Clinicopathologic characteristics and survival rate in patients with synchronous or metachronous double primary colorectal and gastric cancer

PURPOSE: Double primary colorectal cancer (CRC) and gastric cancer (GC) represent the most common multiple primary malignant tumors (MPMT) in Korea. The recognition and screening of hidden malignancies other than the primary cancer are critical. This study aimed to investigate the clinicopathologic characteristics and survival rates in patients with synchronous or metachronous double primary CRC and GC.METHODS: Between January 1994 and May 2018, 11,050 patients were diagnosed with CRC (n=5,454) or GC (n=5,596) at Gil Medical Center. MPMT and metastatic malignant tumors were excluded from this study. A total of 103 patients with double primary CRC and GC were divided into two groups: the synchronous group (n=40) and the metachronous group (n=63). The incidence, clinicopathologic characteristics, and survival rate of the two groups were analyzed.RESULTS: The incidence of synchronous and metachronous double primary CRC and GC was 0.93%. Double primary CRC and GC commonly occurred in male patients aged over 60 years with low comorbidities and minimal previous cancer history. There were significant differences between the synchronous and metachronous groups in terms of age, morbidity, and overall survival. Metachronous group patients were 6 years younger on average (P=0.009), had low comorbidities (P=0.008), and showed a higher 5-year overall survival rate (94.8% and 61.3%, P < 0.001) in contrast to synchronous group.CONCLUSION: When primary cancer (CRC or GC) is detected, it is important to be aware of the possibility of the second primary cancer (GC or CRC) development at that time or during follow-up to achieve early detection and better prognosis.

Assessment of the Risk of Colorectal Cancer Survivors Developing a Second Primary Pancreatic Cancer

BACKGROUND/AIMS: We aimed to investigate the incidence of second primary pancreatic cancer (PC) after colorectal cancer (CRC) and to identify risk factors associated with subsequent PC. METHODS: The observed incidence of a subsequent PC in patients with CRC was standardized using a population with CRC from the Korean Central Cancer Registry (KCCR). The expected incidence rate of PC was obtained by assuming that the select group experienced the same cancer incidence as the corresponding general population in the KCCR. RESULTS: The registry included 4,822 patients with CRC aged 45 to 74 years, representing 16,725.1 person-years of follow-up. Thirteen patients (0.3%) were diagnosed with a subsequent PC, and the overall age-adjusted incidence of second primary PC was 269.6 per 100,000 cases. In contrast, the overall incidence of primary PC in the general population was 18.68 per 100,000 individuals. The standardized incidence ratio of subsequent PC was 14.44, which was significantly higher in patients with CRC than in the general population. Sex, diabetes mellitus, smoking, body mass index, and a history of receiving chemotherapy as a treatment for CRC did not increase the risk of subsequent development of PC. CONCLUSIONS: The risk of a second primary PC was higher in patients with CRC. Further studies are needed to identify the risk factors and generate a screening strategy for cancer survivors.

Incidence of Gastric Cancer in Patients with Laryngeal Cancer

BACKGROUND/AIMS: Gastric cancer (GC) is the second most common cancer in Korea and the most common in men in the south of the country. We investigated the incidence of synchronous GC in patients with head and neck squamous cell carcinoma (HNSCC) in the southern part of Korea. MATERIALS AND METHODS: We retrospectively reviewed the medical records of HNSCC patients treated between 2011 and 2014. In patients with synchronous GC, evaluation included a history of smoking and alcohol consumption, endoscopic findings, Campylobacter-like organism (CLO) test, and immunohistochemical analysis of preserved HNSCC tissues. RESULTS: Analysis of the records of 153 HNSCC patients revealed tumors of the larynx in 56 patients (36.6%), of the pharynx in 74 patients (48.4%), and tumors at other locations in 23 patients (15.0%). The mean age of patients was 66.0 years, and the men:women ratio was 8:1. Synchronous cancers were detected in 12 patients. We observed esophageal squamous cell carcinoma (SCC) in five patients (3.3%), and gastric adenocarcinoma in seven patients (4.6%). Synchronous GC was detected in patients with laryngeal SCC. All cases of GC were classified as early GC. CONCLUSIONS: Synchronous GC was as frequent as esophageal SCC in patients with HNSCC, and all cases of GC were observed to be early stage cancers in this study. Thorough endoscopic examination should be performed in patients with laryngeal cancer to detect the presence of synchronous GC.

