title: Double primary malignancies: a clinical & pathological analysis report from a regional cancer institute in India.
abstract: BACKGROUND
  Patients which have diagnosed with a cancer, have a life time risk for developing another de novo malignancy depending on various inherited, environmental and iatrogenic risk factors. Cancer victims could survive longer due to settling treatment modalities, and then would likely develop a new metachronous malignancy.This article aims to report our observed trend of increasing, in prevalence of both synchronous and metachronous second primary malignancy, among the cancer victims, and to review the relevant literature.
  
  
  METHODS
  A hospital based retrospective gathering of prospective data, among the patients that have diagnosed with second de novo malignancy.The study has conducted over a 4 years period from 2009 to 2012. All patients that have diagnosed with a histologically proven second malignancy as per Warren and Gates criteria have included. Various details which have regarded site, age at presentation, sex, synchronous or metachronous, treatment have recorded.
  
  
  RESULTS
  Among 41 cases of multiple primary malignancies that have observed, 8 were synchronous (19.51%) and 33 were metachronous (80.49%). Out of 41 patients, 25 (60.98%) were females and 16 (39.02%) were males. The most common sites of primary tumor were head and neck cancers that have followed by gynecological cancers, breast cancer, lung cancer, esophageal cancer, and then the others. Among the second malignancy, the most common site was breast and gastrointestinal tract that have followed by lung and gynecological cancers. Out of the total number of cases with double location, 14 tumors (34.15%) have belonged to the breast, out of which 5 (12.20%) have represented first locations and 7 (17.07%) have been second locations. Both locations have belonged to the breast in 2 patients (4.9%). In 5 cases (12.20%), there were associations of breast-cervix and in 6 cases (14.63%), there were association of lung-head & neck cancers.
  
  
  CONCLUSIONS
  The incidence of multiple primary malignancies has not been rare at all. Screening procedures have especially been useful for the early detection of associated tumors, whereas careful monitoring of patients has treated for primary cancer, and then a good communication between patients and medical care team would certify not only an early detection for secondary tumors, but only finally & subsequently, an appropriate management.
authors.affiliation: Dept. of Radiation Oncology; Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner-334003, Rajasthan, India.
authors.forename: Puneet Kumar
authors.initials: PK
authors.lastname: Bagri
authors.affiliation: Dept. of Radiation Oncology; Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner-334003, Rajasthan, India.
authors.forename: Daleep
authors.initials: D
authors.lastname: Singh
authors.affiliation: Dept. of Radiation Oncology; Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner-334003, Rajasthan, India.
authors.forename: Mukesh Kumar
authors.initials: MK
authors.lastname: Singhal
authors.affiliation: Dept. of Radiation Oncology; Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner-334003, Rajasthan, India.
authors.forename: Guman
authors.initials: G
authors.lastname: Singh
authors.affiliation: Dept. of Medicine; PBM hospital, Bikaner-334003, Rajasthan, India.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Mathur
authors.affiliation: Dept. of Radiation Oncology; Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner-334003, Rajasthan, India.
authors.forename: Shankar Lal
authors.initials: SL
authors.lastname: Jakhar
authors.affiliation: Dept. of Medical Oncology; Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner-334003, Rajasthan, India.
authors.forename: Surender
authors.initials: S
authors.lastname: Beniwal
authors.affiliation: Dept. of Radiation Oncology; Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner-334003, Rajasthan, India.
authors.forename: Neeti
authors.initials: N
authors.lastname: Sharma
authors.affiliation: Dept. of Radiation Oncology; Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner-334003, Rajasthan, India.
authors.forename: Harvindra Singh
authors.initials: HS
authors.lastname: Kumar
authors.affiliation: Dept. of Radiation Oncology; Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner-334003, Rajasthan, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Dept. of Radiation Oncology; Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner-334003, Rajasthan, India.
authors.forename: Megh Raj
authors.initials: MR
authors.lastname: Bardia
keywords: Double primary malignancy; Metachronous; Second malignancy; Synchronous