Transcript Multiple Primary Cancers: simultaneously occurring

Multiple Primary Cancers -simultaneously occurring prostate
cancer and other primary tumors: any link or coincidences?
Ademola Popoola ,BUHARI TAJUDEEN ,Fidelis Ushie ,Hamid
Olanipekun.
Department of Surgery
University of Ilorin Teaching Hospital ,Ilorin.
Introduction

Prostate cancer is the most commonly diagnosed malignancy
affecting men beyond middle age.

Is the most common non cutaneous malignancy in the Western
world.

2nd leading cause of cancer death in men.

It is a major public health burden in Sub Sahara Africa.

In practice, prostate cancer has been reported to occur
simultaneously (synchronous) or successively (metachronous).
Introduction [Cont’d]

Some multiple cancer syndromes have been well defined. These
include Von Hippel Lindau Syndrome (cerebellar & retinal
heamangioma, renal, pancreatic and spinal meningeal tumors).
Aim

To report Multiple Primary Cancers (MPC) involving Prostate
cancer in our centre in the last two years.

To identify from the literature possible associations of
simultaneously occurring cancers.
Methodology

Retrospective analyses from our database of patients with MPC
involving prostate cancer in the last two years.

Review of existing literature for possible association.
Discussion
Age
PSA/ GLEASON’S
Score
Duration Btw 1sT & Second
2ND Tumour
Tumour
Treatment
Outcome
75yrs
121ng/ml
3+2 =5
Synchronous
Urinary
Bladder
Chemotherapy
Death due to
urosepsis
(5months)
72yrs
>50ng/ml
5+4 =9
Metachronous
(2yrs)
Colon
LHRH ,
BTO,
Permanent
colostomy
Died of
complications of
intestinal
obstruction
84yrs
116.7ng/ml
4+3=7
Metachronous
(12months)
Colon
BTO
Still being managed
until strike
60yrs
110ng/ml
3+2 =5
Synchronous
Rectum
BTO
Improved
Parasthesia &
urinary symptoms
72yrs
45ng/ml
3+2=5
Metachronous
(24months)
Thyroid
BTO,
Chemotherapy,
Thyroidectomy
Death due to
progression of
Prostate cancer
70yrs
60ng/ml
4+3=7
Synchronous
liver
Supportive care Death due to
hepatic failure
Discussion [Cont’d]

Prostate cancer could occur with other primary tumours as
synchronous or metachronous.

This has been adduced to increased life span and improved
diagnostic tools.

There are existing literatures reporting prostate cancer
occurring with all the other primary tumors in our series.

Lee et al; reported 4.03% finding of prostate cancer in radical
cystoprostatectomy specimen (Asian J. Andrology, 2006).
Discussion [Cont’d]

The incidence of other primary tumours in the setting of
primary liver cell carcinoma is relatively common with a strong
clustering of genitourinary and gastro-intestinal malignancies.

Synchronous thyroid tumours have been reported following
radiation for head and neck tumours. In our report, it was
discovered after External beam radiation therapy to the pelvis.

Prostate cancer with Rectal cancer
- Post Radiotherapy
- Age
Discussion [Cont’d]

Prostate cancer with Colonic tumours
- Genetics: (i) mutation of BRCA2 gene
(ii) mutation of MMR gene (Lynch syndrome)
Challenges

To make Diagnosis.

Diagnostic tools are limited: availability and affordability.

Between oncologic cure and preservation of functional
anatomy/quality of life.
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No established guideline.
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Poor cancer registry.

Low rate of postmortem and radical procedures.
Conclusion

MPC occurrence are probably more than the documented
cases.
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Detailed clinical evaluation is key.
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There is need for more multidisciplinary approach to care.
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There is also need for genetics study.