Second Primary Cancer after Diagnosis and Treatment of Cervical Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study was conducted to investigate the incidence and survival outcomes of second primary cancers after the diagnosis of cervical cancer. MATERIALS AND METHODS: Data from the Korea Central Cancer Registry between 1993 and 2010 were reviewed and analyzed. Standardized incidence ratios (SIRs) of second primary cancers among women with cervical cancer were analyzed. Kaplan-Meier survival curves were constructed for cervical cancer patients with or without a second primary cancer. RESULTS: Among 72,805 women with cervical cancer, 2,678 (3.68%) developed a second primary cancer within a mean follow-up period of 7.34 years. The overall SIR for a second cancer was 1.08 (95% confidence interval, 1.04 to 1.12). The most frequent sites of second primary cancers were the vagina, bone and joints, vulva, anus, bladder, lung and bronchus, corpus uteri, and esophagus. However, the incidence rates of four second primary cancers (breast, rectum, liver, and brain) were decreased. The 5-year and 10-year overall survival rates were 78.3% and 72.7% in all women with cervical cancer, and for women with a second primary cancer, these rates were 83.2% and 65.5% from the onset of cervical cancer and 54.9% and 46.7% from the onset of the second primary cancer, respectively. CONCLUSION: The incidence rates of second primary cancers were increased in women with cervical cancer compared to the general population, with the exception of four decreasing cancers. The 10-year overall survival rates were decreased in cervical cancer patients with a second primary cancer.

Neural Axis Metastasis from Metachronous Pulmonary Basaloid Carcinoma Developed after Chemotherapy & Radiation Therapy of Uterine Cervical Carcinoma / 대한신경손상학회지

Multiple primary or secondary malignancies after anticancer therapy were recently reported to be increasing in frequency. The authors describe a case of metachronous metastatic pulmonary basaloid carcinoma to the central nervous system that was discovered after chemotherapy and radiation therapy for cervical uterine carcinoma. Two different types of cancer developed within some interval. There's the possibility that a secondary pulmonary neoplasm developed after the chemotherapy and radiotherapy conducted as cervical cancer treatment.

Management of cancer survivors in Korea

With the early detection of cancer and advances in cancer treatment, the number of cancer survivors is increasing dramatically and is currently over 1 million. Many cancer survivors face lifetime risks associated with their cancer therapy, with a significant proportion at risk for serious morbidity and premature mortality. The long-term physical and psychosocial effects of cancer treatment on cancer survivors and their families are increasingly being recognized as emerging problems from both clinical and public health perspectives. This article summarizes the core principles of management of cancer survivors: follow-up of primary cancer; screening and prevention of a second primary cancer; management of late effects of cancer treatment and comorbid conditions; promotion of healthy behaviors such as smoking cessation, exercise and physical activity, nutrition, and weight management; management of psychosocial problems; and support for family caregivers. Finally, we discuss the way forward for improving survivorship care: shared care between oncologists and primary care physicians; a comprehensive cancer support program; and further research to generate relevant evidence regarding these management principles.

Management of cancer survivors in Korea

With the early detection of cancer and advances in cancer treatment, the number of cancer survivors is increasing dramatically and is currently over 1 million. Many cancer survivors face lifetime risks associated with their cancer therapy, with a significant proportion at risk for serious morbidity and premature mortality. The long-term physical and psychosocial effects of cancer treatment on cancer survivors and their families are increasingly being recognized as emerging problems from both clinical and public health perspectives. This article summarizes the core principles of management of cancer survivors: follow-up of primary cancer; screening and prevention of a second primary cancer; management of late effects of cancer treatment and comorbid conditions; promotion of healthy behaviors such as smoking cessation, exercise and physical activity, nutrition, and weight management; management of psychosocial problems; and support for family caregivers. Finally, we discuss the way forward for improving survivorship care: shared care between oncologists and primary care physicians; a comprehensive cancer support program; and further research to generate relevant evidence regarding these management principles.

A Case of Osteosarcoma after Treatment of Endodermal Sinus Tumor / 임상소아혈액종양

Endodermal sinus tumor is a type of germ cell tumor that is relatively common in children. An important problem concerns secondary neoplasms after treatment. We report a case of osteosarcoma that developed five years after treatment of intrapelvic endodermal sinus tumor. The patient was a seven-year-old girl who presented with right thigh and knee joint pain. The patient had been diagnosed with endodermal sinus tumor five years previously and treated with a regimen consisting of high dose cisplatin, etoposide, bleomycin and surgery but without radiotherapy. We detected a mass shadow on the right distal femur that proved to be osteoblastic osteosarcoma by incisional biopsy. The patient received surgical treatment after chemotherapy that included high dose methotrexate. The follow-up bone scan revealed no abnormal uptakes. There has been no evidence of recurrence eighteen months of follow-up after chemotherapy.

