위장관 ( 胃腸管 ) : 소화기암과 연관되어 발생한 다발적 원발성 악성종양

윤용범(Yong Bum Yoon),송인성(In Sung Song),김정룡(Chung Yong Kim),이효석(Hyo Suk Lee),최상운(Sang Woon Choi),최규완(Kyu Wan Choi),김용태(Yong Tae Kim),한철주(Cheol Joo Han),이준혁(Joon Hyeok Lee),류지곤(Ji Kon Ryu),정현채(Hyun Chae C 대한소화기학회 1991 대한소화기학회지 Vol.23 No.3

N/A Owing to the development of diagnostic techniques and treatment modalities, more and more cases of multiple primary cancers are being discovered and active researches concerning maltiple primary cancers are being done. The mortrality due to cancers of gastrointestinal tract occupies more than two thirds (68.4%) of total number of deathes due to cancers in Korea, but researches on multiple primary cancers concerning gastrointestinal tract are lacking. We reviwed 70 cases of multiple primary cancers concerning gastrointestinal tract, we experienced in the past decade. The ratio of male to female was 3.7:1, the mean age was 52.8 years. From 70 patients with multiple primary cancers, sixty patients had synchronous multiple primary cancers and ten patients had metachronous ones. The frequent sites involved were stomach (51.9%) and liver (21.2%). The most frequent combination of primary and secondary cancer was stomach cancer and primary liver cancer (27%). These results may be contributed to the actual incidence of each cancer, and routine staging work-up of liver for stomach cancer and routine gastroopy for primary liver cancer. In synchronous cancers, majority of the second cancers were found incidentally during routine staging work-up (58.3%) or during operation (8.4%), whereas only 33.3% of second cancers were found due to concomittent symtoms. Thus the incidence of each multiple primary cancer in our study may reflect the relative frequency of each cancer in Korea. In order to determine the true risk of occurrence of multiple primary cancers in Korea, prospective studies based on the large population of community should be conducted.

대장암을 포함하는 다발성 원발성 악성종양

김수홍,김형진,이재임,이윤석,강원경,박종경,오승택 대한대장항문학회 2008 Annals of Coloproctolgy Vol.24 No.6

Purpose: With advance in diagnostic techniques and treatment modalities, it has been increasing that the patients with colorectal cancer experience another primary malignancies. Understanding the characteristics of multiple primary malignancies is important to establish an effective surveillance program for the early detection of second cancer. Methods: The database of 2,709 patients diagnosed with colorectal cancer between 1985 and 2007 in Kangnam St. Mary's Hospital was analyzed retrospectively. Results: Out of 2,709 patients, 102 (3.76%) of them were found to have multiple malignancies. Among them, 37 patients had synchronous cancers and 65 patients had metachronous cancers. The most common site of multiple primary malignancies was the stomach, followed by kidney, thyroid and breast. Conclusions: In the patients with colorectal cancer, it should be considered to evaluate multiple primary malignancies, especially stomach, during the routine follow up. And the most frequent multiple primary cancer before colorectal cancer was also stomach cancer. Careful attention should be paid to the colorectal cancer in stomach cancer patients. Purpose: With advance in diagnostic techniques and treatment modalities, it has been increasing that the patients with colorectal cancer experience another primary malignancies. Understanding the characteristics of multiple primary malignancies is important to establish an effective surveillance program for the early detection of second cancer. Methods: The database of 2,709 patients diagnosed with colorectal cancer between 1985 and 2007 in Kangnam St. Mary's Hospital was analyzed retrospectively. Results: Out of 2,709 patients, 102 (3.76%) of them were found to have multiple malignancies. Among them, 37 patients had synchronous cancers and 65 patients had metachronous cancers. The most common site of multiple primary malignancies was the stomach, followed by kidney, thyroid and breast. Conclusions: In the patients with colorectal cancer, it should be considered to evaluate multiple primary malignancies, especially stomach, during the routine follow up. And the most frequent multiple primary cancer before colorectal cancer was also stomach cancer. Careful attention should be paid to the colorectal cancer in stomach cancer patients.

다발성 원발 대장암의 임상적 고찰

임용석,이석환,홍성화,윤충,주흥재,이기형 대한대장항문학회 1998 Annals of Coloproctolgy Vol.14 No.1

위암과 병발한 다발성 원발성 악성종양

김희종(Hee Jong Kim),최정매(Jung Mae Choi),허원영(Won Young Huh),김한식(Han Sik Kim),김상균(Sang Kyoon Kim),조진웅(Jin Woong Cho),김민철(Min Chul Kim),김문중(Mun Joong Kim) 대한내과학회 1992 대한내과학회지 Vol.43 No.6

