Primary Triple Cancer Research Articles

Triple Primary Cancers: An Analysis of Genetic and Environmental Factors.

In patients with three or more primary cancers, genetic predisposition explained a significant proportion of cases; however, treatment history, lifestyle habits, and other exposures appeared to play a less significant role. This highlights the value of early genetic screening and the need to develop more sensitive markers of cancer susceptibility. See related Spotlight, p. 193.

Triple primary lung cancer, synchronous and unilateral: about two cases and literature review.

Triple primary lung cancer, synchronous and unilateral: about two cases and literature review.

Multiple primary cancers: a case report and literature review

The fortuitous discovery of synchronous double primary cancers of the lung and stomach is relatively rare, but the discovery of triple primary cancers in one patient remains exceptional. The discovery of triple primary cancers in a single patient remains exceptional. This coexistence corresponds to the syndrome of multiple primary malignancies or multiple primary cancers (MPC). We present a case of synchronous association of squamous cell carcinoma of the lung and gastric adenocarcinoma with a history of mature squamous cell carcinoma of the larynx.

Prostate cancer, chronic myelogenous leukemia and multiple myeloma in a single patient: a case report and review of the literature

BackgroundSynchronous or metachronous multiple primary malignancies (MPMs) are a known phenomenon. These occurrences may be spontaneous or related to environmental risk factors or genetic predisposition. Chronic myelogenous leukemia (CML) and Multiple myeloma (MM) are two uncommon hematologic malignancies, arises from two different cell lineage. The coexistence of CML and MM that is a rare phenomenon, with only 29 cases reported in the literature. To the best of our, this combination of triple primary cancers has not been reported in a single patient.Case presentationHerein, we reported a case of an 85-year-old Iranian male with three confirmed primary malignant neoplasms. The patient presented with synchronous prostate cancer and CML, in august 2016. He received imatinib and nilotinib for CML and hormonal therapy for prostate cancer. He remained in good control at further follow-ups for about 5 years. In the follow-up period and after 61 months treatment with tyrosine kinase inhibitors (TKIs), CML was undetectable in molecular tests, but the presence of serum M-protein, abnormal plasma cells in the bone marrow, and CRAB criteria was compatible with MM.ConclusionWe must evaluate the possibility of multiple primary cancers during cancer treatment and follow-up and it may be worthwhile to monitor serum electrophoresis and protein levels in TKIs-treated patients.

Triple primary lung cancer: a case report

BackgroundThe risk of developing lung cancer is increased in smokers, patients with chronic obstructive pulmonary disease, individuals exposed to environmental carcinogens, and those with a history of lung cancer. Automobile exhaust fumes containing carcinogens are a risk factor for lung cancer. However, we go through life unaware of the fact that automobile exhaust is the cause of cancer. Especially, in lung cancer patient, it is important to search out pre-existing risk factors and advice to avoid them, and monitor carefully for recurrence after treatment.Case presentationThis is the first report of a case with triple lung cancers with different histologic types at different sites, observed in a 76-year-old parking attendant. The first adenocarcinoma and the second squamous cell carcinoma were treated with stereotactic radiosurgery because the patient did not want to undergo surgery. Although the patient stopped intermittent smoking after the diagnosis, he continued working as a parking attendant in the parking lot. After 29 months from the first treatment, the patient developed a third new small cell lung cancer; he was being treated with chemoradiation.ConclusionsNew mass after treatment of lung cancer might be a multiple primary lung cancer rather than metastasis. Thus, precision evaluation is important. This paper highlights the risk factors for lung cancer that are easily overlooked but should not be dismissed, and the necessity of discussion with patients for the surveillance after lung cancer treatment. We should look over carefully the environmental carcinogens already exposed, and counsel to avoid pre-existing lung cancer risk factors at work or residence in patients with lung cancer.

P6-1 A case report on the diagnosis, staging, and management of triple primary cancers of the thyroid, colon, and breast

Management and surveillance are clearly outlined for every stage of colon, breast, and thyroid cancer. However, limited literature is available on the management and surveillance appropriate for a patient having all three malignancies. This case reports outlines how a 55 year old female with triple primary malignancy was managed and how long term care for her was planned.

