Multiple Primary Malignancies

Transcription

1 Updates in Surgery

2 Andrea Renda Multiple Primary Malignancies In cooperation with Luigi Marchiori Silvia Pachera Luca Bortolasi Riccardo Manfredi Paola Capelli 13

3 Andrea Renda Surgical, Anesthesiology-rianimative and Emergency Sciences Department Federico II University The publication and the distribution of this volume have been supported by the Italian Society of Surgery The Editor acknowledges the educational contribution offered by Johnson & Johnson Medical S.p.A. Library of Congress Control Number: ISBN Springer Milan Berlin Heidelberg New York e-isbn Springer is a part of Springer Science+Business Media springer.com Springer-Verlag Italia 2009 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, re-use of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. Duplication of this publication or parts thereof is only permitted under the provisions of the Italian Copyright Law in its current version, and permission for use must always be obtained from Springer. Violations are liable for prosecution under the Italian Copyright Law. The use of general descriptive names, registered names, trademarks, etc., in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publisher cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: Simona Colombo, Milan, Italy Typesetting: Graphostudio, Milan, Italy Printing and binding: Arti Grafiche Nidasio, Assago, Italy Printed in Italy Springer-Verlag Italia S.r.l. Via Decembrio 28 I Milan

4 In loving memory of Gaetano Renda, Giuseppe Zannini and Simone Renda

5 Foreword In 2006, when my colleague Andrea Renda proposed multiple primary malignancies (MPM) as the subject of the Biennial Report to the 2008 Congress of the Italian Society of Surgery, I, together with the Steering Committee, quickly agreed. Recent progress in our understanding of the etiopathology of these neoplasms has led to innovative and significant progress on the clinical level. Importantly, the incidence of the onset of two or more tumors in the same patient suggests a more than casual relationship. Furthermore, the occurrence of MPM derives from several different mechanisms viral, iatrogenic, immunologic, environmental, and hereditary such that any form of treatment must take into account the etiology of these tumors. After an epidemiological introduction, this monograph analyzes various aspects of multitumoral syndromes based on the experience of the Department of Surgical Sciences, along with that of other clinical departments of the University Federico II of Naples. In the discussion of inherited tumors, reference is made to the series of patients treated at the Department of Surgery at the University of Siena. The many topics that comprise this volume range from carcinogenesis to diagnostic strategies, and from epidemiology to innovations in imaging and endoscopic techniques. Among the clinical aspects, particular emphasis is given to sporadic and hereditary syndromes, as these patients are frequently treated by general surgery departments. The correlation between molecular tests and clinical behaviors of MPM is highly relevant, since the diagnostic, therapeutic, and surveillance strategies for more than a few of these syndromes are strongly influenced by the underlying genetics. Despite its wealth of information, this work does not claim to be conclusive. The interesting clinical trials proposed by the authors will no doubt bring further insights and new perspectives regarding the pathogenesis and clinical approach to MPM. I am proud that Italian surgery has been able to provide a relevant contribution to this extremely interesting field, one that will benefit not only surgeons, but also many different research and clinical specialists. Rome, October 2008 Roberto Tersigni President, Italian Society of Surgery

6 Preface Many surgeons are confronted with cancer patients who have already been treated for another malignant neoplasm or who have a lesion formerly considered to be a metastasis but subsequently recognized as a new primary tumor. In other cases, individuals who have been cured of one cancer (i.e., of the digestive tract or breast) may later present with leukemia or lymphoma. In every surgeon s series there are also patients with inherited disease in which there are multiple tumors. In our experience, in studies of familial adenomatous polyposis and colorectal cancer, we have seen many patients with multiple primary tumors. These observations lead to several questions: What is the real incidence of multiple primary malignancies? What are their most frequent causes? Is there a relationship or a dependence among them? How do we best approach their diagnosis and prevention? Is the optimal prophylactic therapy surgical or medical? In this volume, we have tried to answer these questions through in-depth discussions and literature reviews. To this end, I have been greatly assisted by the Board of Società Italiana di Chirurgia (SIC), which I sincerely thank, in its choice of this subject as the focus of a 2-year study. The aim here is not to produce an exhaustive monograph, but to point out topics under investigation. Experts in the field, mostly from the University Hospital Federico II in Naples but also from other institutes in Campania, as well as other guest authors have been invited to relate their own experience and thus to approach the problem from different points of view. I would therefore like to thank all those who took part in this study for their much-appreciated and crucial cooperation. The monograph is divided into three parts: the first mainly concerning the history and the nosography of multiple primary malignancies; the second based on the etiology and the more frequent tumoral associations seen in general surgery; and the third on the clinical concepts. I hope I have succeeded in my intention and apologize for any, inadvertent, omissions. Naples, October 2008 Andrea Renda

