Cancer Research and Treatment

Original Article

Prognosis of Pancreatic Cancer Patients with Synchronous or Metachronous Malignancies from Other Organs Is Better than Those with Pancreatic Cancer Only: Su-Jin Shin, Hosub Park, You-Na Sung, Changhoon Yoo, Dae Wook Hwang, Jin-hong Park, Kyu-pyo Kim, Sang Soo Lee, Baek-Yeol Ryoo, Dong-Wan Seo, Song Cheol Kim, Seung-Mo Hong; Cancer Res Treat. 2018;50(4):1175-1185. Published online December 20, 2017; DOI: https://doi.org/10.4143/crt.2017.494

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Purpose
Pancreatic cancer associated double primary tumors are rare and their clinicopathologic characteristics are not well elucidated.
Materials and Methods
Clinicopathologic factors of 1,352 primary pancreatic cancers with or without associated double primary tumors were evaluated.
Results
Of resected primary pancreatic cancers, 113 (8.4%) had associated double primary tumors, including 26 stomach, 25 colorectal, 18 lung, and 13 thyroid cancers. The median interval between the diagnoses of pancreatic cancer and associated double primary tumors was 0.5 months. Overall survival (OS) of pancreatic cancer patients with associated double primary tumors was longer than those with pancreatic cancer only (median, 23.1 months vs. 17.0 months, p=0.002). Patients whose pancreatic cancers were resected before the diagnosis of metachronous tumors had a better OS than patients whose pancreatic cancer resected after the diagnosis of metachronous tumors (48.9 months and 13.5 months, p=0.001) or those whose pancreatic cancers were resected synchronously with non-pancreas tumors (19.1 months, p=0.043). The OS of pancreatic cancer patients with stomach (33.9 months, p=0.032) and thyroid (117.8 months, p=0.049) cancers was significantly better than those with pancreas cancer only (17.0 months).
Conclusion
About 8% of resected pancreatic cancers had associated double primary tumors, and those from the colorectum, stomach, lung, and thyroid were common. Patients whose pancreatic cancer was resected before the diagnosis of metachronous tumors had better OS than those resected after the diagnosis of metachronous tumors or those resected synchronously.

Citations

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Laparoscopic Radical Total Gastrectomy and Pancreatosplenectomy for Synchronous Cancer of the Stomach and Pancreas
Motoki Ebihara, Kentoku Fujisawa, Shusuke Haruta, Hironori Uruga, Masaki Ueno
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Synchronous primary multiple cancer: distal cholangiocarcinoma of the intrapancreatic common bile duct and intraductal papillary mucinous tumor associated with ductal adenocarcinoma of the pancreatic tail
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Pancreatoduodenectomy after Ivor-Lewis Santi oesophagectomy with gastric tube reconstruction. An European multicentre experience
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Case Report

Five Cases Report of Solid Tumor Synchronously with Hematologic Malignancy: Yuehong Cui, Tianshu Liu, Yuhong Zhou, Yuan Ji, Yingyong Hou, Wen Jin, Yi Feng; Cancer Res Treat. 2012;44(1):63-68. Published online March 31, 2012; DOI: https://doi.org/10.4143/crt.2012.44.1.63

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The reported incidence of synchronous multiple primary cancer (SMPC) is rare, and it is even less common to observe synchronous solid tumor with a hematological malignancy. We report five cases of solid tumor presented synchronously with hematological malignancy, all observed within a 2 year period at the oncology department of a university hospital in Shanghai, China. These individual cases included lung adenocarcinoma with chronic myelogenous leukemia, colon cancer with solitary plasmocytoma, gastric adenocarcinoma with diffuse large B cell non-Hodgkin's lymphoma, lung adenocarcinoma with multiple myeloma, and colon cancer with diffuse large B cell non-Hodgkin's lymphoma. It is challenging to therapeutically control the biological behavior of concurrent multiple primary tumors, and there is no standard treatment for such rare conditions. In this paper we discuss these five cases of SMPC and their treatments.