Triple Primary Head and Neck Cancer : A Case Report and Literature Review

Globally, head and neck cancer is estimated to occur in more than 700,000 patients a year and cause 400,000 deaths and second most common cancer in India among both sexes and all ages. Even after optimal treatment for primary cancer, there are cases where second primary cancers develop around the previously treated areas. This occurrence is explained by the concept of field cancerization, which refers to a term where a carcinogen such as tobacco when chewed, exposes the mucosa to the carcinogen starting from the oral cavity to the upper aerodigestive tract. Combinations of two primary malignancies are seen in around 3% to 5% of patients, combinations of three cancers in about 0.5%, and combinations of four malignant tumors in about 0.3% of patients with a previous history of cancer. Early diagnosis and detection of these cancers are necessary for optimal treatment as with each occurrence the tolerability and the response rates gets poorer.

Two-stage Operation Performed for a Patient with Synchronous Triple Primary Cancer Comprising Esophageal Carcinosarcoma, Gastric Cancer, and Colonic Cancer

症例は67歳，男性．Body mass index （BMI）:12kg/m2の低体重があり，既往歴に糖尿病を認めた．2019年11月，つかえ感と体重減少を主訴に受診し，上部消化管内視鏡検査で胸部中部から下部食道にかけて約8cm大の巨大腫瘤性病変を認めた．同時に早期胃癌と進行S状結腸癌を認め，3重複癌と診断し，手術侵襲を分散する目的で二期分割手術の方針とした．一期目に胸腔鏡下食道亜全摘，腹腔鏡下S状結腸切除，腹腔鏡下胃全摘，頸部食道瘻造設術，腸瘻造設を施行した．35日後に胸骨後経路回結腸再建を施行し，術後経過良好で20日後に退院した．病理組織学的診断は，食道癌肉腫pT3N0M0 pStage II，胃癌pT1aN0M0 pStage Ia，S状結腸癌pT3N1bM0 pStage IIIbであった．まれな3重複癌に対し，鏡視下手術と二期分割手術を選択することで手術侵襲を軽減し，安全に根治切除が可能であった症例を経験した．鏡視下手術，二期分割手術はハイリスク症例に対して有用な治療選択と考えられた．

Triple metachronous primary pancreatic and gallbladder cancer associated with pancreaticobiliary maljunction: a case report

BackgroundMetachronous pancreatic and gallbladder cancer is a rare condition and has a dismal prognosis. Herein, we present a patient with triple metachronous primary pancreatic and gallbladder cancer associated with pancreaticobiliary maljunction who achieved long-term survival after undergoing repeat curative surgery.Case presentationA 65-year-old female patient with advanced gallbladder cancer associated with pancreaticobiliary maljunction underwent extended cholecystectomy with extrahepatic bile duct resection. The pathological diagnosis was T3N0M0 stage III A papillary adenocarcinoma with hepatic invasion. During a monthly follow-up, a diffuse hypovascular 2.0 × 1.5-cm mass was detected in the pancreatic head 6.2 years after the initial surgery. Hence, the patient underwent pancreaticoduodenectomy. Histological examination revealed T3N0M0 stage IIA well-differentiated adenocarcinoma without lymph node metastases. Marked inflammatory reaction was observed in the non-cancerous lesions of the proximal pancreatic head parenchyma containing bile pigment within ductular lumens. After 12.5 years from the initial surgery, total pancreatectomy for a 4.0 × 3.0-cm mass in the remnant pancreas was performed. Histological examination revealed T3N1M0 stage IIB moderately differentiated adenocarcinoma with lymph node metastases. Hence, surgical curative resection was achieved. Based on the pathological findings, a definitive diagnosis of triple metachronous pancreatic and gallbladder cancer was made. The pathology suggests no precursor lesions such as pancreatic intraepithelial neoplasia (PanIN) and atypical flat lesions, but marked inflammations in the non-cancerous lesions, strengthening our hypothesis that chronic inflammation induced by the pancreaticobiliary maljunction is related to carcinogenesis of the pancreas. Despite further adjuvant chemotherapy, the patient’s general condition worsened; however, she remained alive 15.2 years after the initial surgery while receiving the best supportive care.ConclusionsRepeat curative surgery for triple metachronous cancer was associated with a favorable prognosis. Both the biliary tract and the pancreas should be closely monitored during follow-up among patients with pancreaticobiliary maljunction, which can be managed with curative surgery.