7 Contents Contributors XV Chapter 1 - Nosography Andrea Renda, Nicola Carlomagno Chapter 2 - Epidemiology: Data from Cancer Registries Maurizio Montella, Carlotta Buzzoni, Anna Crispo Chapter 3 - Bioinformatics in MPM: Using Decision Trees To Predict a Second Tumor Site Alberto Cavallo, Concetta Dodaro Chapter 4 - Carcinogenesis Nicola Carlomagno, Francesca Duraturo, Gennaro Rizzo, Cristiano Cremone, Paola Izzo, Andrea Renda Chapter 5 - Iatrogenic Second Tumors Pietro Lombari, Loredana Vecchione, Antonio Farella, Sebastiano Grassia, Fernando De Vita, Giuseppe Catalano, Marco Salvatore, Andrea Renda Chapter 6 - Immunodeficiency and Multiple Primary Malignancies Michele Santangelo, Sergio Spiezia, Marco Clemente, Andrea Renda, Arturo Genovese, Giuseppe Spadaro, Concetta D Orio, Gianni Marone, Stefano Federico, Massimo Sabbatini, Eliana Rotaia, Pierluca Piselli, Claudia Cimaglia, Diego Serraino Chapter 7 - Multiple Primary Malignancies and Human Papilloma Virus Infections Stefania Staibano, Massimo Mascolo, Lorenzo Lo Muzio, Gennaro Ilardi, Loredana Nugnes, Concetta Dodaro, Andrea Renda, Gaetano De Rosa Chapter 8 - The Hereditary Syndromes Nicola Carlomagno, Luigi Pelosio, Akbar Jamshidi, Marius Yabi, Francesca Duraturo, Paola Izzo, Andrea Renda

8 XII Contents Chapter 9 - Multifocal and Multicentric Tumors Carlo de Werra, Ivana Donzelli, Mario Perone, Rosa Di Micco, Gianclaudio Orabona Chapter 10 - The Cancer Spectrum Related to Hereditary and Familial Breast and Ovarian Cancers Matilde Pensabene, Rosaria Gesuita, Ida Capuano, Caterina Condello, Ilaria Spagnoletti, Eleonora De Maio, Flavia Carle, Stefano Pepe, Alma Contegiacomo Chapter 11 - The Role of Genetic Predisposition and Environmental Factors in the Occurrence of Multiple Different Solid Tumors. The Experience of the University Hospital of Sienna Francesco Cetta, Armand Dhamo, Annamaria Azzarà, Laura Moltoni Chapter 12 - Sporadic Colorectal Tumors in Multiple Primary Malignancies Concetta Dodaro, Enrico Russo, Giuseppe Spinosa, Luigi Ricciardelli, Andrea Renda Chapter 13 - Multiple Primary Malignancies: Non-codified Associations Alessandro Scotti, Alessandro Borrelli, Gioacchino Tedesco, Francesca Di Capua, Cristiano Cremone, Michele Giuseppe Iovino, Andrea Renda Chapter 14 - Laboratory for Patients at Risk of Multiple Primary Malignancies Marcello Caggiano, Angela Mariano, Massimiliano Zuccaro, Sergio Spiezia, Marco Clemente, Vincenzo Macchia Chapter 15 - Multiple Primary Malignancies: Role of Advanced Endoscopy To Identify Synchronous and Metachronous Tumors of the Digestive Tract Giuseppe Galloro, Luca Magno, Giorgio Diamantis, Antonio Pastore, Simona Ruggiero, Salvatore Gargiulo, Marcello Caggiano Chapter 16 - Diagnostic Imaging Techniques for Synchronous Multiple Tumors Vincenzo Tammaro, Sergio Spiezia, Salvatore D Angelo, Simone Maurea, Giovanna Ciolli, Marco Salvatore Chapter 17 - DNA-Guided Therapy Nicola Carlomagno, Luigi Pelosio, Akbar Jamshidi, Francesca Duraturo, Paola Izzo, Andrea Renda

