METACHRONOUS BREAST AND RECTAL CANCERS: A CASE REPORT OF SUCCESSFULLY TREATED MULTIPLE PRIMARY MALIGNANT TUMORS

Abstract

Genetic predispositions, host characteristics, environmental factors and higher cancer patient survival rates are all contributing to the rising prevalence of multiple primary malignant tumors (MPMTs). The global incidence of MPMTs is as high as 11.7%.

It is uncommon for MPMTs to affect both breast and rectum. Owing to the scarcity of available literature, there is lack of high-quality evidence that can guide clinicians on the management strategies of this complex oncological entity. In our study, we report a case of successfully treated metachronous tumors of the breast and rectum in a 71-year-old woman. The patient was first diagnosed with moderately differentiated invasive ductal carcinoma of left breast in 2019 for which she underwent modified radical mastectomy (MRM) followed by adjuvant chemo and radiotherapy. In 2021, she was diagnosed with adenocarcinoma of the rectum following multiple episodes of per rectal bleeding. The case was discussed in a multidisciplinary tumor board and after ruling out metastasis, a decision of neoadjuvant chemo-radio therapy followed by anterior resection of the tumor was made. The patient remains disease free so far.

In a nutshell, the likelihood of developing a primary second malignancy should always be kept in mind while evaluating a cancer patient. There are no specific guidelines for the management of MPMTs due to the paucity of available data. Therefore, it is imperative that both the patient and the clinician be vigilant for the emergence of new signs and symptoms after the occurrence of index primary malignancy.