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Multiple Primary Malignancies—Challenges in Diagnosis and Management for a Gynecological Oncologist

Abstract

Background

Multiple primary malignancies in an individual is an uncommon condition, but is increasingly being seen in high volume centers. They could be due a common etiological factor, inherited gene mutations, inherited syndromes, or could simply be an unfortunate coincidence.

Purpose

To determine the common associations of multiple primary malignancies in relation to the female genital tract, and to determine the hurdles in their diagnosis and management.

Methods

All patients having multiple primary malignancies with at least one gynaecological primary during the period 01–07-2019 to 30–06-2021 were studied. Each case was studied to determine the primaries- whether synchronous or metachronous, and if synchronous, whether the diagnosis of the second primary was a surprise/missed finding, and finally, if the management of each case was satisfactory or not.

Results

A total of 13 cases of multiple primary malignancies were detected, out of which 8 cases were synchronous, 4 were metachronous, and one was a case of synchronous and metachronous malignancy. The most common association was that of carcinoma ovary being the first detected primary with that of carcinoma cervix/vault. The diagnosis of the second primary was a surprise in 3 cases. The treatment outcome was satisfactory in only about 6 cases.

Conclusion

The optimal management of multiple primary malignancy depends on effective screening, early diagnosis, and offering risk reduction surgeries to at risk patients. It also involves the utilization of superior imaging, cytological and histological techniques, and better clinical judgement by all the treating oncologists.

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References

  1. 1.

    Datta A, et al. Synchronous tumors in gynecological malignancies. Indian J Gynecol Oncolog. 2020;18:54.

    Article  Google Scholar 

  2. 2.

    Mylavarapu S, Das A, Roy M. Role of BRCA mutations in the modulation of response to platinum therapy. Front Oncol. 2018;8:16.

    PubMed  PubMed Central  Article  Google Scholar 

  3. 3.

    Ryan NAJ, et al. Lynch syndrome for the gynaecologist. Obstet Gynaecol. 2021;23(1):9–20.

    PubMed  PubMed Central  Google Scholar 

  4. 4.

    Shankaranarayanan R, Ferlay J. Worldwide burden of gynaecological cancer: the size of the problem. Best Pract Res Clin Obstet Gynaecol. 2006;20(2):207–25.

    Article  Google Scholar 

  5. 5.

    Meredith RF, Eisert DR, Kaka Z, Hodgson SE, Johnston GA Jr, Boutselis JG. An excess of uterine sarcomas after pelvic irradiation. Cancer. 1986;58(9):2003–7.

    CAS  PubMed  Article  Google Scholar 

  6. 6.

    Ukah CO, Ikpeze OC, Eleje GU, Eke AC. Adult granulosa cell tumor associated with endometrial carcinoma: a case report. J Med Case Rep. 2011;5:340.

    PubMed  PubMed Central  Article  Google Scholar 

  7. 7.

    May T, Goldstein DP, Berkowitz RS. Current chemotherapeutic management of patients with gestational trophoblastic neoplasia. Chemother Res Pract. 2011. https://doi.org/10.1155/2011/806256.

    PubMed  PubMed Central  Article  Google Scholar 

  8. 8.

    Tong SY, Lee YS, Park JS, Bee SN, Lee JM, Mankoong SE. Clinical analysis of synchronous primary neoplasms of the female reproductive tract. Eur J Obstet Gynecol Reprod Biol. 2008;136:78–82.

    PubMed  Article  Google Scholar 

  9. 9.

    Irimie A, Achimas-Cadariu P, Burz C, Puscas E. Multiple primary malignancies–epidemiological analysis at a single tertiary institution. J Gastroint Liv Dis. 2010;19(1):69–73.

    Google Scholar 

  10. 10.

    Bhattacharya AK, Nath GD, Deka H. Comparative study between pap smear and visual inspection with acetic acid (via) in screening of CIN and early cervical cancer. J Midlife Health. 2015;6(2):53–8.

    Google Scholar 

  11. 11.

    Fan Y, et al. Ovarian metastasis in women with cervical carcinoma in stages IA to IIB: a systematic review and meta-analysis. Medicine. 2020;99:31.

    Google Scholar 

  12. 12.

    Verma A, Julka PK, Kaur J. Mutations in BRCA 1/2 genes: unexpected higher prevalence in Indian patients. Cancer Res Stat Treat. 2020;3:376–7.

    Article  Google Scholar 

  13. 13.

    Singh J, et al. Screening of over 1000 Indian patients with breast and/or ovarian cancer with a multi-gene panel: prevalence of BRCA1/2 and non-BRCA mutations. Breast Cancer Res Treat. 2018;170(1):189–96.

    CAS  PubMed  Article  Google Scholar 

  14. 14.

    Adams TS, Cuello MA. Cancer of the vagina. Int J Gynecol Obstet. 2018;143(S2):14–21.

    Article  Google Scholar 

  15. 15.

    Zhang Y, Wang J. Controversies in the management of endometrial cancer. Obstet Gynecol Int. 2010

  16. 16.

    Frelaut M, et al. Are Older Patients with Cervical Cancer Managed Differently to Younger Patients? An International Survey. Cancers. 2019;11(12):1955.

    PubMed Central  Article  Google Scholar 

  17. 17.

    Ilancheran A. Neoadjuvant chemotherapy in cervical cancer in pregnancy. Best Pract Res Clin Obstet & Gynaecol. 2016;33:102–7.

    Article  Google Scholar 

  18. 18.

    de Azevedo CR, Thuler LC, de Mello MJ, Ferreira CG. Neoadjuvant chemotherapy followed by chemoradiation in cervical carcinoma: a review. Int J Gynecol Cancer. 2016;26(4):729–33.

    PubMed  Article  Google Scholar 

  19. 19.

    Nagel CI, Thomas SK, Richardson DL, Kehoe SM, Miller DS, Lea JS. Adnexal masses requiring surgical intervention in women with advanced cervical cancer. Gynecol Oncol. 2014;134(3):552–5.

    PubMed  Article  Google Scholar 

  20. 20.

    Lv S, et al. Synchronous primary malignant neoplasms of the cervix and endometrium. Mol Clin Oncol. 2017;6:661–4.

    PubMed  PubMed Central  Article  Google Scholar 

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Correspondence to Anirudha Rohit Podder.

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Kumari, A., Podder, A.R. Multiple Primary Malignancies—Challenges in Diagnosis and Management for a Gynecological Oncologist. Indian J Gynecol Oncolog 19, 88 (2021). https://doi.org/10.1007/s40944-021-00588-8

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Keyword

  • Multiple primary malignancies
  • Synchronous malignancies
  • Metachronous Malignancies