Aim: Epidemiological studies have reported a 2 – 17% incidence of double malignancies. Cancer predisposition syndromes, common environmental exposure, late effects of radiotherapy and chemotherapy can lead to the development of second primary malignancies. The aim of our study is to report the prevalence of multiple pimary malignant neoplasms in our setting and to review the relevant literature.

Materials and Methods: Details of patients presenting with histologically proven synchronous or metachronous double malignancies between January 2016 and May 2017 were collected. Details like age at the time of presentation, gender, location of the first and second primary malignancy, histopathology of both the malignant neoplasms and treatment given for both the malignant neoplasms were recorded.

Results: The incidence of multiple primary malignant neoplasms was 1.25%. 68.75% of patients developed metachronous double primary malignancy and 31.25% of patients had synchronous double malignancy. The duration between the development of first and second malignancy ranged between 1 to 30 years. 53.12% of patients who developed second primary malignancy were males, whereas 46.88% were females. Head and neck cancer was the most common first and second primary malignant neoplasm. The common histopathologies of the double malignancy were squamous cell carcinoma, adenocarcinoma, transitional cell carcinoma and sarcoma.

Conclusion: A regular follow up, a strong clinical suspicion and thorough evaluation could detect most of the metachronous second malignancies at an earlier stage. An individualised treatment approach is warranted for patients with multiple malignancies. The prognosis of these patients depends on the individual tumor biology and the stage of presentation of the individual tumor.

1. Coyte A, Morrison DS, McLoone P. Second primary cancer risk - the impact of applying different definitions of multiple primaries: results from a retrospective population-based cancer registry study. BMC Cancer 2014;14:272.
2. Buiatti E, Crocetti E, Acciai S, et al. Incidence of second primary cancers in three Italian population-based cancer registries. Eur J Cancer 1997;33:1829–34.
3. Weir HK, Johnson CJ, Thompson TD. The effect of multiple primary rules on population-based cancer survival. Cancer Causes Control 2013;24:1231–42.
4. Rosso S, De Angelis R, Ciccolallo L, et al. Multiple tumours in survival estimates. Eur J Cancer 2009;45:1080–94.
5. Karaholios E, English D, Thursfield V, et al. Second primary cancers in Victoria. 2013. http://www. cancervic.
6. Moertel CG. Multiple primary malignant neoplasms: Historical perspectives. Cancer 1977;40(Suppl 4):1786-92.
7. Warren S, Gates O. Multiple primary malignant tumors: A survey of the literature and statistical study. Am J Cancer. 1932; 16:1358-414.
8. Amer MH. Multiple neoplasms, single primaries, and patient survival. Cancer Manag Res 2014;6:119–34.
9. Weir HK, Johnson CJ, Thompson TD. The effect of multiple primary rules on population-based cancer survival. Cancer Causes Control 2013;24:1231–42.
10. Kim JY, Song HS. Metachronous double primary cancer after treatment of breast cancer. Cancer Res Treat 2015;47:64–71.
11. Ricceri F, Fasanelli F, Giraudo MT, et al. Risk of second primary malignancies in women with breast cancer: results from the European prospective investigation into cancer and nutrition (EPIC). Int J Cancer 2015;137:940–8.
12. Molina-Montes E, Pérez-Nevot B, Pollán M, et al. Cumulative risk of second primary contralateral breast cancer in BRCA1/BRCA2 mutation carriers with a first breast cancer: a systematic review and meta-analysis. Breast 2014;23:721–42.
13. Jin T, Song T, Deng S, et al. Radiation-induced secondary malignancy in prostate cancer: a systematic review and meta-analysis. Urol Int 2014;93:279–88.
14. Wallis CJ, Mahar AL, Choo R, et al. Second malignancies after radiotherapy for prostate cancer: systematic review and meta-analysis. BMJ 2016;352:i851.
15. Bhuller KS, Zhang Y, Li D, et al. Late mortality, secondary malignancy and hospitalisation in teenage and young adult survivors of hodgkin lymphoma: report of the childhood/adolescent/young adult cancer survivors research program and the BC cancer agency centre for lymphoid cancer. Br J Haematol 2016;172:757–68.
16. Lisik-Habib M, Czernek U, Dębska-Szmich S, et al. Secondary cancer in a survivor of hodgkin's lymphoma: a case report and review of the literature. Oncol Lett 2015;9:964–6.
17. Sanchez De Cos Escuin J, Rodriguez Lopez DP, Delgado Utrabo I, et al. Disease recurrence and second tumors in Long-term survivors of lung Cancer. Arch Bronconeumol 2016;52:183–8.
18. Garber JE, Offit K. Hereditary cancer predisposition syndromes. J Clin Oncol 2005;23:276–92.

Kannan Jayaraman