(CS35) Rare Triple Primary Malignancies- Case Series

Introduction:

Multiple malignancies are rare. We discuss diagnostic and management challenges in extremely rare triple primary malignancies.

Case series :

Synchronous triple primaries

82-year-old male ex-smoker with intestinal obstruction was diagnosed with sigmoid adenocarcinoma pT2N0Mx. Staging positron-emission topography (PET) discovered increase uptake in prostate and parotid. Biopsy confirmed prostate adenocarcinoma Gleason 4+4, while partial parotid resection confirmed parotid mucoepidermoid carcinoma pT2N0.

Metachronous triple primaries

62-year-old male non-smoker presented with hearing loss 16 years ago. Nasopharyngeal carcinoma (NPC) was successfully diagnosed and treated. After a decade, painful left ear discharge revealed left ear squamous cell carcinoma (SCC) which responded to resection and adjuvant radiotherapy. Four years later, screening uncovered left tonsillar SCC.

59-year-old male ex-smoker initially diagnosed with NPC, completed combined chemoradiotherapy (CCRT). After nine-year remission, surveillance scope discovered base of tongue SCC that underwent resection and chemotherapy. In the ensuing two years, computated tomography (CT) scan uncovered a solitary lung lesion which proved to be SCC.

Discussion :

Epidemiological studies over the past decade have shown an alarming increase in incidence of multiple malignancies. Longer life expectancy, advancement in cancer detection and treatment have improved detection. Factors increasing individual susceptibility include underlying genetic predisposition, environmental and lifestyle factors, and paradoxical carcinogenic effects of cancer treatment. These impart  diagnostic and management challenges to the clinician.

Conclusion :

A multidisciplinary holistic approach, vigilant multimodal surveillance, and a high index of suspicion are essential in providing the best possible outcome for patients.