MULTİPL PRİMER JİNEKOLOJİK TÜMÖRLER

Abstract

Amaç: Kliniğimizde tedavi görmüş ve takibi devam eden multipl jinekolojik tümörlü hastalar görülme sıklığı, klinik ve patolojik özellikleri ve sağkalım açısından değerlendirilmiştir.

Gereç ve yöntem: 1992 ile 2010 yılları arasında jinekolojik malignite tanısıyla kliniğimize başvuran 2373 hasta retrospektif olarak incelenmiştir. Multipl jinekolojik organ kaynaklı neoplazi 26 (%1.09) hastada gözlenmiştir. 25 hastada iki primer neoplazi saptanırken, 1 hastada 3 primer neoplazi saptanmıştır. Yirmi üç hastada senkron kanser, 3 hastada ise sırası ile 7, 22 ve 24 yıl sonra metakron kanser gelişmiştir. Evrelemede FIGO 2009 sistemi kullanılmıştır. Endometrium-over kanserli hasta grubu için genel sağkalım Kaplan-Meier yöntemine göre belirlenmiştir.

Bulgular: Ortanca yaş 51’dir (34-79 yaş). En sık endometrium-over kanser birlikteliği (16 hasta, %61.5) gözlenmiştir. Diğer multipl primer tümörler ise; endometrium-serviks (4 hasta,%15.3), serviks-over (3 hasta %11.5), serviks-vajina (2 hasta, %7.6) ve endometrium-over-serviks kanserli 1 olgu (%3.8) şeklindedir. En sık evre1 ve grad1 malignite gözlenmiştir. En sık yakınma düzensiz vajinal kanamadır. Endometrium-over kanser grubu için 5 yıllık genel sağkalım %83 olarak bulunmuştur.

Sonuç: Günlük pratikte sık karşılaşılmamakla birlikte jinekolojik organlarda multipl primer kanser görülebilir. Senkron endometrium ve over kanseri bu durumlar içinde en sık görülenidir. Göreceli olarak daha erken evrede saptandıkları için iyi prognoza sahiptir. Kanserde erken tanının prognoza olumlu etkisi düşünüldüğünde jinekolojik malignite tanısı almış olgularda ikinci bir kanser gelişme riski her zaman akılda tutularak, bu olguların takibinde daha dikkatli olunmalıdır.

Keywords

• Multipl primer kanser
• senkron kanser
• metakron kanser

MULTIPLE PRIMARY GYNECOLOGIC TUMORS

Abstract

Objective: To evaluate incidence, clinical and pathological features and survival of patients who had multiple gynecological tumors.

Material and methods: 2373 patients treated between 1992 and 2010 with gynecological malignancy were analyzed retrospectively. Multiple gynecological malignancy was observed in 26 (1.09%) patients. While 25 patients had two different malignancy, only one patient had three different primary cancer. Twenty-three patients had synchronous cancer and 3 patients developed metachronous cancer after 7, 22, and 24 years of treatment. 2009 FIGO staging system was used. Overall survival was analyzed by Kaplan-Meier method for endometrium-ovary group.

Results: The median age was 51 years (34-79 years). Coexistence of endometrial and ovary cancer was most common (61.5%). Other coexistence of malignancies were; endometrium-cervix (4 patients, 15.3%), cervix-ovary (3 patients, 11.5%), cervix-vagina (2 patients, 7.6%) and endometrium-over-cervix cancer (1 patient, 3.8%). The most common stage and grade were; stage1 and grade1. The most common complaint was abnormal vaginal bleeding. 5 year overall survival was 83% for endometrium-ovary group.

Conclusion: Multiple primary gynecological cancer is not common in daily practice. Synchronous endometrial and ovarian cancer is the most common in this population. They have a good prognosis due to detection at a relatively early stage. When we consider the positive impact of early diagnosis for its prognosis, the risk of developing a secondary cancer always should be kept in mind in the presence of a primary malignancy and follow-up of these patients should be done carefully.

Keywords

• Multiple primary cancer
• synchronous cancer
• metachronous cancer

References

1. Ayhan A, Yalçın OT, Tuncer ZS, Gurgan T,Küçükali T. Synchronous primary malignancies of the female genital tract. Eur J Obstet Gynecol Reprod Biol 1992;45:63-6.
2. Behtash N, Tehranian A, Ardalan FA, Hanjani P. Uterine papillary serous carcinoma after pelvic radiation therapy for cancer of the cervix. J Obstet Gynaecol. 2002;22(1):96-7.
3. Casro IM, Connell PP, Waggoner S, Rotmensch J, Mundt AJ. Synchronous ovarian and endometrial malignancies. Am J Clin Oncol 2000;23:521-5.
4. Cecen E, Bolaman Z. İkincil Kanserler. International Journal of Hematology and Oncology 2010;20(3):190-200.
5. Chen L, Zhao Q, Lv X. Characteristics and prognosis of coexisting adnexa malignancy with endometrial cancer: a single institution review of 51 cases. Arch Gynecol Obstet 2011;283:1133-7.
6. Eifel P, Hendrickson M,Ross J,Balon S,Martinez A,Kempson R. Simultaneous presentation of carcinoma involving the ovary and the uterine corpus. Cancer 1982;50:163-70.
7. Eisner RF, Nieberg RK, Berek JS. Synchronous primary neoplasms of the female reproductive tract. Gynecol Oncol 1989; 33:335-9.
8. Eser S et al. Synchronous primary cancers of the female reproductive tract in Turkish women. Asian Pacific J Cancer Prev, 2011;12(4):857-9.

