authors prospectively studied 127 patients with squamous cell carcinoma of the head and neck. The overall incidence of second primary tumors was 13.5% (simultaneously, 3%; synchronously, 5.5%; and metachronously, 8%). More than 90% of the recurrences of the first primary tumor occurred within the first 2 years following primary treatment, but the second primary tumors continued to occur gradually in the course of follow-up. Most of the second primary tumors were discovered because the patients developed symptoms (14/17). Survival after detection of the second primary tumor was poor. The development of a second primary tumor was of equivalent prognosis to a recurrence of the primary tumor. Future directives include the development of more adequate screening methods. Identification of potential early markers for the development of a squamous cell carcinoma at the level of the mucosa at risk and in serum could be of value for the early detection of individuals at risk.

Synchronous and metachronous multiple primary laryngeal malignancies.

The article reviews the literature on synchronous and metachronous multiple primary malignant laryngeal tumors of the same phenotype, of different phenotypes, and of different histogenesis.

Author reply

The article by Nishikubo et al.1 on the interesting subject of multiple primary malignant tumors (MPMTs) reviewed 186 cases of renal cell carcinoma (RCC) and 405 cases of lymphoid malignancies; the authors described eight patients with RCC in association with metachronous lymphoid malignancies. They noted that the incidence of this association in the same patient is higher than anticipated in the general population and discussed two possible causative factors: 1) a common genetic mutation, and 2) an immunomodulatory role of the first malignancy predisposing to the second. (The tumors did not occur simultaneously in any of these patients.) Recently, we observed in a white man, age 66 years, an RCC and synchronous bilateral lymphomas of the testes. Since 1989 he received procainamide for atrial fibrillation. In 1976 he had a carcinoma in situ of the floor of the mouth and in 1989 a squamous cell carcinoma of the roof of the mouth. He underwent bilateral orchiectomy in July 1996 for orange-size testicular tumors, present for 1 week. The microscopic diagnosis was large cell, noncleaved, diffuse malignant lymphoma, virtually replacing both testes. A month later, an ultrasound study revealed a 7 × 7 cm tumor in the lower pole of the left kidney. Microscopic examination of the resected kidney disclosed an encapsulated RCC 7 cm in diameter and microscopic malignant lymphoma in the soft tissues of the hilum. The patient received chemotherapy. He had 7 brothers and 3 sisters: 3 brothers died of cancer (esophageal, lung, and unknown) in their seventies; a sister died of breast carcinoma at age 49 years. The case was unique because the lymphoma involved both testes simultaneously and the lymphomas were synchronous with the RCC. Lymphoma of the testis is the most common testicular neoplasm in men over age 60 years. It is usually a secondary manifestation of systemic disease. Primary synchronous bilateral malignant lymphoma of the testes is a rare phenomenon2; we reported such a case in 1994.3 The occurrence of primary synchronous, bilateral, malignant lymphoma of the testes with RCC is rarer still. Because of the synchronous occurrence of the tumors in our case, the second possibility entertained by Nishikubo et al. becomes weaker, and the first possibility remains the only one that may explain the pathogenetic link. For decades we have been following with interest the involvement of urinary tract cancers and especially RCC in MPMT. As early as 1954, Haddad4 reported a case of a primary transitional cell carcinoma of the right ureter in association with an adenocarcinoma of the colon in a female patient, age 66 years. In 1984, we reported among 2005 patients with malignancies, proven at autopsy, 93 patients (4.6%) as having MPMTs in two different organs; the MPMTs had component of non-Hodgkin's lymphoma in 7 cases, RCC in 6 cases, and prostate carcinoma in 2 cases.5, 6 However, not a single patient harbored RCC and a lymphatic malignancy synchronously or metachronously. In 1996, Haddad reported one patient with adenocarcinoma of the prostate associated with small cell carcinoma of the lung and another patient with transitional cell carcinoma of the bladder associated with chronic lymphatic leukemia.7 Of our recent 31,477 surgical specimens (1991-1996), we found 95 malignant lymphomas (including Hodgkin's disease) and 30 RCCs; the patient described above was the only one suffering from both malignant lymphoma and RCC. Recently, we also observed at autopsy of a white man, age 78 years, a localized, 5 cm in diameter, clear cell carcinoma (Grade 1) of the right kidney associated with a synchronous, widely metastatic, poorly differentiated hepatocellular carcinoma. We agree with Nishikubo et al. that further studies are warranted on this interesting subject. Ifat A. Shah M.D.*, Farid S. Haddad M.D.*, Osama S. Gani M.D.*, C. Cecilie Alfsen M.D.*

