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PubMed2002

Relative survival of patients with subsequent cancer.

BACKGROUND: With the increasing numbers of patients with multiple primary cancers, survival from subsequent cancers is of growing interest. The majority of the analyses on the subject so far have, however, suffered from methodological difficulties. METHODS: A new model is now proposed for estimating relative survival of patients with subsequent primary cancer. The model is an extension to that proposed earlier by Estève et al. for estimating relative survival using individual patient data. The model is illustrated with real data on patients with one or two primary breast cancers and used in comparing the excess hazards between first and subsequent breast cancer. RESULTS: For patients with multiple cancers, the traditional analysis of relative survival can be made cancer-specific. The excess hazards are different between the first and subsequent breast cancer: The excess hazard of the subsequent breast cancer tends to decrease with increasing age when compared to the corresponding hazard of the first breast cancer. CONCLUSIONS: Relative survival of patients with subsequent cancer can be modelled facilitating studies on different hypothesis on the excess hazards of a first and subsequent cancer.

Adult↗

PubMed2002

Hepatic resection for metastatic tumors from gastric cancer.

OBJECTIVE: To assess the surgical results and clinicopathologic features of hepatic metastases from gastric adenocarcinoma to identify patients with a better probability of survival. SUMMARY BACKGROUND DATA: Many studies have reported the benefit of hepatic resection for metastatic tumors from colorectal cancer. However, indications for a surgical approach for gastric adenocarcinoma involving the liver have not been clearly defined. METHODS: Ninety (11%) of 807 patients with primary gastric cancer were diagnosed with synchronous (n = 78) or metachronous (n = 12) hepatic metastases. Of these, 19 underwent 20 resections intended to cure the metastatic lesion in the liver. The clinicopathologic features of the hepatic metastases in, and the surgical results for, the 19 patients were analyzed. RESULTS: The actuarial 1-year, 3-year, and 5-year survival rates after hepatic resection were, respectively, 77%, 34%, and 34%, and three patients survived for more than 5 years after surgery. Solitary and metachronous metastases were significant determinants for a favorable prognosis after hepatic resection. Pathologically, a fibrous pseudocapsule between the tumor and surrounding hepatic parenchyma was found in 13 of the 19 patients (68%). The presence of a peritumoral fibrous pseudocapsule and a well-differentiated histologic type of metastatic nodule were significant prognostic factors. Factors associated with the primary lesion were not significant prognostic determinants in patients who underwent curative resection of the primary cancer. CONCLUSIONS: Solitary and metachronous metastases from gastric cancer should be treated by a surgical approach and confer a better prognosis. A new prognostic factor, the presence of a pseudocapsule, may be helpful in defining indications for postoperative adjuvant treatment.

Actuarial Analysis↗

PubMed1985

Radiation-associated gliomas: a report of four cases and analysis of postradiation tumors of the central nervous system.

Four cases of radiation-associated gliomas are described. All patients were white men, irradiated in childhood for craniopharyngioma, anaplastic ependymoma, retinoblastoma of the orbit, and Burkitt's lymphoma, respectively. The dose ranged from 1800 to 5900 rads, and the latency period was 5 to 25 years. All primary and secondary tumors were verified histologically, and no evidence of persistence of the primary tumors was found. All secondary tumors arose in the fields of irradiation. Ninety-six cases of radiation-induced tumors of the central nervous system have been reported in the literature to date. Twenty-four were gliomas and occurred mainly in young men.

Adolescent↗

PubMedDate not supplied

Well differentiated astrocytoma occurring nine years after radiation therapy for medulloblastoma.

Conventional treatment for medulloblastoma includes surgical resection followed by craniospinal irradiation, with the potential risk of subsequent radiotherapy-induced secondary neoplasms. We report a 23-year-old woman previously irradiated nine years earlier for a cerebellar medulloblastoma who developed a new enhancing lesion in the primary radiation field four weeks following completion of high dose chemotherapy with bone marrow transplantation for recurrent disease. Resection of this lesion revealed a low grade glioma with no evidence of recurrent medulloblastoma.

Adult↗

PubMed1998

The incidence of other primary tumours in patients with oral cancer in Scotland.

