Multiple primary malignancies
Section snippets
Pathogenesis of multiple primary malignancies
At least two mechanisms of multiple primary malignancies are recognized: inheritance of predisposing genomic defects4, 5, 6, 7 and field carcinogenesis.7, 8, 9, 10
Common to most familial cancers is a germ-line mutation (first hit) that primes the somatic cells to environmental carcinogens (second hit).11 This germ-line mutation may result in malignancies confined to one organ system (familial polyposis coli, in the most common variant, or BRCA 1 and 2 mutations for breast cancer); or it may be
Methodology issues
The study of multiple primary malignancies is complicated by a number of difficulties including definition and data retrieval. Specific to our investigation is the problem of deciding whether the age at which the first cancer was detected or that of subsequent cancers should be used to establish a correlation between multiple malignancies and age.
Multiple primary cancers in the same patient were originally reported in 1889 by Billroth30; subsequently, many other authors have described this
Epidemiology of multiple primary malignancies and age
The autopsies studies are of necessity cross-sectional, while registry studies may be either cross-sectional or cohort studies. Cohort studies are more laborious to conduct, but more reliable in assessing the relative risk of a second malignancy after development of a primary cancer.40
Smoking-related cancers
The association of cancer of the lung and upper aerodigestive tract has been well documented in the literature and does not need further mention.14, 48, 55, 58 On the basis of the SEER data, Begg et al58 showed a higher than expected association among the following smoking-related cancers: lung, head and neck, kidney, bladder, and esophagus. The association between kidney and bladder cancer was the strongest and could not be accounted for on the basis of smoking only. Smoking cessation efforts
Clinical consequences
Our review shows that the incidence of multiple primary malignancies increases with the age of the patient. This increment does not appear be caused by an aging phenotype particularly susceptible to cancer, but rather to represent a random event because of the fact that aging is a risk factor for cancer (Model A, Fig 2). Surprisingly, multiple primary malignancies are not more common in association with indolent cancers (eg, prostate or breast cancer), and in the case of prostate cancer, the
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Metachronous primary adenocarcinoma of the ascending colon and major duodenal papilla: A case report
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2022, Radiology Case ReportsCitation Excerpt :Compare to the conventional “field effect”, which hypothesized the occurrence of irregular changes in cells inclining to malignance in a connecting anatomic structure, the new concept took into account that synchronous tumors are not limited by anatomic frontiers, emphasizing the effect of both host and exogenous factors which generate tissue microenvironment alterations [9]. In addition, aging and improved diagnostic techniques are also possible causes of multiple primary cancer in general and synchronous cancer in particular [10]. The presence of synchronous second primary cancers in patients with esophageal cancer was about 6%-12% in previous reports [11–14].
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