Multiple Primary Malignant Tumors in a National Cancer Registry: Reliability of Reporting

During the years 1958–1988, 808 522 individuals were registered in the Swedish national population-based cancer register with a total of 933 900 primary malignant tumors. Roughly 11% of the tumors reported to the Swedish Cancer Registry in 1988 were found in persons earlier registered for another primary malignancy. One hundred of the individuals registered with multiple primary malignant tumors were randomly selected for a study of the reliability of reporting of multiple malignancies. Medical records and—when necessary—histopathological slides and other relevant diagnostic material for each malignancy were collected and the diagnoses reevaluated. Three persons had to be excluded; thus 97 cases with 209 reported malignancies were analysed. Of these, 94% of the first, 98% of the second and 79% of the third malignancy were accepted. Twelve of the reported tumors were not accepted as malignant, five were benign or cancer in situ, five were incorrectly reported as new primaries and two were a second incorrect registration of a previously registered malignancy. All 97 persons had at least one malignant tumor, in 90% of the persons all reported diagnoses were accepted and 93% had multiple primary malignancies. The results of this quality control study indicate that suitable data are available in the Swedish Cancer Registry for investigations related to the occurrence of multiple primary malignancies in a large unselected population. The Swedish Cancer Registry, to which all newly diagnosed malignancies by law have to be reported, comprise today close to one million individuals with registered malignancies.

A case of quadruple cancer, including triple cancers in the head and neck region

As improvements in the diagnosis and treatment of malignant tumors extend the average length of patients' lives, the incidence of multiple primary malignant tumors has been increasing. As a result, incidents of triple cancer are frequently found and even quadruple cancers are observed occasionally. However, a case in which radical operations can be performed for all the tumors of quadruple cancer is still rare. We report an unusual case of metachronous quadruple cancers, which included triple cancers in the head and neck region, where it was possible to perform surgery on all the primary lesions.

A CASE OF QUINTUPLE CANCER COMPOSED OF UTERINE CANCER, PAGET'S DISEASE, CECAL CANCER, CANCER OF THE BLADDER AND HEPATOMA

A case of quintuple cancer including uterine cancer, Paget's disease, cecal cancer, cancer of the bladder and hepatoma which metachronously occurred during period of 34 years in a 69-year-old woman is reported. The patient had undergone a hysterectomy, radiation therapy and blood transfusion for a uterine cancer at age 37, resection of perineal skin widely for Paget's disease at age 60 and abdominoperineal resection for recurrence of Paget's disease at age 66, when she was pointed out liver cirrhosis. This time she was seen at the hospital because of sever anemia and diagnosted as having cecal cancer, cancer of the bladder and hepatoma. We can consider several pathogenic factors for multiple primary malignant tumors including radiation therapy and hereditary factors. It was inferred that etiologic factor in this case might be irradiation for the first uterine cancer, because all tumors except hepatoma arose in the pelvic organs which were involved in the irradiation therapy. Immunohistorical study for anti-oncogene factors showed that p-53 gene was overexpression in the cecal canncer, but not in other cancers. Retinoblastoma gene was positive in the cecal cancer and part of Paget's disease, but any findings suggestive of gene abnormality were not revealed. With a recent expansion of aged population and an improving trend of therapeutic result of the first cancer with a favorable prognosis, multiple primary cancer tends to increase. It is important to take a careful attitude not only for recurrence but also for possible multiple cancer.

Multiple primary tumors of the gastrointestinal tract

The existence of multiple primary malignant tumors (PMT) is currently beyond doubt. The most common descriptions of a combination of stomach cancer with malignant tumors of the breast, uterus, bladder and skin. The rarity of the combination of gastric cancer with cancer of the cecum and rectum and the difficulty of diagnosis prompted us to share our observation.

徳島大学における10年間の重複悪性腫瘍症例の検討

徳島大学における10年間の重複悪性腫瘍症例の検討

Multiple primary malignant tumours in patients with head and neck cancer: the implications for follow-up.

The pattern of second primary cancer occurrence in 518 Scottish patients with head and neck cancer was determined by a retrospective study. The overall incidence of second cancers was 9% but the true incidence increased steadily in the years following initial diagnosis to reach a maximum of 21% at 11 years. After 4 years of follow-up patients were more likely to die from a second primary cancer than from the effects of the initial tumour. The Scottish cohort differed from previously reported, overseas, study groups in having a high incidence of second primary cancers in sites outside the upper aerodigestive tract. This potential demographic difference suggests a need for local audit prior to design and implementation of screening protocols for second primary cancers.

