As the utilization of computed tomography in lung cancer screening becomes more prevalent in the post-pandemic era, the incidence of multiple primary lung cancer (MPLC) has surged in various countries and regions. Despite the continued application of advanced histologic and sequencing technologies in this research field, the differentiation between MPLC and intrapulmonary metastasis (IM) remains challenging. In recent years, the specific mechanisms of genetic and environmental factors in MPLC have gradually come to light. Lobectomy still predominates in the treatment of MPLC, but the observation that tumor-specific sublobar resection has not detrimentally impacted survival appears to be a viable option. With the evolution of paradigms, the amalgamated treatment, primarily surgical, is an emerging trend. Among these, stereotactic ablative radiotherapy (SABR) and lung ablation techniques have emerged as efficacious treatments for early unresectable tumors and control of residual lesions. Furthermore, targeted therapies for driver-positive mutations and immunotherapy have demonstrated promising outcomes in the postoperative adjuvant phase. In this manuscript, we intend to provide an overview of the management of MPLC based on the latest discoveries.
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Humans ; Lung Neoplasms/therapy* ; Early Detection of Cancer ; Lung/surgery* ; Treatment Outcome ; Radiosurgery/methods* ; Neoplasms, Multiple Primary/pathology*

OBJECTIVE: To investigate the treatment and prognosis of multiple primary malignant neoplasms (MPMN) complicated with renal cell carcinoma (RCC), and to make risk stratification. METHODS: A retrospective study of 27 cases of MPMN with RCC in two centers, including the different tumors of MPMN, specific treatment methods, and the interval between primary cancers. At the same time, the survival conditions, including recurrence, metastasis and survival, were followed up for statistical analysis. The interval between the two kinds of primary cancer within 6 months was simultaneous MPMNs, and more than 6 months was metachronous MPMNs. For simple risk stratification of cases, as long as one of the MPMNs had a stage Ⅲ or higher malignancy, which was defined as high risk. RESULTS: Among the 27 patients, 20 were male and 7 were female, with age at the time of diagnosis was 42-82 years, with an average age of (61.3±11.7) years. The age at the diagnosis of renal cancer was 43-87 years, with an average age of (66.0±11.3) years. There were 21 cases with duplex primary malignant neoplasms, 4 cases with triple primary malignant neoplasms, and 2 cases with quadruple primary malignant neoplasms. The interval between first cancer and second cancer was 0-360 months, with a median of 18 months. There were 17 cases of metachronous multiple primary malignant neoplasms and 10 cases of simultaneous multiple primary malignant neoplasms. The most common system of MPMN with comorbid RCC involved urologic system, digestive system and respiratory system. The most common locations of MPMN with comorbid RCC were bladder cancer, lung cancer and colon cancer. Follow-up time calcu- lated from the last cancer was 2-156 months, with a median of 32 months. And 14 cases survived and 13 cases died, with 11 cases being tumor related. Tumor stage was the risk factor of prognosis. Any kind of tumor stage in stage Ⅲ or above had a relatively poor prognosis. CONCLUSION MPMN complicated with RCC is relatively rare. Standard treatment should be used for each cancer type during the treatment process. The prognosis mainly depends on the highest stage of each tumor. Simple risk stratification shows that the prognosis of the high-risk group is worse. This simple stratification method may be helpful to predict the prognosis.
Aged ; Carcinoma, Renal Cell/therapy* ; Female ; Humans ; Kidney Neoplasms/therapy* ; Male ; Middle Aged ; Neoplasms, Multiple Primary/therapy* ; Prognosis ; Retrospective Studies

Located in the pelvic cavity and contiguous to the anal sphincter complex and urogenital organs, the rectum has more intricate anatomical features compared with the colon. Consequently, the treatment of rectal cancer involves more consideration, including pelvic radiation, lateral lymph node dissection, transanal access, postoperative function, sphincter preservation, and nonoperative management. Based on the last set of American society of colon and rectal surgeons (ASCRS) practice parameters for the management of rectal cancer published in 2013, the 2020 guidelines present evidence-based updates for both long-existing and emerging controversies on surgical management of rectal cancer. These updates include the indication for local resection, lymph node dissection for radical proctectomy, minimally invasive surgery, the "watch and wait" strategy for patients with clinical complete response, and prevention of anastomotic leak. Meanwhile, the guidelines recommend a risk-stratified approach for perioperative therapies for non-metastatic disease, and an individualized multimodality treatment based on treatment intent for synchronous metastatic disease.
Humans ; Lymph Node Excision ; Neoplasms, Multiple Primary/therapy* ; Practice Guidelines as Topic ; Proctectomy ; Rectal Neoplasms/therapy* ; Rectum/surgery* ; United States