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Original Article

Clinicopathologic Features of Metachronous or Synchronous Gastric Cancer Patients with Three or More Primary Sites: Joo Hoon Kim, Sun Young Rha, Chan Kim, Gun Min Kim, Sang Hyun Yoon, Ki Hyang Kim, Min Jae Kim, Joong Bae Ahn, Hyun Cheol Chung, Jae Kyung Roh, Hyo Song Kim; Cancer Res Treat. 2010;42(4):217-224. Published online December 31, 2010; DOI: https://doi.org/10.4143/crt.2010.42.4.217

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Purpose

We investigated the clinicopathologic information of patients with gastric cancer with multiple primary cancers (GC-MPC) of three or more sites.

Materials and Methods

Between 1995 and 2009, 105,908 patients were diagnosed with malignancy at Severance Hospital, Yonsei University Health System. Of these, 113 (0.1%) patients with MPC of three or more sites were registered, and 41 (36.3%) of these were GC-MPC. We retrospectively reviewed the clinical data and overall survival using the medical records of these 41 GC-MPC patients. We defined synchronous cancers as those occurring within 6 months of the first primary cancer, while metachronous cancers were defined as those occurring more than 6 months later.

Results

Patients with metachronous GC-MPC were more likely to be female (p=0.003) and young than patients with synchronous GC-MPC (p=0.013). The most common cancer sites for metachronous GC-MPC patients were the colorectum, thyroid, lung, kidney and breast, while those for synchronous GC-MPC were the head and neck, esophagus, lung, and kidney. Metachronous GC-MPC demonstrated significantly better overall survival than synchronous GC-MPC, with median overall survival durations of 4.7 and 14.8 years, respectively, and 10-year overall survival rates of 48.2% and 80.7%, respectively (p<0.001).

Conclusion

Multiplicity of primary malignancies itself does not seem to indicate a poor prognosis. The early detection of additional primary malignancies will enable proper management with curative intent.

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Case Report

A Case of Synchronous Double Primary Cancer of the Penis and Urinary Bladder: Yong Soo Cho, Jung-Ae Lee, Si Bum Kim, Soo Jung Gong, Joo Heon Kim, Seon Min Youn, Eun Tak Kim; Cancer Res Treat. 2010;42(1):53-56. Published online March 31, 2010; DOI: https://doi.org/10.4143/crt.2010.42.1.53

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Multiple primary cancers are the occurrence of more than two cancers of different origin in an individual. Penile cancer is a rare disease, and finding it combined with other cancers is even rarer. A 64-year-old man with a painful penile mass was referred to us from a primary urological clinic. We performed a biopsy of the penile mass and the histology revealed a well-differentiated squamous cell carcinoma. Abdominal computed tomography showed a localized bladder tumor with inguinal lymphadenopathy. The patient underwent a partial penectomy, transurethral resection of the bladder tumor and inguinal lymph node dissection. The histology of the bladder tumor was high-grade papillary carcinoma, and that of the lymph node was squamous cell carcinoma. The penile and bladder tumors were in stage II (T1N1M0) and stage I (T1N0M0), respectively. We successfully treated the patient with adjuvant radiotherapy and systemic chemotherapy.

Citations

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Synchronous Double Primary Cancer of the Penisand Urinary Bladder
Deora H
MOJ Surgery.2017;[Epub] CrossRef

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Original Article

Clinical Characteristics of Multiple Primary Colorectal Cancers: Joo Won Yoon, Seung Hyun Lee, Byung Kwon Ahn, Sung Uhn Baek; Cancer Res Treat. 2008;40(2):71-74. Published online June 30, 2008; DOI: https://doi.org/10.4143/crt.2008.40.2.71

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Purpose

Although multiple primary colorectal cancer has been recognized as a significant clinical entity, its clinical and pathological features and its prognosis are still controversial. The purpose of this study was to clarify clinical and pathological features of multiple primary colorectal cancer.

Materials and Methods

Among 1669 patients who underwent surgery for primary colorectal cancer from January 1997 to June 2005, 26 patients (1.6%) with multiple primary colorectal cancer were identified. We reviewed clinical characteristics including diagnostic interval, lesions, operating methods, and TNM stage, and we defined the index lesion as the most advanced lesion among the synchronous lesions. For the purposes of the study, the colon and rectum were classified into three segments. The right-side colon included the appendix, cecum, ascending colon, hepatic flexure, and transverse colon, and the left-side colon included the splenic flexure, descending colon, and sigmoid colon.