当科における重複癌症例の臨床統計

We studied clinicostatistically the cases of multiple primary malignant tumors in 336 patients with malignancies of the oral and maxillary region treated in the First Department of Oral and Maxillofacial Surgery, Osaka University Faculty of Dentistry during the period from 1978 to 1988. In this study, we employed the criteria for multiple primary malignant tumors presented by Hiyama et al., but omitted the tumor cases with the same histology in the oral mucosa as a multicentric cancer.The following results were obtained.1. Multiple primary malignant tumors were observed in 17 among 336 cases (5.1%), and all was of double malignancies.2. Thirteen cases were males and 4 cases were females. The age distribution was from 46 to 82 years, mostly in the 5th and 6th decades. The mean age was 59. 5 years.3. Of 17 cases, synchronous tumors with the duration of disease within 3 months were found in 2 cases (11. 8%) and the non-synchronous in 15 cases (88. 2%). The average duration was 35. 8 months.4. Histologically, a combination of squamous cell carcinoma and adenocarcinoma was observed in 11 cases (65%), two squamous cell carcinomas in 4 cases (23. 5%), squamous cell carcinoma/transitional cell carcinoma and malignant sclawannoma/malignant melanoma in each one case.5. Carcinomas in the digestive system such as stomach and esophagus were frequently combined with oral carcinoma, in which tongue carcinoma was most common.6. As for the prognosis, 8 cases died of the secondary tumor, 2 cases died of the initial tumor, 5 cases were alive and 2 cases were others.

頭頚部悪性腫ようにおける重複癌症例の検討

Twenty cases (4.3%) of multiple primary malignant tumors, including 3 cases of oral multicentric carcinoma, were found among 463 patients with malignant tumor of head and neck region at the our department, from September, 1978 through August, 1989. Ten were male and ten were female. Their mean age was 67.7±11.5 years with a range 34 to 82 years. Synchronous (within 1 year) tumor were 8 cases and metachronous were 12. The average interval between the first and second tumors was 4.0 years with a range of from 6 months to 14 years.There was a wide variety of other tumors distributed as follows: pharynx (3), bladder (2), and parotid region, thyroid, bronchus, breast, esophagus, stomach, uterine cervix, and skin, each. One of this group, forty percent (8/20 cases, including oral multicentric carcinoma) were combined cancers of digestive system.Three cases of radiation induced cancer were found.

A Case with Three Primary Malignant Tumors, such as Malignant Lymphoma, Carcinomas of the Bladder and the Colon

We report a 66-year-old female with multiple primary malignant tumors: malignant lymphoma, transitional cell carcinoma of the urinary bladder, adenocarcinoma of the colon and anaplastic carcinoma of neck originated in the unknown site. Firstly, the patient was treated with antitumor agents for malignant lymphoma. During the course of treatment, carcinoma of the bladder was found by urologidt since hematuria occurred, and she was also treated with 60Co irradiation after intra-arterial infusion of CDDP for carcinoma of the bladder. Nine months later, swelling of cervical, intraperitoneal and inguinal lymph nodes were noticed, and some of them were metastasis of anaplastic carcinoma, but the origin of them was unknown. Additionally, she complained of fullness of lower abdomen, and endoscopic examination revealed the carcinoma of the colon, and died of cachexy on 30 months after initial chemotherapy.We have had 51 cases of multiple primary tumors of the head and neck in our Department from 1978 to 1987. The incidence rate of these patients in all the cases with head and neck tumors was 5.9%, and it was higher than those reported elswhere. The clinical problems concerning diagnosis and treatment for multiple malignant tumors was discussed briefly.

Mutiple Primary Malignant Tumor

Though the occurrence of multiple primary malignant tumor is a rare finding but the reported cases of it has increased in recent years. We collected multiple primary cancer of different organ, tissue and the multicentric origin of bilaterally paired organs. This paper reports 6 cases of multiple primary malignant tumors which were experienced at Yeungnam university hospital in Taegu during the past 2 years with review of journals. The results were as follows. 1. The incidence of multiple primary cancer was 0.31% for 2 years(1987-1988). 2. The ratio between male and female was 1:1 and mean age of incidence was 54.1 years. 3. The ratio between synchronous and metachronous(interval more than 6 months) was 1:1. 4. The time interval between first and second cancer was average 2.7 years in metachronous cases. 5. The most frequent involved organ was stomach, breast and colon in order of frequency. 6. The incidence of familial cancer associations was found in one out of 6 cases. 7. The test of DNCB, multi test CMI and ratio of T4 to T8 were performed in 4 cases but there was no definitive evidence of abnormality. We concluded that every effort should be made to discover the presence of synchronous malignancies in the patients who are being treated for a known tumor, and also special care should be given to detect new metachronous lesions is required.