CARTAS AL DIRECTOR

 

Synchronous small-cell lung cancer following colorectal carcinoma. An uncommon entity in the elderly

Cáncer sincrónico de células pequeñas seguido de carcinoma colorrectal. Una rara entidad en el anciano

 

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Palabras clave: Cáncer sincrónico. Carcinoma colorrectal. Cáncer pulmonar de células pequeñas. Ancianos.

Key words: Synchronous cancer. Colorectal carcinoma. Small-cell lung cancer. Elderly.

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To the editor:

Second primary tumors are definied as tumors present at the same time, separated, and with different histology. Synchronous cancer is related with two or more tumors present or detected at the same time or with an interval of less than one year, whereas primary tumors that are detected within an interval of two years and different histology are called metachronous (1). An elderly patient in whom two synchronous primary lung and colon tumors were detected is reported herein. Association of colorectal carcinoma with synchronous small-cell lung cancer remains very uncommon in literature.

A 75-year old man was admitted with dark-colored feces of several months duration. He was a heavy current smoker of 60 packs-year, and drank 50 grams of ethanol per day. Past medical history was significant for hypertrophic myocardiopathy, and embolic stroke treated with oral anticoagulants. Physical examination revealed melena in rectal touch. He had no adenopathy. Biochemistry and haemogram were normal, CEA 8.2 ng/mL, and occult blood positive in fecatest. The chest X-ray revealed cardiomegaly. There were no findings in the gastroscopy. The abdominal echography showed a 3 cm-growth of sigmoid wall. The barium enema and colonoscopy revealed a stenosis in recto-sigma. The sigmoid endoscopy biopsy was diagnostic for adenocarcinoma. Staging was T3N0M0 (Duke staging). A surgical intervention with sigmoidectomy and termino-terminal anastomosis was carried out. He was readmitted four months later with cough, expectoration, progressive dyspnea, asthenia, and 6-kilogram weight loss lasting 15 days. The physical exploration disclosed right supraclavicular adenopathies. The chest radiograph showed right pleural effusion and ipsilateral growth of the hilum. The abdominal and thoracic computerized tomography scan revealed a pulmonary mass in the right intermediate bronchus with obstructive pneumonia and ipsilateral pleural effusion (Fig. 1). There were no abdominal metastases. The fine-needle punction-aspiration of supraclavicular adenopathies was diagnostic for small cell carcinoma. The bronchoscopy showed stenosis of the intermediate bronchus. The pathologic study showed a small-cell anaplastic carcinoma. The clinical picture progressively worsened and the patient died two months later.

Incidence of cancer rises with age, including the occurrence of multiple primary malignant neoplasms. The prevalence of two or more malignancies in one patient has increased over the past decades (2). Increasing diagnosis of multiple primary tumors due to better diagnostic techniques, and better treatment options for other diseases, could explain that the life expectancy in the elderly has increased which definitely affects the prevalence of malignancies in general. In addition, the increased use of radiation therapy and, or chemotherapy for the first tumor may be a cause of increased survival rates. One per cent of 26,255 patients with cancer had multiple primary malignant tumors, 34% of these were synchronous tumors (3). In large series of patients with colorectal carcinoma, only 1% developed second other site primary cancer in follow-up (mainly within the gastrointestinal tract, female reproductive tract, and genitourinary tract), lung being involved in 1 per 1,000 (4). Beside the genetic risk factors, environmental factors such as quality of diet, cigarette smoking, and heavy cumulative intake of alcohol play an important role as carcinogenic agents for some malignancies (5). Therefore, smokers and drinkers have been reported more common in the synchronous cancer group (3).

 

M. Escalante, J. Martí and E. Antón

Department of Internal Medicine. Hospital of Zumárraga. Guipuzcoa, Spain

 

References

1. Martini N, Melamed MR. Multiple primary lung cancer. J Thorac Cardiovasc Surg 1975; 70: 606-12.

2. Duchateau C, Stokkel M. Second primary tumors involving non-small cell lung cancer. Prevalence and its influence on survival. Chest 2005; 127: 1152-8.

3. Aydiner A, Karadeniz A, Uygun K, Tas S, Tas F, Disci R, et al. Multiple primary neoplasms at a single institution: differences between synchronous and metachronous neoplasms. Am J Clin Oncol. 2000; 23: 364-70.

4. Chiang JM, Yeh CY, Changehien CR, Chen JS, Tang R, Tsai WS, et al. Clinical features of second other-site primary cancers among sporadic colorectal cancer patients-a hospital-based study of 3722 cases. Hepatogastroenterology 2004; 51: 1341-4.

5. Maekawa SJ, Aoyama N, Shirasaka D, Kuroda K, Tamura T, Kuroda Y, et al. Excessive alcohol intake enhances the development of synchronous cancerous lesion in colorectal cancer patients. Int J Col Dis 2004; 19: 171-5.