Bladder and upper urinary tract cancers as first and second primary cancers

Synchronous Primary Gallbladder and Colon Adenocarcinoma: A Case Report and Systematic Literature Review

Synchronous primary malignancies, defined as two or more primary malignancies diagnosed simultaneously or within six months, are uncommon and present unique diagnostic and therapeutic challenges. Synchronous primary adenocarcinoma of the gallbladder and colon is particularly rare. We report a case of a 48-year-old female presenting with persistent right upper abdominal pain. Laboratory tests and imaging studies initially suggested xanthogranulomatous cholecystitis. However, subsequent laparoscopic cholecystectomy and pathological examination revealed a moderately differentiated adenocarcinoma of the gallbladder (pT2bN1M0). Further staging with CT and PET-CT scans identified a suspicious mass in the transverse colon, confirmed by colonoscopy and surgical resection as well-differentiated adenocarcinoma of the transverse colon (pT3N0M0). Immunohistochemistry and genetic profiling of both tumors indicated distinct primary origins without loss of mismatch repair (MMR) protein expression. The patient underwent additional liver resection, lymph node dissection, and right extended hemicolectomy. She is currently undergoing further staging and awaiting chemotherapy. A review of English-language literature revealed eight reported cases of synchronous primary gallbladder and colorectal cancer and a total of 13 with synchronous primary malignancy of other organs. Such cases are rare and diagnostically complex cases. Common factors contributing to multiple primary malignancies (MPM) include genetic predispositions, previous cancer treatments, and lifestyle factors such as smoking and alcohol consumption. This case underscores the importance of thorough investigation and prompt treatment in patients suspected of having MPM. Advances in diagnostic imaging and molecular profiling are crucial for early detection and tailored therapeutic strategies. Standardized guidelines for managing synchronous cancers are needed to improve patient outcomes.

Risk of extracolonic second primary cancers following a primary colorectal cancer: a systematic review and meta-analysis

PURPOSE

The purpose of the study is to assess the global risk of extracolonic secondary primary cancers (SPCs) in patients with colorectal cancer (CRC).

METHODS

Studies of SPC in patients with CRC were included if they reported the standardised incidence ratio (SIR) for extracolonic SPCs in patients with CRC compared with the general population. Pooled summary estimates were calculated using a random-effects model.

RESULTS

A total of 7,716,750 patients with CRC from 13 retrospective cohort studies that reported extracolonic SPC incidence were included. The overall risk of several SPCs was significantly higher in patients with CRC compared with the general population, including cancers of the urinary bladder (pooled SIR 1.19, 95% confidence interval (CI) 1.06-1.33; p = 0.003), female genital tract (1.88, 1.07-3.31; p = 0.03), kidney (1.50, 1.19-1.89; p = 0.0007), thorax (lung, bronchus and mediastinum) (1.16, 1.01-1.32; p = 0.03), small intestine (4.26, 2.58-7.01; p < 0.0001), stomach (1.22, 1.07-1.39; p = 0.003), and thyroid (1.40, 1.28-1.53; p < 0.0001), as well as melanoma (1.28, 1.01-1.62; p = 0.04). There was also a decreased risk of developing cancer of the gall bladder (0.75, 0.60-0.94; p = 0.01).

CONCLUSION

Patients with CRC had a significantly increased risk of extracolonic SPCs compared with the general population. These findings highlight the need to develop research strategies for the management of second primary cancer in patients with CRC.