N/A Background: There have been many reports about the multiple primary cancers, and they have played a role to study the pathogenesis of the cancer. Methods: During 25 years from 1967 until 1991, 22946 primary cancers had registered at the Presbyterian Medical Canter, and there were 68 cases of multiple primary cancers compatible with Warren k Gates' criteria. Among them 29 cases were multiple primary cancers associated with gastric cancer. Results: The incidence of multiple primary cancers associated with gasric cancer is 0.13% in total primary cancers (0. 38% in total stomach cancers, 42,6% in total multiple primary cancers). All stomach cancers were adenocarcinomas. The other sites except for stomach are esophagus (8; all squamous cell carcinomas), liver (4; all hepatocellular carcinomas), uterine cervix (4; all squamous cell carcinomas), larynx (3; all squamous cell carcinomas) and miscellaneous (10). The ratio between synchronous and metachronous (interval more than 6 months) is 1.07:1, and the average time interval between first and second cancer in the metachronous cases is 5, 7 years. The 9 cases of 14 metachronous cases were treated with chemotherpy of radiation therapy after first surgery. Conclusion: The multiple primary cancers associated with gastric cancer may be largely caused by exposure to the same carcinogens in the contiguous aerodigestive organs and also iatrogenic causes play an important role in the pathogenesis of the multiple primary cancers.

Lymphoproliferative Disorders in Multiple Primary Cancers

Demirci, Umut,Ozdemir, Nuriye,Benekli, Mustafa,Babacan, Nalan Akgul,Cetin, Bulent,Baykara, Meltem,Coskun, Ugur,Zengin, Nurullah,Buyukberber, Suleyman Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.1

Background: Cancer survivors are at increased risk of second cancers. Lymphoproliferative disorders (LPD) are common neoplasms that are primary or subsequent cancers in cases of multiple primary cancer. We here analyzed metachronous or synchronous LPD in multiple primary cancers. Methods: Between 2001 and 2010, LPD were assessed retrospectively in 242 multiple primary cancers patients. Results: Forty nine (20.2%) patients with LPD were detected. Six patients had two LPD where one patient had three LPD. The median age of patients was 60.5 years (range: 28-81). LPD were diagnosed in 29 patients as primary cancer, in 23 patients as second cancer, and in three patients as third cancer in multiple primary cancers. Primary tumor median age was 56 (range: 20-79). Diffuse large B cell lymphoma (n=16), breast cancer (n=9), and lung cancer (n=6) were detected as subsequent cancers. Alklylating agents were used in 19 patients (43.2%) and 20 patients (45.5%) had received radiotherapy for primary cancer treatment. The median follow-up was 70 months (range: 7-284). Second malignancies were detected after a median of 51 months (range: 7-278), and third malignancies with a median of 18 months (range: 6-72). Conclusions: In this study, although breast and lung cancer were the most frequent detected solid cancers in LPD survivors, diffuse large B cell lymphoma was the most frequent detected LPD in multiple primary cancers.

Clinical Characteristics of Colorectal Cancer Patients With a Second Primary Cancer

이진우,김종우,김남근 대한대장항문학회 2014 Annals of Coloproctolgy Vol.30 No.1

Purpose: The incidence of colorectal cancer is increasing due to a westernized dietary lifestyle, and improvements in treatment and diagnostic tools have resulted in more patients being confirmed of having multiple primary cancers. However, studies regarding multiple primary cancers are insufficient. In this study, the clinical aspects of patients with primary multiple cancers, including colorectal cancers, were investigated, and the results were compared to those of patients with primary colorectal cancer only. Methods: Seven hundred eighteen patients who received surgery for colorectal cancer between March 2003 and September 2012 in CHA Medical Center were enrolled. A retrograde cohort was done for comparison of the two groups: those with and those without multiple primary cancer. The analysis was done according to sex, age, tumor location, tumor size, metastatic regional lymph-node number, vascular/lymphatic microinvasion, staging, tumor markers, microsatellite instability, and C/T subgroup of polymorphism in methylenetetrahydrofolate reductase. Results: Of the 718 subjects, 33 (4.6%) had multiple primary cancers: 12 (36.4%) synchronous and 21 (63.6%) metachronous. The malignancy most frequently accompanying colorectal cancer was gastric cancer, followed by thyroid, prostate, and esophageal malignancies in that order. In the comparison between groups, mean age, tumor location, and microsatellite instability showed statistically significant differences; others parameters did not. Conclusion: The incidence of multiple primary cancers, including colorectal cancer, is increasing. Therefore, defining the characteristics of patients with multiple primary cancers is crucial, and those characteristics need to be acknowledged in the follow-up of colorectal cancer patients.