Multidisciplinary Treatment for Triple Primary Cancers-Esophageal, Oropharyngeal and Renal Cancer: A Case Report

Multidisciplinary Treatment for Triple Primary Cancers-Esophageal, Oropharyngeal and Renal Cancer: A Case Report

Whole-exome sequencing in a patient with synchronous triple primary malignancies involving lung cancer: a case report.

The incidence of multiple primary malignancies (MPMs) has been increasing rapidly in recent years, however, the genetic pathogenesis is largely unknown on account of rare cases, especially for those patients who are diagnosed with three or more tumors. Under these circumstances, whole-exome sequencing (WES) may help to provide more comprehensive genomic information and guidance to proper therapeutic strategies. Here, we presented a rare case of a 66-year-old Chinese male patient who was diagnosed with synchronous triple primary malignancies: esophageal squamous cell carcinoma (ESCC), lung adenocarcinoma (LA), and hepatocellular carcinoma (HCC). Tumors were surgically removed within 3 months. WES was performed when the patient suffered from cancer recurrence and tumor-specific neoantigens were predicted. Each tumor displayed a distinct somatic mutation profile, providing direct evidence of independent origins. No shared driver gene mutation or neoantigen was detected among the three tumors. Two germline alterations of cancer susceptibility genes—SPINK1 c.194 + 2T>C and JAK3 c.425G>A were identified. This case is the first report of synchronous primary triple cancers covering the esophagus, lung, and liver. Our findings highlight the complexities of MPMs that even when under identical germline genetic backgrounds, the occurrence of MPMs can be a random event and driven by distinct somatic gene mutations. Synchronous multiple primary cancers that originated from different organs may not have common therapeutic gene targets, and it can be difficult to find a treatment to cover all the tumors.

Risk factors of ipsilateral breast tumor recurrence in triple-negative or HER2-positive breast cancer patients who achieved pathological complete response after neoadjuvant chemotherapy.

e12599 Background: To date, patients undergo breast surgery after neoadjvant chemotherapy (NAC) even though they achieve clinical complete response (cCR). The safety of omitting breast surgery for the patients who are predicted to be pCR has recently investigated in some research, however we still have not reached to a definite consensus yet. We may consider the breast surgery omission on the assumption that the rate of ipsilateral breast tumor recurrence (IBTR)after achieving pCR is acceptably low. The purpose of this study is to examine the rate of and evaluate the clinical features of IBTR in patients achieving pCR after NAC. Methods: In this study, a total of 278 patients with HER2-positive or Triple negative type primary breast cancer were enrolled from4 institutions. They were all diagnosed as ypT0 after breast conserving surgery and received postoperative radiotherapy. Occurrence of IBTR and other clinicopathological factors were collected by retrospective chart review. Results: Of the 278 patients, 49 patients (18%) were ER+/HER2+, 106 patients (38%) were ER-/HER2+ and 123 patients (44%) were ER-/HER2-. We found breast recurrence in 11 patients (4%) as a first recurrence. The 5-year breast recurrence rate was 4.5% in total, 2.2% in ER+/HER2+, 4.0% in ER-/HER2+ and 4.6% in ER-/HER2-, respectively. There was no significantly difference among subtypes. Interestingly, the 5-year breast recurrence rate of patients under 40-year-old was 12.3% which was significantly higher than patients with and above 40-year-old (3.1%, p=0.002). Conclusions: We should be extremely careful when consider omitting breast surgery for patients younger than 40 even if they achieved pCR after NAC.