9. Georgieva S, Iordanov V. A woman with synchronous cervical, vaginal and laryngeal squamous cell carcinomas and positive human papillomavirus type 16; case presentation with literature review. J BUON. 2008;13(1):109-12.
10. Huang YD, Hung YC, Yeh LS, Chiang IP, Zeng GC, Chang WC. Synchronous ovarian endometrioid adenocarcinoma and endocervical mucinous adenocarcinoma. Taiwan J Obstet Gynecol 2006; 45(3):264-7.
11. Gungor T, Pektas MK, Ustunyurt E, Mollamahmutoglu L (2009). Synchronous primary tumors of the female genital tract: a single center experience. Arch Gynecol Obstet, 2009;279(5):667
12. Kim MK, Song SY, Do IG, Kim SH, Choi CH, Kim TJ et al. Synchronous gynecologic malignancy and preliminary results of Lynch syndrome. J Gynecol Oncol. 2011;22(4):233-8.
13. Kleinerman RA, Kosary C, Hildesheim A. New Malignancies Following Cancer of the Cervix Uteri, Vagina, and Vulva. In: Curtis RE, Freedman DM, Ron E, Ries LAG, Hacker DG, Edwards BK, Tucker MA, Fraumeni JF Jr. (eds). New Malignancies Among Cancer Survivors: SEER Cancer Registries, 1973-2000. National Cancer Institute, NIH Publ. No. 05-530 Bethesda, MD, USA, 2006;207-229.
14. Kumar S, Shah JP, Bryant CS, Awonuga AO, Imudia AN, Ruterbusch JJ et al. Second neoplasms in survivors of endometrial cancer: impact of radiation therapy. Gynecol Oncol. 2009;113(2):233-9.
15. Lynch HT, Smyrk T. Hereditary non poliposis colorektal cancer (Lynch syndrome). An updated review. Cancer 1996;78:1149-67.
16. Natee J, Kietpeerakool C, Srisomboon J, Khunamornpong S, Suprasert P, Phongnarisorn Cet al. Clinicopathologic Analysis of Women with Synchronous Primary Carcinomas of the Endometrium and Ovary: 10- Year Experience from Chiang Mai University Hospital, Asian Pacific J Cancer Prev, 2006;7(2):234-8.
17. Oranratanaphan S, Manchana T, Sirisabya N. Clinicopathologic Variables and Survival Comparison of Patients with Synchronous Endometrial and Ovarian Cancers Versus Primary Endometrial Cancer with Ovarian Metastasis. Asian Pacific J Cancer Prev. 2008;9(3):403-8.
18. Pothuri B, Ramondetta L, Martino M, Alektiar K, Eifel PJ, Deavers MT et al. Development of endometrial cancer after radiation treatment for cervical carcinoma. Obstet Gynecol. 2003;101(5 Pt 1):941-5.
19. Ramus SJ, Elmasry K, Luo Z, Gammerman A, Lu K, Ayhan A et al. Predicting clinical outcome in patients diagnosed with synchronous ovarian and endometrial cancer. Clin Cancer Res 2008;14:5840–
20. Soliman PT, Broaddus RR, Schmeler KM, Daniels MS, Gonzalez D, Slomovitz BM et al. Women with synchronous primary cancers of the endometrium and ovary: do they have Lynch syndrome? J Clin Oncol, 2005;23(36):9344-50.
21. Soliman PT, Slomovitz BM, Broaddus RR, Sun CC, Oh JC, Eifel PJ et al. Synchronous primary cancers of the endometrium and ovary: a single institution review of 84 cases. Gynecol Oncol. 2004;94(2):456-62
22. Song T, Seong SJ, Bae DS, Suh DH, Kim DY, Lee KH et al. Synchronous primary cancers of the endometrium and ovary in young women: a KoreanGynecologic Oncology Group Study. Gynecol Oncol. 2013;131(3):624-8.
23. Ulbright T, Roth L. Metastatic and independent cancers of the endometrium and ovary: a clinicopathologic study of 34 cases. Hum Pathol 1985;16:28–34.
24. Van Leeuwen FE, Klokman WJ, Veer MB, Hagenbeek A, Krol AD, Vetter UA et al. Long-term risk of second malignancy in survivors of Hodgkin's disease treated during adolescence or young adulthood. J Clin Oncol 2000;18:487-97.
25. Van Leeuwen FE, Travis LB. Second cancers. In: Devita VT, et al.,(ed). Cancer: principles and practice of oncology. 7th ed. Philadelphia (PA): Lippincott Williams & Wilkins; 2005;2575-602.
26. Warren S, Gates O. Multiple primary malignant tumors. A survey of the literature and a statistical study. Am J Cancer 1932;16:1358-414.
27. Welte B, Suhr P, Bottke D, Bartkowiak D, Dörr W, Trott KR, Wiegel T. Second malignancies in high-dose areas of previous tumor radiotherapy. Strahlenther Onkol. 2010;186(3):174-9.
28. Williams MG, Bandera EV, Demissie K et al. Synchronous primary ovarian and endometrial cancers: a population-based assessment of survival. Obstet Gynecol 2009;113:783–89.
29. Woodruff JD, Solomon D, Sullivant H.Multifocal disease in the upper genital canal.Obstet Gynecol 1985;65:695-8.
30. Zaino R, Whitney C, Brady MF, DeGeest K, Burger RA, Buller RE. Simultaneously detected endometrial and ovarian carcinomas-a pathologıc clinicopathologıc study of 74 cases:a gynecologiconcology group study. Gynecol Oncol 2001;83:355-62.