Hypopharyngeal cancer and esophageal cancer often occur synchronously or metachronously. Timely screening, diagnosis and individual treatment are important to improve the prognosis of patients. At present, there is no clinical guideline or consensus in this cross-cutting area in China, and there is a need of consistent diagnosis and treatment recommendation for these patients. Under the sponsorship of the Committee of Esophageal Cancer in China Anti-Cancer Association, the Chinese Working Group on Cooperative Diagnosis and Treatment of Hypopharyngeal and Esophageal Cancer was established by domestic experts in the fields of otolaryngology head and neck surgery, radiation oncology, and gastrointestinal endoscopy. This consensus document on multiple primary cancers (simultaneous or metachronous) of the hypopharynx and esophagus was developed through literature review, collective experience and expert discussions. The goals of the consensus include: (1) raising concern for this cross-cutting field; (2) establishing a preliminary clinical diagnosis and treatment recommendation; (3) preparing for the establishment of future high-level guidelines through standardized clinical practice.
China ; Consensus ; Esophageal Neoplasms ; diagnosis ; therapy ; Humans ; Hypopharyngeal Neoplasms ; diagnosis ; therapy ; Neoplasms, Multiple Primary ; diagnosis ; therapy ; Neoplasms, Second Primary ; diagnosis ; therapy ; Prognosis

Humans ; Lung Neoplasms ; diagnosis ; therapy ; Neoplasms, Multiple Primary ; diagnosis ; therapy ; Prognosis

Aged ; Antineoplastic Agents ; adverse effects ; Carcinoma, Hepatocellular ; drug therapy ; Hand-Foot Syndrome ; diagnosis ; etiology ; Humans ; Liver Neoplasms ; drug therapy ; Male ; Neoplasms, Multiple Primary ; drug therapy ; Niacinamide ; adverse effects ; analogs & derivatives ; Phenylurea Compounds ; adverse effects

BACKGROUND/AIMS: Unexpected diagnosis of synchronous second primary cancers (SPC) complicates physicians' decision-making because clinical details of squamous esophageal cancer (EC) patients with SPC have been limited. We evaluated clinical features and treatment outcomes of patients with synchronous SPC detected during the initial staging of squamous EC. METHODS: We identified a total of 317 consecutive patients diagnosed with squamous EC. Relevant clinical and cancer-specific information were reviewed retrospectively. RESULTS: EC patients with synchronous SPC were identified in 21 patients (6.6%). There were significant differences in median age (70 years vs. 63 years, p = 0.01), serum albumin level (3.3 g/dL vs. 3.9 g/dL, p < 0.01) and body mass index (20.4 kg/m2 vs. 22.8 kg/m2, p = 0.01) between EC patients with and without SPC. Head and neck, lung and gastric cancers accounted for 18.2%, 22.7%, and 18.2% of SPC, respectively. Positron emission tomography-computed tomography (PET-CT) detected four cases (18.2%) of SPC that were missed on CT. Management plans were altered in 13 of 21 patients (61.9%) with detected SPC. Curative esophagectomy was attempted in 28.6% of EC patients with SPC (vs. 59.1% of patients without SPC; p = 0.006). EC patients with SPC had significantly lower 5-year survival than patients without SPC (10.6% vs. 36.7%, p = 0.008). CONCLUSIONS: Synchronous SPC were found in 6.6% of squamous EC patients, and PET-CT contributed substantially to the detection of synchronous SPC. EC patients with SPC had poor survival due to challenges of providing stage-appropriate treatment.
Aged ; Carcinoma, Squamous Cell/diagnostic imaging/mortality/*pathology/therapy ; Esophageal Neoplasms/diagnostic imaging/mortality/*pathology/therapy ; Esophagectomy ; Esophagoscopy ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Staging ; Neoplasms, Multiple Primary/diagnostic imaging/mortality/*pathology/therapy ; Positron Emission Tomography Computed Tomography ; Predictive Value of Tests ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome

