Issledovaniâ i Praktika v Medicine (Jun 2024)
Primary multiple cancer in practice of urological oncologist
Abstract
Primary multiple malignancies (PMMs) are defined as two or more malignant tumors of various pathogenic origin detected simultaneously or sequentially in one patient. Despite the successes of modern medicine, the incidence of PMMs is steadily increasing. According to worldwide statistics, the incidence of PMMs in the oncological population has increased from 2.4 to 8.0 % over the course of the 20 year span. The number of patients with PMMs is also increasing in the Russian Federation. Total of 58,217 PMMs were detected for the first time in our country in 2021, which constitutes 10.0 % of all newly diagnosed malignant neoplasms. Two tumors are usually observed among patients with PMMs (in 84–100 % of patients), three tumors occur in 9.9–16.0 % of these patients, four in 1.62 %, and five or more occur in only 0.095 %.Currently, the pathogenesis of this condition has not yet been fully studied. There are hypotheses that endogenous, exogenous, hereditary, and therapeutic factors are involved in the occurrence of PMMs. Endogenous factors include immunologic status, endocrine factors, and hereditary predisposition. Exogenous factors are represented by lifestyle and environmental factors such as smoking and alcohol, low physical activity, as well as prolonged exposure to ultraviolet radiation and industrial pollution. Iatrogenic factors, including radiation therapy and chemotherapy, can also increase the risk of developing PMMs.This article represents a clinical case of a patient born in 1942, in whom, during 11 years of follow-up care, primary multiple synchronous metachronous cancers of 5 localizations and 4 histological types were verified and treated. The presented clinical case is interesting for a very rare number of neoplasms and a relatively high duration of follow-up period. The authors describe in detail each stage, the choice of diagnostic methods and the definition of treatment tactics with an assessment of the accuracy of clinical decision-making.