OBJECTIVE: To find out the incidence of second or multiple primary malignant tumours in patients with oral cancer in Scotland and identify the sites at most risk. DESIGN: Retrospective cohort study of data from the Cancer Registry. SUBJECTS: 1891 patients registered with oral cancer in Scotland between 1 January 1980 and 31 December 1986. MAIN OUTCOME MEASURES: Relative risks of subsequent cancers in patients with oral cancer. Identification of the sites at most risk of second cancers. RESULTS: Of the 1891 patients, 228 (12%) developed a second primary cancer. The mean follow-up period was 3.2 years. Fourteen patients had 3, and 2 patients had 4 primary cancers. The overall risk of second primary cancers was 2.03 (95% confidence intervals (CI) 1.77 to 2.39) times greater than expected in the general population. The relative risk for male patients was 1.95 (95% CI 1.65 to 2.24) and for female patients 2.29 (95% CI 1.7 to 2.9). CONCLUSIONS: Men with cancer of the lip in Scotland have an increased risk of developing second cancers of the lip and skin (excluding melanoma), whilst women with cancer of the lip have an increased risk of developing skin cancer only. Both men and women with intra-oral cancers have increased risks of developing second cancers of the oral cavity, pharynx, and trachea, bronchus, and lung, while men alone have an increased risk of developing second cancers in the oesophagus.

Adolescent↗

PubMedDate not supplied

Differences in histology between first and second primary lung cancer.

Data from the Surveillance, Epidemiology, and End Results (SEER) Program were used to compare the histological distribution of second lung cancer following an initial cancer of the lung, head and neck, and breast to primary lung carcinoma occurring as a first cancer. Following initial head and neck cancer or initial squamous cell carcinoma of the lung, the proportion of second primary lung cancer which was of squamous cell histology rose dramatically, while the proportion of pulmonary adenocarcinomas rose following initial adenocarcinoma of the lung. The histological distribution of lung cancer following an initial breast cancer in women was similar to the distribution of de novo lung cancer in women. These results persisted as the time interval between diagnosis of the two primaries was increased from 12 to 48 months. We conclude that the histology of a second primary lung cancer following an initial cancer of the lung or head and neck tends to repeat the histology of the initial cancer (field effect), and this observation is not likely to be due to misdiagnosis of a recurrence of the initial cancer.

Adenocarcinoma↗

PubMed1978

Coexistent parathyroid adenomas and thyroid carcinoma. Can radiation be blamed?

The coexistence of parathyroid adenomas and thyroid cancer in a substantial number of patients with primary hyperparathyroidism has led to speculation implicating ionizing radiation as a possible cause. Experience with a group of 40 individuals harboring both tumors was reviewed and evidence of roentgen ray exposure to the head and neck was found in only one of these patients. Association of parathyroid adenomas and thyroid carcinoma cannot be explained on the basis of prior irradiation to the neck.

Adenocarcinoma↗

PubMed1996

Association of bronchial and pharyngo-laryngeal malignancies. A reappraisal.

OBJECTIVE: The purpose of this study was to re-evaluate operative risk and probability for survival patients with a history of upper aerodigestive cancer, who underwent thoracotomy for presumed primary bronchogenic cancer. Our hypothesis was to consider any isolated lung opacity as a primary bronchogenic cancer. METHODS: The cohort under investigation included 114 consecutive patients. Histology of bronchial cancer was squamous cell carcinoma in 98 patients (86%), adenocarcinoma in 14 (12%) and large cell carcinoma in 2 (2%). Exploratory thoracotomy was performed in 5 patients (4%); the remaining 109 patients underwent a potentially curative resection, including 25 pneumonectomies (22%) and 84 conservative resections (74%). Pathological staging was as follows: 66 stage I (58%), 20 II (17.5%), 20 IIIa (17.5%), 6 stage IIIb (5%), and 2 stage IV (2%). RESULTS: Four patients died post-operatively (3.5%). Non-fatal morbidity concerned 32 patients (28.1%) and was dominated by respiratory superinfections. Incidence of respiratory infections was increased after voice-sparing resections (chi 2 = 4.311, P < 0.05), and more particularly after transmaxillary buccopharyngectomy (chi 2 = 12.224; P < 0.01). Estimated 5-year survival was 28.7% (33.3% in stage I, 19.2% in stage II, and 30.2% in stage III). There was no difference in survival with reference to the location of head and neck cancer (chi 2 = 3.412; 0.05 < P < 0.1) or chronology (chi 2 = 0.005; P > 0.9). CONCLUSIONS: We conclude that isolated lung opacities in patients with previous or simultaneous head and neck cancer are most likely primary bronchogenic cancers. The acceptable operative mortality legitimizes surgical treatment despite an impaired 5-year survival; patients with a previous voice-sparing operation are at increased risk for respiratory complications and should be managed carefully.