Results

Of the 26 patients with multiple primary colorectal cancers, nineteen patients were male and seven patients were female, with a mean age of 61.5 years. Nineteen patients had synchronous colorectal cancers and seven patients had metachronous colorectal cancers. In the metachronous cases, the mean diagnostic interval was 36.8 months. The site of the first lesion in metachronous colorectal cancers was the right colon in five cases (71.4%) and the left colon in two cases (28.6%), and the site of the second lesion was the rectum in six cases (55.5%), the right colon in three cases (33.3%), and the left colon in one case. The TNM stage of the second lesions in the metachronous colorectal cancers was stage II in four cases (57.1%), stage III in one case (14.3%), and stage IV in one case (14.3%). For the synchronous colorectal cancers, the operation methods were single-segment resection combined with endoscopic mucosal resection in five cases (26.3%), single-segment resection alone in six cases, two-segment resection in six cases, and total colectomy in two cases.

Conclusion

In metachronous colorectal cancers, the secondary lesions were later-stage cancer. Therefore, careful postoperative follow-up is necessary for patients who have undergone surgery for colorectal cancers. Further study of therapeutic modalities is important for synchronous colorectal cancers.

Citations

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Case Report

A Case of Synchronous Gastric Non - Hodgkin's Lymphoma and Renal Cell Carcinoma: Je Jung Lee, Moo Rim Park, Young Eun Joo, Young Jin Kim, Hyeoung Joon Kim, Chan Choi, Ik Joo Chung; J Korean Cancer Assoc. 1999;31(3):635-640.

Abstract PDF: We report a 58-year-old man who developed synchronous gastric non-Hodgkin`s lymphoma (NHL) and renal cell carcinoma. He presented with epigastric discomfort for 2 months. Endoscopic finding of the stomach disclosed a large inegular ulceration with nodular margin on the upper body. Constrast enhanced CT scan of the abdomen showed an ulceration and focal wall thickening in the greater curvature side of stomach, and an enhanced bulging mass in the left kidney incidentally. The tissue obtained by radical proximal gastrectomy and nephrectomy showed diffuse large B-cell lymphoma on stomach and chromophobic type of renal cell carcinoma on kidney. To our knowledge, this is the first report of synchronous gastric NHL and renal cell carcinoma in Korea.

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Original Articles

Multiple Primary Malignant Neoplasm with Colorectal Cancer: Hee Chul Kim, Chang Nam Kim, Chun Sik Jung, Chang Sik Yu, Jin Cheon Kim; J Korean Cancer Assoc. 1998;30(4):668-674.

Abstract PDF: PURPOSE
The incidence of multiple primary malignant neoplasm has increased in recent decades. The etiologies and epidemiologies of multiple primary malignant neoplasm are still remained to be verified. A group of patients with multiple primary malignant neoplasms accompanied by colorectal cancer was analyzed to determine the relationship between certain cancers and colorectal cancer.
MATERIALS AND METHODS
From Jan. 1989 to Jun 1997, there were 56 patients with colorectal cancers accompanied by cancers of another organs. The retrospective analysis was done on the basis of cancer origin and intervals between the cancers.
RESULTS
The male-to-female ratio was 25 to 31. The characteristics of colorectal cancers in multiple primary malignant neoplasm were similar to the colorectal cancers without other cancers. Among 56 patients, 50 patients had the double primaries and 6 had the triple primaries. In the patients with double primaries, extracolonic cancers were found in the stomach(16), hepatobiliary system(12), urologic system(6), gynecologic organ(6) and others. In the patients with triple primaries, extracolic cancers were found in the stomach(5), uterus(2), lung(2) and others. The patients with family history of malignancy were 10 cases and the rate in the triple primaries seemed to be higher than double primaries.
CONCLUSION
It could be desirable to follow-up and work-up the patients with colorectal cancer keeping in mind that the malignancy in other organs especially stomach might be present.

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Multiple Primary Cancers Associated with Lung Cancer: Won Young Huh, Han Sik Kim, Eun Hwa Kim, Soon Heung Lee, Min Chul Kim, Kwi Wan Kim, Hye Kyung Lee, Kwang Min Lee; J Korean Cancer Assoc. 1994;26(3):425-431.