A Path Analysis on Factors Influencing Second Primary Cancer Screening Practices in Stomach, Colon, and Breast Cancer Survivors

PURPOSE: This study was conducted to identify the factors influencing second primary cancer (SPC) screening practice by examining the relationships of physical symptoms, knowledge and attitudes regarding SPC screening, perceived risk, primary cancer type, and demographic factors of cancer survivors. METHODS: Participants were 308 survivors of stomach, colon, or breast cancer recruited from 2 university hospitals in Korea. Data were collected using a questionnaire and analyzed using IBM SPSS 21.0 and AMOS 18.0. RESULTS: The proportion of participants taking all cancer screenings according to national guidelines was 40%. They had moderate knowledge and a relatively positive attitude regarding SPC screening and high cancer risk perception. The participants had taken fewer SPC screenings after than before cancer diagnosis. The factors influencing cancer risk perception were age, physical symptoms, knowledge regarding SPC and primary cancer type (stomach). The factors influencing SPC screening practice were age, gender, economic status, knowledge regarding SPC screening, and primary cancer types (colon). CONCLUSION: It is important for clinical professionals to recognize that survivors of cancer are susceptible to another cancer. Education on SPC screening for these survivors should focus on communicating with and encouraging them to have regular cancer screenings.

A Case of Osteosarcoma after Treatment of Endodermal Sinus Tumor / 임상소아혈액종양

Endodermal sinus tumor is a type of germ cell tumor that is relatively common in children. An important problem concerns secondary neoplasms after treatment. We report a case of osteosarcoma that developed five years after treatment of intrapelvic endodermal sinus tumor. The patient was a seven-year-old girl who presented with right thigh and knee joint pain. The patient had been diagnosed with endodermal sinus tumor five years previously and treated with a regimen consisting of high dose cisplatin, etoposide, bleomycin and surgery but without radiotherapy. We detected a mass shadow on the right distal femur that proved to be osteoblastic osteosarcoma by incisional biopsy. The patient received surgical treatment after chemotherapy that included high dose methotrexate. The follow-up bone scan revealed no abnormal uptakes. There has been no evidence of recurrence eighteen months of follow-up after chemotherapy.

Management of Cancer Survivors in Clinical and Public Health Perspectives: Current Status and Future Challenges in Korea

The number of cancer survivors is increasing dramatically. Many cancer survivors face lifetime risks associated with their cancer therapy, with a significant proportion at risk for serious morbidity and premature mortality. Concerns regarding the long-term physical, psychosocial, and economic effects of cancer treatment on cancer survivors and their families are increasingly being recognized and addressed by public and private sector. This article summarizes economic burden of cancer survivors, main post-treatment health problems including secondary primary cancer and comorbidities, health behaviors such as smoking, exercise and physical activity, nutrition, and psychosocial problems. Faced with various health and psychosocial problems specific to this population, several healthcare and policy models are being suggested to address these issues, including 'shared care model' and 'integrative supportive care service delivery system for cancer survivors'. More effort is needed to make the cancer survivorship agenda a reality, attended by a wide variety of stakeholders including researchers, patients, providers, and policy makers.

Role of Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography in Preoperative Staging of Early Glottic Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) has been widely used to detect regional and distant metastasis or second primary cancers at initial evaluation. The aim of this study was to evaluate the role of combined FDG-PET/CT in detecting early glottic cancers, which has low incidence of regional or distant metastasis. SUBJECTS AND METHOD: We enrolled in our study 551 patients who had previously untreated glottic cancer between 2001 and 2008. Of these, 124 patients with early glottic cancer underwent FDG-PET/CT. Retrospectively, we compared the detection rates of regional, distant metastasis or second primary cancer by FDG-PET/CT with those after neck computed tomography (CT), chest X-ray, and liver sonography. RESULTS: In detecting regional metastasis, the sensitivity and specificity of FDG-PET/CT were 66.67% and 97.25%, respectively, with the positive predictive value (PPV) of 40%, the negative predictive value (NPV) of 99.16%, and the accuracy of 96.77%. The sensitivity, specificity, PPV, NPV and accuracy of neck CT were 66.67%, 96.69%, 33.33%, 99.15%, and 95.96%, respectively. The suspicious distant metastasis (n=1) and second primary cancers (n=7) were observed in FDG-PET/CT. The true second primary cancers occurred at the colon (n=1) and the prostate (n=2). The other cases were proved to be false positive. Distant metastasis and second primary cancers were not detected by the conventional work-up tests. CONCLUSION: The regional metastasis detection rate of FDG-PET/CT was similar to those of the conventional work-up tests. However, compared to the conventional tests, FDG-PET/CT is useful for detecting distant metastasis or second primary cancers in patients with early glottic cancer.