Adult↗

PubMedDate not supplied

Cohort study of the long-term effect of irradiation for carcinoma of the uterine cervix. Second primary malignancies in the pelvic organs in women irradiated for cervical carcinoma at Radiumhemmet 1914-1965.

The risk of second primary malignancy arising after therapeutic irradiation was evaluated in the Radiumhemmet series of carcinoma of the uterine cervix treated in 1914-1965. Only tumours appearing more than 10 years after irradiation were taken into account. Comparisons of observed with expected incidence showed excess of malignancies in urinary bladder, endometrium, ovaries and rectum, but not of colon carcinoma. Comparisons were made with cohorts from the Swedish Cancer Registry.

Adult↗

PubMed1995

Second primary lung cancer and relapse: treatment and follow-up.

During a 14-year period (1980-1993) second primary lung cancer or relapse was treated in 44 consecutive patients. Thirty-seven patients had synchronous (n = 18) or metachronous (n = 19) second primary lung cancer. Ten synchronous tumors were ipsilateral and treated contemporarily with five pneumonectomies, three lobectomies and two double wedge resections. The bilateral synchronous lesions (8 patients) were treated by staged bilateral thoracotomy (mean interval; 2 months). The first resection consisted of a lobectomy in six patients and wedge resection in two. The second one was a wedge resection in six patients and a lobectomy in two. In the metachronous presentation 15 patients (79%) were asymptomatic and detected by follow-up chest X-ray. In this group the first operation was a lobectomy in 12 patients, a wedge resection or segmentectomy in 6 and a pneumonectomy in 1. The second one was a wedge resection in nine patients, a lobectomy in six and completion pneumonectomy in four. Seven patients, all of them asymptomatic, had local recurrence from their primary lung cancer. The first lung resection was a lobectomy in five patients and a wedge resection in two. The second one was completion pneumonectomy in five patients and completion lobectomy in two. We had no operative death. The actuarial over-all 5-year survival rate after the second pulmonary resection for second primary lung cancer was 38.3% with a median survival time of 13.5 months. The synchronous presentation had a better survival than the metachronous one (46.2% and 25.9%), respectively). The actuarial overall 5-year survival rate for patients with relapse was 38.1% with a median survival time of 37 months. We may conclude that an aggressive surgical approach is safe, effective and warranted in patients with either a second primary lung cancer or relapse from their primary lung cancer. Moreover, for early detection of the second lesions, follow-up at a maximum of 6-monthly intervals should be continued for more than 5 years after the first resection.

Actuarial Analysis↗

PubMedDate not supplied

Heterogeneity of drug resistance in human breast and ovarian cancers.

PURPOSE: This study quantitates the extent of heterogeneity of drug resistance in breast and ovarian cancers. Identification of drug-specific resistance in tumors from multiple sites provides information necessary to understand the unique biology of a patient's disease. MATERIALS AND METHODS: Drug resistance to cisplatin, paclitaxel, and doxorubicin was measured in multiple synchronous or metachronous tumors using the extreme drug resistance (EDR) assay. The degree of resistance for each tumor was classified into one of three categories: low drug resistance (LDR), EDR, or intermediate drug resistance (IDR). RESULTS: When tested against cisplatin, 66% of primary ovarian cancers and their paired synchronous distant metastases (N = 88) shared the same resistance category, while 4% of the results were discordant (one site had EDR and the other site had LDR). Of the paired results for paclitaxel (N = 68), 54% were in the same resistance category, while 13% of the comparisons were discordant. Heterogeneity of drug response to cisplatin was also measured in primary ovarian cancers and paired recurrent tumors from 108 women. Median time to recurrence was 9.6 months. Only 55% of the paired results fell into the same resistance category, while 19% of the results were discordant. Drug resistance to doxorubicin was measured in primary breast cancers and paired synchronous metastases from 23 women: 74% of the paired results fell into the same resistance category, while 13% of the results were discordant. Metastatic sites had a slightly higher incidence of EDR than primary sites (26% and 17%, respectively). Heterogeneity of drug response to doxorubicin was then determined in primary breast cancers and paired recurrent tumors from 26 women with a median time to recurrence of 14.3 months. Only 52% of the paired results fell into the same resistance category, while 24% of the results were discordant. DISCUSSION: Heterogeneity of drug resistance for ovarian and breast cancer is a serious clinical problem encountered in administering chemotherapy for overt metastatic or recurrent cancers. The first step in managing this problem is to recognize that heterogeneity of drug resistance exists. Drug resistance tests may then help the physician avoid administering certain chemotherapeutic agents when a patient's metastatic or recurrent tumor is found to be resistant to those agents.