Asymptomatic Patient with Unilateral Triple Synchronous Primary Lung Cancer

Asymptomatic Patient with Unilateral Triple Synchronous Primary Lung Cancer

Sporadic synchronous triple primary cancers in elderly female: Microsatellite instability high resectable colon cancer, epidermal growth factor receptor-mutated metastatic lung cancer, and neuroendocrine tumor of appendix

Colorectal cancer and lung cancer are the most common malignancies in the world. However, not all pulmonary nodules in a case of colon cancer are considered as metastasis, especially with features suggestive of limited colon disease without any nodal or liver involvement. The morphology of the pulmonary nodules is also an important consideration before subjecting the patient to another invasive procedure, as solitary pulmonary nodule with irregular margins, suggestive of another primary lesion. We describe a case of a patient with colon cancer, nonsmall cell lung cancer with single bone lesion, and neuroendocrine tumor of appendix. Initially suspected to be a case of metastatic colon cancer, the patient was later diagnosed as epidermal growth factor receptor-mutant metastatic pulmonary adenocarcinoma, with localized microsatellite instability high phenotype colon cancer.

健診を契機に発見された直腸，結腸，胆嚢3重複がんの1例

健診を契機に発見された直腸，結腸，胆嚢3重複がんの1例

Triple primary cancer of the head and neck, skin and prostate: A case report and literature review.

Second primary cancer (SPC) is an important prognostic factor for patients with head and neck cancer (HNC); therefore, the association between the prognosis and development of SPC has been well-reported. The use of 2-[18F]-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) is valuable to examine cancer stage, evaluate treatment responses and investigate suspected relapses or metastases. In the present study, the case of a male patient who was diagnosed with three primary cancer types, including well to moderately differentiated squamous cell carcinoma (SCC) of the mandible, axillary cutaneous poorly differentiated SCC and prostate adenocarcinoma, was described. Among these, mandible cancer was the first diagnosed when the patient was 70 years of age. Synchronous skin and prostate cancer (PRC) types then developed 3 years later. To the best of our knowledge, this is the first report of the aforementioned combination of cancer types. Postoperative FDG-PET was not performed as no lesions of recurrence or metastases of mandible cancer were found. Three years later, the PRC was asymptomatic and was incidentally detected by FDG-PET performed for a preoperative evaluation of skin cancer. It was indicated that FDG-PET could be utilized in patients with HNC due to there being no accurate FDG-PET protocol to detect SPC over a long-term follow-up.

Clinical analysis of 138 multiple primary cancers diagnosed of digestive system malignant tumor initially

Objective: To study the clinical characteristics, strategy of treatment and prognosis of multiple primary cancers(MPC) diagnosed of digestive system malignant tumor firstly. Methods: From January, 2000 to December, 2015, the clinical, follow-up and prognostic data of 138 MPC patients diagnosed of digestive system malignant tumor firstly were retrospectively analyzed. Results: 138 cases were found in 10 580 cases with malignant tumors, and the incidence was 1.30%. There were 129 cases of duplex primary cancers, 8 cases of triple primary cancers and 1 case of quintuple primary cancers. The repetitive primary cancer was occurred in digestive system (61cases, 44.2%) most frequently, with the next in respiratory system (46 cases, 33.3%). 52.2% (72 cases) suffered second primary cancer in 2 years after first primary cancer diagnosed, and 75.4% (104 cases) in 5 years. The median overall survival in patients with all cancer lesions radically treated was 168 months, better than any other treatment (68 months, P<0.05). Conclusions: The second primary cancers of MPC cases initially diagnosed of digestive system malignant tumor most frequently occurred in the digestive system and respiratory system. More concern should be attracted in follow-up, especially in the first 5 years. The key to improve patient' prognosis was radical treatment to every primary cancer.

A Case of Simultaneous Triple Primary Cancers of the Hypopharynx, Esophagus, and Stomach Which Were Dissected by Endoscopic Laryngo-Pharyngeal Surgery Combined with Endoscopic Submucosal Dissection

