Author of

• 12853

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  P3.24 - Poster Session 3 - Supportive Care (ID 160)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Supportive Care
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12864

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    P3.24-011 - Multiple primary tumors in 65-year old heavy smoker (ID 776)

    09:30 - 09:30  |  Author(s): E. Swietlik
    • Abstract

    Background
    Since Billroth s report, in 1889, of a patient with multiple synchronous tumors, multiple primary malignances (MPM) have been recognized as a growing problem. The increase in incidence of MPM has been ascribe to several factors, such as increase in the incidence of many forms of cancer, the increase in longevity and cancer survival and better cancer follow-up.

    Methods
    Case report

    Results
    Here we present 65-year old ex-smoker with history of recent surgery for vocal cord squamous cell cancer who was seen in pulmonary out-patient clinic due to nodular lesion in the left lung seen on chest x-ray. Subsequent chest CT scan revealed focal lesion 18 mm in diameter with spicular margins located in the right upper lobe, another lesion with septa and cavitation, 62 x 58 mm in the right lower lobe and calcified nodule in the left lung, no enlarged lymph nodes or pleural effusion was seen. He underwent upper right lobe resection and sleeve resection of the lower right lobe. Histopathological examination revealed adenocarcinoma in the right upper lobe with lymph node metastasis. Tumor emboli in tumor lymphatic and pleural vessels were reported along with infiltration of visceral pleura. Examination of the right lower lobe showed squamous cell carcinoma with tumor emboli in tumor blood vessels. Subsequently, the patient was treated with adjuvant chemotherapy.He subsequently was treated with adiuvant chemotherapy (cisplatin+vinerolabine). During seven months of follow up he remained in good health with no signs of disease progression. MPM are defined as malignant tumors based on histology criteria with distinct location, which do not represent skip lesions, metastatic disease or recurrence of a primary pulmonary malignancy. According to time category they can divided as synchronous or metachornous. Retrospective date show an increased risk of developing a second lung cancer following the diagnosis of a first lung neoplasm, in patients who survive more than three years as many as 10 to 25% will develop a second primary lung cancer. The male to female ratio of individuals developing pulmonary MPMs is approximately 3:1 with the median age at presentation in the sixth decade. Patients who present with pulmonary MPM have a greater cigarette smoke exposure than those who developed a single lung cancer. 50 to 70% of patients have similar tumor histology in both primaries and identical genetic changes are find in 77% of tumors, supporting monoclonal origin in majority of MPMs. Diagnosis of multiple synchronous primary cancers must be distinguished from a primary tumor with one or more pulmonary metastases and from an extrapulmonary primary tumor with multiple lung metastases. Moreover, a second synchronous primary cancer must be distinguished from a coexisting benign pulmonary nodule detected on preoperative imagining.

    Conclusion
    Patients with synchronous multiple primary lung malignances have significantly worse prognosis than those with single primary lung malignancy, although it can be considerably improved with an aggressive surgical approach.