Antineoplastic Agents↗

PubMed2000

Survival of patients with synchronous brain metastases: an epidemiological study in southeastern Michigan.

OBJECT: It has been suggested that synchronous brain metastases (that is, those occurring within 2 months of primary cancer diagnosis) are associated with a shorter survival time compared with metachronous lesions (those occurring more than 2 months after primary cancer diagnosis). In this study the authors used data obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results program to determine the incidence of synchronous brain metastases and length of survival of patients in a defined population of southeastern Michigan residents. METHODS: Data obtained in 2682 patients with synchronous brain metastases treated between 1973 and 1995 were reviewed. Study criteria included patients in whom at least one brain metastasis was diagnosed within 2 months of the diagnosis of primary cancer and those with an unknown primary source. The incidence per 100,000 population increased fivefold, from 0.69 in 1973 to 3.83 in 1995. The most frequent site for the primary cancer was the lung (75.4%). The second largest group (10.7%) consisted of patients in whom the primary site was unknown. The median length of survival was 3.2 months. There was no significant difference in the median survival of patients with primary lung/bronchus and those with an unknown primary site (3.3 months and 3.2 months, respectively). CONCLUSIONS: Patients who present with synchronous lesions have a poor prognosis, and the predominant cause of death, in more than 90% of cases, is related to systemic disease; however, despite poor median survival times, certain patients will experience prolonged survival.

Adolescent↗

PubMed1999

The utility of endoscopic screening for patients with esophageal or head and neck cancer.

In a series of 378 patients with esophageal carcinoma, 43 patients with head and neck carcinoma were divided into two groups: 30 patients without symptoms whose esophageal or head and neck second primary carcinomas were incidentally detected by an endoscopic examination for the second carcinoma (group 1) and 13 patients with symptoms whose esophageal or head and neck second primary carcinomas were detected by routine examinations (group 2). Regarding the second primary carcinomas, the incidence of stage 0-I and curability were significantly higher in group 1 than in group 2 (p < 0.001 and p < 0.05 respectively). The 5-year overall survival rates of patients with the second primary carcinomas were significantly higher in group 1 (60.4%) than in group 2 (0%) (p < 0.01). We suggest that a routine endoscopic screening of the upper aerodigestive tract in patients with esophageal carcinoma or head and neck carcinoma contributes to the improvement of the prognosis and the patient's quality of life.

Adult↗

PubMed2003

[Metachronous multiple primary tumors of the female genitals. Role of radiotherapy in secondary tumorigenesis].

According to the Center's register, primary multiple tumors were detected in 584 patients (5%) (metachronous--413 (70.7%); synchronous--138 (23.6%) in 1960-1998. In 4.8%, both types were hormonally-dependent; familial cancer was identified in 10.8%. Out of 298 patients treated with radiation, 41 (13.8%) developed tumors in the area of exposure. Excessive dosage due to taking repeat courses for relapse was received by 10 (24.4%). Thirty patients (10.1%) had malignancies outside the exposed area, in distant organs. Such factors as total over dosage due to repeat courses, extensive exposure of the bone marrow and idiosyncrasy to radiotherapy were mainly responsible for secondary tumorigenesis both in and outside zone of exposure.

Female↗

PubMed1992

[Bilateral primary breast cancer. An analysis of 64 cases].

