Lung Cancer |

Simultaneous Detection of Two Primary Malignancies in a Patient FREE TO VIEW

Saad Khan*, MD; Ahmad Alhajhusain, MD
Chest. 2012;142(4_MeetingAbstracts):601A. doi:10.1378/chest.1388821
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SESSION TYPE: Cancer Case Report Posters I

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Many investigators have reported the occurrence of multiple tumors in patients with Head and Neck Cancer. Before 1990 hypopharynx and oropharynx cancers carried the highest risk of second primary malignancy. We report a case of a patient with known history of head and neck cancer 14 years later presenting with two primary cancers diagnosed at the same time.

CASE PRESENTATION: 77 year old male with history of T3 N2b M0 squamous cell ca of the floor of mouth and left tonsil in 1998 s/p resection of the floor of the mouth. He underwent post op radiation and was subsequently followed by ENT with yearly follow ups. In Sept of 2011 he presented to the ER with an episode of dizziness and lightheadedness and was found to be anemic. He underwent upper GI scope for evaluation of source of anemia. The biopsy from the stomach showed poorly differentiated adenosquamous cell carcinoma. Patient underwent a PET Scan showing hyper metabolic tumor of proximal stomach associated with hyper metabolic right lower lobe pulmonary nodule. He underwent right lower lobe trans bronchial biopsy which showed invasive well to moderately differentiated squamous cell carcinoma. Patient was referred to Oncology and was thought that the gastric and lung malignancies were both considered to be two separate primary cancers.

DISCUSSION: The mechanism for pathogenesis of multiple primary cancers has yet to be clarified, some factors such as hereditary, environment, immunology, and carcinogens have shown to play a role. Patient with head and neck cancer are at higher risk for second primary malignancy than any other cancer patient. The development of second malignant tumor in patient who have had their first tumor treated successfully represents a serious limitation of current therapeutic strategies for head and neck cancer.

CONCLUSIONS: Squamous cell carcinoma of the head and neck is complicated by second primary cancer in 10-40% of the patients. Metachronous second cancers most often involve the esophagus or the lung, whereas synchronous second cancers are more common in head and neck as occult lesions. To our knowledge the description of two primary cancers diagnosed at the same time in patient with history of cancer of floor of mouth and tonsils is rare.

1) Antonio Vitor Martins Priante ,Emanuel Celice Castilho Second Primary Tumors in Patients with Head and Neck Cancer Curr Oncol Rep (2011) 13:132-137

DISCLOSURE: The following authors have nothing to disclose: Saad Khan, Ahmad Alhajhusain

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Morgantown, WV




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