Double Primary Malignancies at a Tertiary Cancer Hospital : Our experience

Abstract

Background: Patients who have been detected with cancer, have a life time risk of developing a new second cancer depending on several genetic, environmental and lifestyle risk factors as well as long term side effects of cancer treatment. They can be detected simultaneously or in the follow up period. Improved diagnostic techniques, newer treatment modalities and improved survival in cancer patients can be responsible for this trend.

Aim: Our aim was to report our observation of incidence, management and outcome analysis of the second primary malignancies in a tertiary cancer hospital.

Materials & Methods: A single center retrospective study collected and analyzed data of patients diagnosed with double primary malignancies in a tertiary cancer hospital The study was conducted over a 5 year period from 2013 till 2018. All patients satisfying the Warren & Gates criteria were included in the study. The details like sex, age at diagnosis, site, synchronous or metachronous, treatment and outcomes were noted.

Results: Among the 30 cases of dual primary cancers detected, 14 (46.66%) were synchronous and 16 (53.33%) were metachronous. Out of the 30 patients, 19 were females and 11 were males. The most common sites of primary malignancy was breast(12 cases) followed by head & neck(6 cases). Among the second malignancies, the most common was head & neck followed by breast, gynaecological and lower gastrointestinal tract. The incidence of double primary malignancy was 0.7%. All the patients received the proper treatment for both the malignancies. Median OS was 65 months in the synchronous group and 108 months in the metachronous group. There was no significant difference in DFS between the 2 groups.

Conclusion:  The occurrence of double primary malignancies is not uncommon in Indian cancer patients. They can manifest as synchronous or metachronous. A strong clinical suspicion, thorough assessment and regular monitoring is a must among clinicians in the management of these tumors. Counseling of patients is a must after treatment of the primary neoplasm.