Clinical Characteristics of Multiple Primary Colorectal Cancers

윤주원,이승현,안병권,백승언 대한암학회 2008 Cancer Research and Treatment Vol.40 No.2

Purpose: Although multiple primary colorectal cancer has been recognized as a significant clinical entity, its clinical and pathological features and its prognosis are still controversial. The purpose of this study was to clarify clinical and pathological features of multiple primary colorectal cancer. Materials and Methods: Among 1669 patients who underwent surgery for primary colorectal cancer from January 1997 to June 2005, 26 patients (1.6%) with multiple primary colorectal cancer were identified. We reviewed clinical characteristics including diagnostic interval, lesions, operating methods, and TNM stage, and we defined the index lesion as the most advanced lesion among the synchronous lesions. For the purposes of the study, the colon and rectum were classified into three segments. The right-side colon included the appendix, cecum, ascending colon, hepatic flexure, and transverse colon, and the left-side colon included the splenic flexure, descending colon, and sigmoid colon. Results: Of the 26 patients with multiple primary colorectal cancers, nineteen patients were male and seven patients were female, with a mean age of 61.5 years. Nineteen patients had synchronous colorectal cancers and seven patients had metachronous colorectal cancers. In the metachronous cases, the mean diagnostic interval was 36.8 months. The site of the first lesion in metachronous colorectal cancers was the right colon in five cases (71.4%) and the left colon in two cases (28.6%), and the site of the second lesion was the rectum in six cases (55.5%), the right colon in three cases (33.3%), and the left colon in one case. The TNM stage of the second lesions in the metachronous colorectal cancers was stage II in four cases (57.1%), stage III in one case (14.3%), and stage IV in one case (14.3%). For the synchronous colorectal cancers, the operation methods were single-segment resection combined with endoscopic mucosal resection in five cases (26.3%), single- segment resection alone in six cases, two-segment resection in six cases, and total colectomy in two cases. Conclusion: In metachronous colorectal cancers, the secondary lesions were later-stage cancer. Therefore, careful postoperative follow-up is necessary for patients who have undergone surgery for colorectal cancers. Further study of therapeutic modalities is important for synchronous colorectal cancers.

다발성 원발성 대장 직장암의 임상 병리학적 특성

김용진,김남규,이강영,손승국,민진식 대한대장항문학회 2002 Annals of Coloproctolgy Vol.18 No.5

Quadruple Primary Malignancies in an Old Male Smoker Treated with Cooperative Surgery

장전엽,차원재,김현성,조정수,왕수건 대한이비인후과학회 부산,울산,경남 지부회 2015 임상이비인후과 Vol.26 No.2

The patients with head and neck cancers are frequently elderly with history of smoking that may harbor possibilities of multiple primary malignancies. Recent use of PET-CT as an initial diagnostic tool facilitates the finding of unexpected primary malignancies. Here we present a case of quadruple primary malignancies treated with cooperative surgery. A 66 year-old male presented with sore throat. He was identified as a current smoker and had a history of alcohol ingestion. Physical examination followed by office-based biopsy revealed supraglottic squamous cell carcinoma. Imaging studies including PET-CT found multiple suspicious malignant lesions involving thyroid gland, esophagus, sigmoid colon as well as the larynx. Further multidisciplinary consultation suggested that all of the evaluation lesions were primary malignancies without evidence of systemic spread. The patient underwent cooperative surgery ; supraglottic partial laryngectomy with neck dissection for supraglottic cancer, left hemithyroidectomy for thyroid cancer, Ivor Lewis operation for esophageal cancer, lower anterior resection for colon cancer. Careful postoperative care was provided without a complication. Office-based observation has been ongoing without an evidence of recurrence.

유방암 환자에서 타장기에 발생한 원발성 악성종양의 임상적 특성

정상희,곽승수,김성철,박문기,이건석,김희정,이정선,안세현,손병호 한국유방암학회 2007 Journal of breast cancer Vol.10 No.4

Purpose: Since 2001, breast cancer has been the most common type of cancer observed in Korean women. Due to improved screening and treatment, multiple primary cancer (MPC) in association with breast cancer has been more prevalent. However, there is a lack of information regarding MPC in Korea. Therefore, this study was conducted to provide an overview of the clinical characteristics of MPC that occurs in association with breast cancer. Methods: We retrospectively investigated 149 patients with MPC, including breast cancer patients, who were treated between July 1989 and December 2005 at the Breast clinic in Asan Medical Center. Patients with contra-lateral breast cancer as well as patients that experienced a recurrence of breast cancer were excluded from this study. We studied the clinical characteristics of patients including the mean age, stage of disease, hormone receptor status, cause of death, common cancers that were combined with breast cancer, the time interval between the onset of breast cancer and other cancers, and mean survival. We considered the cancer to be synchronous if a second cancer has been diagnosed at least six months before the diagnosis of an initial primary cancer, however, other forms of cancer were considered to be metachronous. Results: Of 149 patients, 146 patients were female (98.0%) and 3 were male (2.0%). The mean age of the study group was 51.5, which is higher than the mean age of 47.3 that was observed in breast cancer patients at our hospital during the same period (p<0.001). Forty-four of the patients evaluated in this study had synchronous cases of cancer, whereas the remaining 88 patients had metachronous MPC. In metachronous cancers, the average time between diagnosis with the primary cancer and the secondary cancer was 5.2 yr. The most common cancer found to be combined with breast cancer included cancer of the thyroid (45, 29.2%), cervix and uterus (28, 18.2%), stomach (19, 12.3%), colon and rectum (15, 9.7%), ovary (11, 7.1%) and lung (9, 5.8%). Conclusion: Thyroid cancer is the cancer most commonly associated with breast cancer, and the mean age of MPC patients was higher than that of patients who only had breast cancer. Due to the improved survival length and treatment, MPC associated with breast cancer is now a greater concern.