64 cases of bilateral primary breast cancer were confirmed pathologically and treated in our hospital from 1973 to 1990. There were seven synchronous cases and 57 cases of sequential type. The patients were treated by surgery, radiotherapy and chemotherapy, separately or in combination. 2-, 5-, and 10-year survival rate were 81%, 46.7% and 20%, respectively. The incidence, diagnosis, clinical features, and therapeutic indications for bilateral breast cancer were discussed.

Adenocarcinoma↗

PubMed1996

The association of cancers of the larynx with cancers of the lung.

We report 77 cases of associated primary cancers of the larynx and lung that were managed at the Department of Otolaryngology, University of Padua, between 1980 and 1994. To our knowledge, this is the largest series reported in the literature to date. This association is not a chance finding, but presumably the result of common pathogenetic factors.

Adenocarcinoma↗

PubMed1995

Potential value of biliary CEA assay in early detection of colorectal adenocarcinoma liver metastases.

Elevation of the biliary CEA level in patients with liver metastases from colorectal carcinoma has been reported. The aim of this study is to determine the potential value of biliary CEA assay in the early detection of liver metastases. Biliary and serum CEA levels were determined in patients operated on for a colorectal cancer and in control groups. Among 13 patients with liver metastases from colorectal carcinomas, biliary CEA levels were markedly elevated (> 40 ng/ml) in nine, moderately elevated (5-40 ng/ml) in two and normal (arbitrarily defined as < 5 ng/ml) in two. Of 28 patients with primary colorectal carcinoma without detectable hepatic secondaries, three had marked CEA elevation in the bile, 10 had moderate CEA elevation and 15 had normal levels. Among nine patients with non-malignant hepatobiliary pathology, there was one marked biliary CEA elevation, one moderate elevation and seven normal levels. None of the 13 individuals with no identified hepatobiliary pathology had elevated biliary CEA levels. The follow-up of patients with a primary colorectal tumour, no evidence of hepatic secondaries and a biliary CEA elevation is of particular interest. If subsequent appearance of liver metastases is found in such cases, intra-operative biliary CEA assay could be considered a valuable diagnostic test. Further studies will then have to prove the possible benefit of a specific treatment for this group of patients.

Adenocarcinoma↗

PubMed2005

Gynecologic cancer as a "sentinel cancer" for women with hereditary nonpolyposis colorectal cancer syndrome.

OBJECTIVE: Women with hereditary nonpolyposis colorectal cancer syndrome have a 40-60% lifetime risk for colon cancer, a 40-60% lifetime risk for endometrial cancer, and a 12% lifetime risk for ovarian cancer. A number of women with hereditary nonpolyposis colorectal cancer syndrome will have more than one cancer in their lifetime. The purpose of this study was to estimate whether women with hereditary nonpolyposis colorectal cancer syndrome who develop 2 primary cancers present with gynecologic or colon cancer as their "sentinel cancer." METHODS: Women whose families fulfilled Amsterdam criteria for hereditary nonpolyposis colorectal cancer syndrome and who developed 2 primary colorectal/gynecologic cancers in their lifetime were identified from 5 large hereditary nonpolyposis colorectal cancer syndrome registries. Information on age at cancer diagnoses and which cancer (colon cancer or endometrial cancer/ovarian cancer) developed first was obtained. RESULTS: A total of 117 women with dual primary cancers from 223 Amsterdam families were identified. In 16 women, colon cancer and endometrial cancer/ovarian cancer were diagnosed simultaneously. Of the remaining 101 women, 52 (51%) women had an endometrial or ovarian cancer diagnosed first. Forty-nine (49%) women had a colon cancer diagnosed first. For women who developed endometrial cancer/ovarian cancer first, mean age at diagnosis of endometrial cancer/ovarian cancer was 44. For women who developed colon cancer first, the mean age at diagnosis of colon cancer was 40. CONCLUSION: In this large series of women with hereditary nonpolyposis colorectal cancer syndrome who developed 2 primary colorectal/gynecologic cancers, endometrial cancer/ovarian cancer was the "sentinel cancer," preceding the development of colon cancer, in half of the cases. Therefore, gynecologists and gynecologic oncologists play a pivotal role in the identification of women with hereditary nonpolyposis colorectal cancer syndrome.

Adult↗