Abstract PDF: We experienced 6 cases of multiple primary cancers associated with lung cancer and report these with a brief review of the literature. During 13 years and 7 months from January 1979 to July 1993, 1312 cases of primary lung can- cer were registered at the Presbyterian Medical Center. Among them, 6 cases were multiple primary cancers compatible with Warren and Gates Criteria. We reviewed the clinical characteristics of theses 6 cases retrospetivly of the basis of medical record. We analyse these 6 cases as below; 1) The incidence of multiple primary cancers associated with lung cancer was 0.46%. 2) Male: female ratio was 5: l. 3) The average time interval between the first and the second cancer was 3.98years. 4) The involved sites were aerodigestive tract in 5 cases and endometrium in 1case. 5) Above 5 cases had heavy smoding history. According to the analysis of our 6 multiple primary cancers associated with lung caner, there seems to be a tendency of developing secondary cancers along the aerodigestive organs which are contiguous with lung. Although we cannot find-out the common etiologic relationship, 5 cases out of 6, has a heavy smoking history. We believe that it is mandatory to have nationwide statistics of mutiple primary cancers associated with lung cancer and to sesrch for the common etioloies, if any.

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A Case of Thyroid Cancer Combined with Gastric Cancer: Yun Ho Lee, Seok Hwan Lim, Won Yeop Bae, Seung Jun Kim, In Pyo Jeon, Yeun Keun Lim, Hong Bae Park, Chin Duk Huh, Jang Sin Shon; J Korean Cancer Assoc. 1994;26(6):984-991.

Abstract PDF: Multiple primary malignant neoplasms in an individual are not rare. Recent reports indicate a gradual and steady increase of such occurences. This increase has been attributed to the fact that lifespan of cancer patients is longer than it used to be; the increase also has been attributed to more throught clinical evaluations and increased autopsies. We report a patient who had papillary carcinoma of the thyroid combined with adenocarcinoma of the stomach. The lesions were confirmed by endoscopic and fine needle aspiration biopsies. Our case is multiple primary malignant neoplasm of different organs a#nd is not common. Until present time, most commonly associated tumors with thyroid cancer were breast cancer, cervical cancer, ovarian cancer, pheochromocytoma, and leukemia. In this report, we discuss the multiple primary malignant neoplasm.

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A Case of Synchronous Multiple Primary Cancers in Stomach and Esophagus , Which Were Resected Curatively: Seung Jae Chung, Young Don Min, Chan Guk Park; J Korean Cancer Assoc. 1995;27(2):340-347.

Abstract PDF: A case of synchronous multiple primary tumors in a 63-year-old man is described. The tumors included a squamous cell carcinoma of the esophagus and a mucinous adenacarcinoma of the stomach. As we could perform the curative resection of the tumors successfully, we report this case with review of literatures about the criteria, incidence, organ relationship and tumorogenesis of the multiple primary tumors.

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Bone Metastasis as the Initial Symptom of Gastric Cancer: Laercio Gomes Lourenco, Rodrigo Gorayeb, Jesus Garcia Filho, Jose Roberto Ferraro, Ramiro Colleroni, Jose Carlos Del Grande, Chibly Michael Haddad; J Korean Cancer Assoc. 1995;27(2):347-352.

PDF

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A Case of Synchronous Triple Primary Cancers in Larynx , Esophageu , and Stomach: Gyo Seon Kwun, Kyung Tae Kim, Yong Cho Kim, Ju Byeung Sung, Young Wo Lee, Eun Jung Jang, Baek Yeol Ryoo, Tae You Kim, Young Hyuck Im, Yoon Koo Kang, Seung sook Lee, Jim Oh Lee, Tae Woong Kang; J Korean Cancer Assoc. 1996;28(5):888-897.

Abstract PDF: Multiple primary cancers can occur in up to 20% of primary aerodigestive tract cancer patients. The multiplicity of cancer in aerodigestive tract suggests that the exposure to common carcinogen may be the cause of multiplicity(field cancerization). Continuous alcohol drinking and smoking are considered to be the major factors in development of multiple cancers. Also, high frequency of genetic alterations in multiple primary cancer patients implys that the genetic instability such as replication error or mutation of tumor suppressor gene may play a role in the development of multiple primary cancers. We report a case of a 61 year-old man who had triple synchronous cancers in larynx, esophagus, and stomach. He was a heavy smoker of 30-pack-years and a heavy drinker. Pathological examination showed squamous cell carcinoma of larynx and esophagus, and adenocarrinoma of stomach, respectively.

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