A 65-year-old man was admitted to our hospital following 6 months of dysphagia. At first, conventional endoscopy showed a reddish and depressed lesion in the stomach and an elevated lesion in the posterior wall of the hypopharynx. An endoscopic biopsy showed adenocarcinoma in the stomach, and squamous cell carcinoma in the hypopharynx. On the further examination, trans-nasal endoscopy with narrow band imaging (NBI) was performed. During the trumpet maneuver, a huge protruded lesion was observed and it reached to the orifice of the esophagus. Other superficial lesion located at left pyriform sinus was detected by NBI system as brownish area with brown dots. Furthermore, superficial esophageal cancer in the cervical esophagus was detected. Finally, 4 carcinomas in upper gastrointestinal tract were detected. Among them, the hypopharyngeal cancer was the most advanced (T3N0). The patient hoped to preserve his voice and swallowing function, endoscopic laryngo-pharyngeal surgery (ELPS) was performed for the hypopharyngeal cancer. Endoscopic mucosal resection (EMR) was performed for the esophageal cancer, and Endoscopic submucosal dissection (ESD) was performed for the gastric cancer. Under collaboration between a head and neck surgeon and an endoscopist, the tumor was resected en-bloc. The histopathological findings of hypopharyngeal cancer were squamous cell carcinoma, subeipthelial invasion, 29 × 28 × 4.2 mm. The others were diagnosed as mucosal cancers. The patient is currently alive with no recurrence at 28 months after the surgery; there is no stricture at the cervical esophagus. Endoscopic laryngopharyngeal surgery for the tumor of pharyngo-esophageal junction can provide a less invasive treatment.

Triple synchronous primary lung cancer: a case report and review of the literature

BackgroundMultiple primary lung cancer may present in synchronous or metachronous form. Synchronous multiple primary lung cancer is defined as multiple lung lesions that develop at the same time, whereas metachronous multiple primary lung cancer describes multiple lung lesions that develop at different times, typically following treatment of the primary lung cancer. Patients with previously treated lung cancer are at risk for developing metachronous lung cancer, but with the success of computed tomography and positron emission tomography, the ability to detect both synchronous and metachronous lung cancer has increased.Case presentationWe present a case of a 63-year-old Hispanic man who came to our hospital for evaluation of chest pain, dry cough, and weight loss. He had recently been diagnosed with adenocarcinoma in the right upper lobe, with a poorly differentiated carcinoma favoring squamous cell cancer based on bronchoalveolar lavage of the right lower lobe for which treatment was started. Later, bronchoscopy incidentally revealed the patient to have an endobronchial lesion that turned out to be mixed small and large cell neuroendocrine lung cancer. Our patient had triple synchronous primary lung cancers that histologically were variant primary cancers.ConclusionsTriple synchronous primary lung cancer management continues to be a challenge. Our patient’s case suggests that multiple primary lung cancers may still occur at a greater rate than can be detected by high-resolution computed tomography.

Analysis on the Prognostic and Survival Factors of Synchronous Multiple Primary Lung Cancer

背景与目的同时性多原发肺癌（synchronous multiple primary lung cancer, sMPLC）既往属少见疾病，近年发病率呈持续上升趋势，但缺乏对其大样本的研究报道。本研究对357例sMPLC的临床病理资料进行分析总结，籍以为临床诊断、治疗及预后提供理论依据。方法参考Martini-Melamed诊断标准和国际肺癌研究协会（International Association for the Study of Lung Cancer, IASLC）第8版肿瘤-淋巴结-转移（tumor-node-metastasis, TNM）分期标准，对357例sMPLC的临床病理资料进行分析。结果357例患者中，双原发病灶269例（75.35%），三原发病灶65例（18.21%），四原发病灶及以上者23例（6.44%），最多者为8个病灶。病灶好发于上叶，特别是右上叶（35.77%, 298/833），病理类型以腺癌为主（95.56%, 796/833），鳞癌次之（2.40%, 20/833），腺癌亚型中以腺泡样为主的比例较高（70.81%, 313/442），分期以Ib期及以下为主（68.35%, 244/357）。病理类型相同者发病率（92.72%, 331/357）远高于不同病理类型（7.28%, 26/357），其中腺癌-腺癌比例较高（99.40%, 329/331）。sMPLC的3年总生存率（overall survival, OS）为91.93%，5年总生存率为84.37%，多因素生存分析显示，有吸烟史（P=0.012）、最大病灶直径大于2 cm（P=0.027）、淋巴结转移（P=0.015）和胸膜受累（P＜0.001）为影响sMPLC预后生存的独立危险因素。结论sMPLC好发于右上叶，以腺癌最常见，腺泡样为主的亚型多见。吸烟史、最大结节直径、淋巴结转移和胸膜侵犯是影响sMPLC预后生存的独立危险因素。早期发现和积极的手术可以使sMPLC患者获得较好的预后。