OBJECTIVE: To evaluate the prevalence and features of non-endometrial cancers in Thai endometrial cancer (EC) patients. METHODS: EC patients treated in our institution were identified and the following data were collected: age, EC stage, histopathology, adjuvant therapy, other cancers, living status, and cause of death. RESULTS: The mean age of the 344 patients was 56.8+/-10.8 years. Fifty (14.5%) had other synchronous and metachronous cancers. Mean ages of the patients with or without other cancers were not significantly different, 55.7+/-10.04 years versus 57.1+/-11.0 years, respectively (p=0.358). History of any cancer in the family and tumor in the lower uterine segment were more frequent among the patients with other cancers (6.0% vs. 1.7%, p=0.095; 12.0% vs. 1.0%, p<0.001; respectively). Six patients had > or =2 other cancers. Ovarian, breast, and colon were the three most common other cancers. After a median follow-up of 57.1 months, 18.3% of patients had died: 30.0% of patients with other cancers and 16.3% of those without other cancers. The corresponding EC deaths were 14.0% and 11.2%. The 5-year overall survival was significantly lower in patients who had other cancers: 79.3% (95% confidence interval [CI], 68.3 to 90.3) vs. 86.0% (95% CI, 81.7 to 90.3) than in those without (p=0.023). However, the corresponding disease-specific survival was not significantly different: 85.1% (95% CI, 75.5 to 94.7) compared with 89.0% (95% CI, 85.1 to 92.9), respectively (p=0.514). CONCLUSION: Thai EC patients had a high incidence of other cancers. Overall survival of EC patients who had other cancers was worse than those without, while disease-specific survival was not significantly different.
Breast Neoplasms/mortality/pathology/therapy ; Chemotherapy, Adjuvant/methods ; Colonic Neoplasms/mortality/pathology/therapy ; Disease-Free Survival ; Endometrial Neoplasms/mortality/*pathology/therapy ; Female ; Humans ; Kaplan-Meier Estimate ; Middle Aged ; Neoplasm Recurrence, Local/mortality ; Neoplasms, Multiple Primary/mortality/*pathology/therapy ; Neoplasms, Second Primary/mortality/*pathology/therapy ; Radiotherapy, Adjuvant/methods ; Tertiary Care Centers/statistics & numerical data ; Thailand/epidemiology

BACKGROUND/AIMS: We investigated the clinical outcomes according to the method of treatment in synchronous esophageal and gastric cancer. METHODS: Synchronous esophageal squamous cell carcinoma and gastric adenocarcinoma were diagnosed in 79 patients between 1996 and 2010. We divided the patients into four groups according to treatment; Group 1 received surgical resection for both cancers or surgery for gastric cancer with chemoradiotherapy for esophageal cancer (n=27); Group 2 was treated by endoscopic resection with or without additional treatment (n=14); Group 3 received chemoradiotherapy only (n=18); and Group 4 received supportive care only (n=20). RESULTS: The median survival times in groups 1 and 2 were 86 and 60 months, respectively. The recurrence rate and mortality were 23% and 48%, respectively, in group 1 and 21% and 4%, respectively, in group 2. The median survival time was 12 months in group 3 and 9 months in group 4. Multivariate analysis showed that age (p<0.001) and treatment group (p=0.019) were significantly associated with death. Compared with group 1, treatment in the intensive care unit (p=0.003), loss of body weight (p=0.042), and decrease in hemoglobin (p=0.033) were worse in group 1. CONCLUSIONS: Endoscopic resection for synchronous esophageal and gastric cancer could be considered as a possible alternative to surgery for early-stage cancer.
Adenocarcinoma/mortality/*surgery/therapy ; Aged ; Carcinoma, Squamous Cell/mortality/*surgery/therapy ; Combined Modality Therapy ; Endoscopy, Gastrointestinal/*methods ; Esophageal Neoplasms/mortality/*surgery/therapy ; Female ; Humans ; Male ; Middle Aged ; Neoplasms, Multiple Primary/mortality/*surgery/therapy ; Nutritional Status ; Risk Factors ; Stomach Neoplasms/mortality/*surgery/therapy ; Survival Analysis

Breast cancer coexisting with lymphoma is a rare condition with various diagnostic and therapeutic implications. In this report, we describe the case of a 55-year-old Caucasian woman who presented with simultaneous ductal carcinoma in situ of the right breast, and follicular lymphoma involving an inguinal lymph node and the left breast. The patient underwent local excision and radiotherapy for the ductal carcinoma in situ, while a watch and wait strategy was adopted for the lymphoma. Two years later, the patient presented with multifocal ductal carcinoma of the left breast and reappearance of the lymphoma in the left axillary lymph nodes. She underwent bilateral mastectomy, left sentinel node biopsy, and chemotherapy. Synchronous follicular lymphoma and bilateral metachronous breast carcinoma has not been described previously. Diagnosis is based on tissue histology after excision or a needle biopsy. Treatment for these two diseases is distinct, and a multidisciplinary approach should be adopted.
Biopsy ; Biopsy, Needle ; Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Diagnosis ; Drug Therapy ; Female ; Humans ; Lymph Nodes ; Lymphoma ; Lymphoma, Follicular* ; Mastectomy ; Middle Aged ; Neoplasms, Multiple Primary ; Radiotherapy