Clinical, demographic, and follow-up characteristics of patients with two primary metachronous tumors, one of them being in the colon

Multiple primary malignancies: An epidemiological and pedigree analysis of 57 patients with at least three tumours

AIM AND METHODS

Data of our patients with at least three primary malignancies were retrospectively analysed to detect any remarkable patterns which might be of interest for follow-up or early tumour detection and to identify a possible hereditary cancer predisposition. From 1.1.1954 to 1.8.1995 57 patients (0.1%) among a grand total of 52 398 cancer patients had a minimum of three malignancies.

RESULTS

The 5-year survival rates after colorectal, bladder, prostate, uterine corpus and gastric cancer were higher than those seen in patients with the corresponding solitary tumours. In both sexes, the mean interval between the individual tumours was greater (4.0 years) between the first and second tumours than between the second and third (2.5 years). In women, the intervals were roughly twice as long (6.8 and 3.7 years) as in men (3.7 and 2.0 years). 40.4% (n=23/57) had a colorectal, 28.1% (n=16) a bladder, and 41.7% (n=15/36 men) had a prostate carcinoma. 66.7% (n=14/21 women) contracted at least one gynaecological tumour. In 24 families HNPCC, in one a Li-Fraumeni Syndrome, and in another Hereditary Diffuse Gastric Cancer was suspected.

Frequency and clinical features of multiple tumors of the large bowel in the general population and in patients with hereditary colorectal carcinoma

BACKGROUND

Reports on the frequency of multiple carcinomas of the colon and rectum have varied from 3-4% to more than 10% of all tumors of the large bowel.

METHODS

We reviewed the files of a specialized colorectal cancer registry with the following objectives: a) to determine the frequency of multiple tumors (synchronous or metachronous) in the general population; b) to compare these values with those observed in patients with hereditary nonpolyposis colorectal carcinoma (HNPCC); and c) to evaluate the clinical outcome of patients with multiple tumors and the role of other clinical parameters in the development of these neoplasms.

RESULTS

From 1984 to 1992, 53 patients with multiple tumors (of 1298 registered patients, 4%) had large bowel carcinoma; 33 (2.5%) were synchronous and 20 (1.5%) metachronous. The total number of multiple colorectal carcinomas was 95, which was 7% of all registered colorectal carcinomas (1337 carcinomas in 1298 patients). Multiple tumors occurred significantly more often in patients with HNPCC than in those with sporadic carcinomas (P < 0.001); this increased prevalence was more marked for metachronous lesions, which occurred almost 4 times more often in patients with HNPCC (5.8% vs. 1.3%; P < 0.001). The average interval of time between the first and the second malignancy was 8.7 years; there was no significant difference between hereditary and sporadic tumors. Patients with synchronous tumors did not show appreciable differences in survival when compared with individuals who had single neoplasms. In contrast, a poor clinical outcome was observed in patients with metachronous tumors after the development of the second carcinoma. Finally, polypoid adenomas of the large bowel were found significantly more often in patients with multiple primary tumors than in those with a single tumor.

CONCLUSIONS

These results emphasize the importance of preoperative pancolonoscopy for the identification of possible synchronous tumors (both benign and malignant) and long-lasting endoscopic follow-up for the detection of recurrent or metachronous lesions. The conclusions are even more pertinent for patients with HNPCC, whose risk of metachronous tumors is significantly higher than that of patients with sporadic carcinoma.

Clinical characteristics of non-Hodgkin's lymphoma as a second primary tumor: a population-based survey

Data from 29,845 patients with lymphomas, 981 of whom had lymphoma as a second primary tumor, registered in the Surveillance Epidemiology and End Results (SEER) program in the U.S.A. between 1973 and 1986 were analyzed. The characteristics of the 274 patients with lymphoma as a second tumor who had received chemotherapy and/or radiotherapy for their primary tumor (SEP PT) were compared with 675 patients with second primary lymphomas who had no prior treatment (SEP NT) and with patients with single lymphomas (SIP). Patients with SEP PT disease had a significantly higher percentage of intermediate and high-grade tumors (80%) compared to those with SEP NT or SIP tumors (73% and 72%, respectively). The survival of all patients with SIP tumors did not differ from those with SEP tumors, but the median survival of those with SEP PT disease was shorter than for SEP NT disease. This was most probably due to the high percentage of intermediate and high-grade lymphomas in the SEP PT group. This was statistically significant in the group treated by combined chemotherapy and radiotherapy but not in those treated by a single modality alone. These findings relating to a worse prognosis in patients with SEP PT lymphoma are in line with our previous observations of a poor survival in patients with other multiple primary tumors.

Anastomotic recurrence at hepaticojejunostomy in a long-term survivor of bile duct carcinoma: report of a case

A rare case of autopsy-proven recurrence 10 years after a radical resection for lower bile duct carcinoma is herein reported. The subject is a 53-year-old man who underwent a curative resection of distal bile duct carcinoma with pancreatoduodenectomy in 1981. The lesion was a 1.0 x 1.5 x 1.0 cm well-differentiated papillotubular adenocarcinoma invading the fibromuscular layer of the bile duct with a slight infiltration to the lymphatics but without any extension to the vessels, nerves, connective tissues, or nodes. The patient demonstrated a recurrence 10 years after the initial operation and died 4 months later. An autopsy revealed a 2.0 x 2.5 x 1.6 cm mass at the anastomotic site of hepaticojejunostomy without any distant metastases. Although a late anastomotic recurrence after more than 10 years is unique, this case highlights the difficulty of the operative eradication of bile duct carcinoma. As a result, all possible maneuvers either during or after operation to promote the prophylaxis of recurrence are warranted.