Multiple Primary Malignancies- Synchronous and MetachronousExperience at a Tertiary Care Center in South India

Abstract

BACKGROUND Patients diagnosed with cancer have a lifetime risk of developing another denovo malignancy depending on various inherited, environmental and iatrogenic risk factors. However, in recent years multiple primary malignancies have been reported with increasing frequency. The occurrence of second malignancy in a different organ in a known patient with malignancy is known as dual malignancy. There is increase in prevalence of both synchronous and metachronous second primary malignancy, among the cancer patients. The aim of the study was to report our observation of increasing incidence of multiple primary malignancies and analyse metachronous and synchronous types at MNJ Institute of Oncology and Regional Cancer Centre which is a tertiary care and referral center in south India. METHODS The study was done in MNJIO & RCC over a period of 4 years (June 2015 to June 2019). All the patients diagnosed with a histologically proven second malignancy as per Waren and Gates criteria were included. Various details regarding sex, age at presentation, synchronous or metachronous were recorded. RESULTS Among the total number of cases studied from June 2015 to June 2019, there were 14838 malignancies. The common malignancies noted are from cervix, head and neck, breast. Out of these cases we came across total 12 cases of dual primary malignancies and one triple malignancy. CONCLUSIONS There is no reliable clinical means of distinguishing a second primary malignancy from metastasis. The diagnosis must be made only by exploration and biopsy which should be confirmed by IHC when necessary. Therefore, in cancer patients any suspicious lesion not responding to treatment, in contrast to other areas of the disease should be biopsied, as the presence of different pathology and second primary malignancy should always be considered. Second primary malignancy in this era is a double edge sword as a result of multi-modality treatment.