Recently, the early detection and the advances in
therapy for malignant diseases have contributed to prolonged survival of patients, resulting in an increment of multiple primary
malignancies. We describe a 55-year-old man, at the first presentation, with six
malignancies over 14 years(
malignant lymphoma,
gastric cancer,
ureteral cancer,
small cell lung cancer,
bladder cancer, and squamous cell
lung cancer). A case of six primary
malignancies is extremely rare and, as far as we know, this is the 16th case of its kind reported in Japan. The overlapping of many malignant diseases resulted in some difficulties with treatment. Whereas the
ureteral cancer and
small cell lung cancer were synchronous, considering the therapeutic duration of
lung cancer, we proceeded with the operation for
ureteral cancer and had to delay the start of
chemotherapy for
small cell lung cancer for more than one month. Moreover, dose intensity of the
chemotherapy for the
small cell lung cancer was limited by expectancy of augmented myelosuppression, due to the effect of prior
chemotherapy for
malignant lymphoma. However, a strong
neutropenia-induced postoperative abdominal
infection necessitated discontinuation of
chemotherapy and treatment with
radiotherapy alone. In addition, the
therapies for the newly developed squamous cell
lung cancer, the sixth
malignancy, were also limited because of reduced lung function and myelopoiesis. In treatment or follow-up of patients with multiple primary
malignancies, as opposed to those with a single malignant disease, the characteristics of other
malignancies and the morbidities by preceding
therapies must be considered.