9 Contents XIII Chapter 18 - Chemoprevention Pietro Lombari, Gaetano Aurilio, Fernando De Vita, Giuseppe Catalano Conclusions Andrea Renda Subject Index

10 Contributors Gaetano Aurilio Medical Oncology, Department of Clinical and Experimental Medicine F. Magrassi A. Lanzara ; Second University of Naples, Annamaria Azzarà Department of Surgery, University of Sienna, Sienna, Italy Alessandro Borrelli Surgical Sciences and Diagnostic and Therapeutic Advanced Technologies Ph.D. Course, Federico II University, Naples Carlotta Buzzoni AIRTUM and Epidemiology Clinical and Descriptive Unit CSPO, Florence, Italy Marcello Caggiano Ida Capuano Flavia Carle Centro di Epidemiologia, Biostatistica e Informatica Medica, Università Politecnica delle Marche, Ancona, Italy Nicola Carlomagno

11 XVI Contributors Giuseppe Catalano Medical Oncology, Department of Clinical and Experimental Medicine F. Magrassi A. Lanzara, Second University of Naples, Alberto Cavallo Department of Engineering of Informations, Second University of Naples, Francesco Cetta Department of Surgery, University of Sienna, Sienna, Italy Claudia Cimaglia Department of Epidemiology, INMI L. Spallanzani IRCCS, Rome, Italy Giovanna Ciolli Surgical Sciences and Diagnostic and Therapeutic Advanced Technologies Ph.D. Course, Federico II University, Naples Marco Clemente Caterina Condello Alma Contegiacomo Cristiano Cremone Anna Crispo Epidemiology Unit, INT, Salvatore D Angelo

12 Contributors XVII Concetta D Orio Department of Clinical Medicine, Cardiovascular ed Immunologic Sciences, Gaetano De Rosa Department of Biomorfological and Functional Sciences, Unit of Pathology, Fernando De Vita Medical Oncology, Department of Clinical and Experimental Medicine F. Magrassi A. Lanzara, Second University of Naples, Carlo de Werra Armand Dhamo Department of Surgery, University of Sienna, Sienna, Italy Francesca Di Capua Eleonora De Maio Rosa Di Micco Giorgio Diamantis Concetta Dodaro Ivana Donzelli

13 XVIII Contributors Francesca Duraturo Department of Biochemistry and Biomedical Technologies, Federico II University, Antonio Farella Department of Biomorfological and Functional Sciences, Unit of Diagnostic Imaging and Radiotherapy, Stefano Federico Department of Systematic Pathology, Faculty of Medicine, Federico II University, Giuseppe Galloro Salvatore Gargiulo Arturo Genovese Department of Clinical Medicine, Cardiovascular ed Immunologic Sciences, Rosaria Gesuita Sebastiano Grassia Gennaro Ilardi Department of Biomorfological and Functional Sciences, Unit of Pathology, Michele Giuseppe Iovino Paola Izzo Department of Biochemistry and Biomedical Technologies, Federico II University,

14 Contributors XIX Akbar Jamshidi Lorenzo Lo Muzio Department of Biomorfological and Functional Sciences, Unit of Pathology, Pietro Lombari Vincenzo Macchia Department of Clinical Pathology, Faculty of Medicine, Federico II University, Luca Magno Surgical Sciences and Diagnostic and Therapeutic Advanced Technologies Ph.D. Course, Federico II University, Naples Angela Mariano Department of Clinical Pathology, Faculty of Medicine, Federico II University, Gianni Marone Department of Clinical Medicine, Cardiovascular ed Immunologic Sciences, Massimo Mascolo Department of Biomorfological and Functional Sciences, Unit of Pathology, Simone Maurea Department of Biomorfological and Functional Sciences, Unit of Diagnostic Imaging and Radiotherapy, Laura Moltoni Department of Surgery, University of Sienna, Sienna, Italy Maurizio Montella Epidemiology Unit, INT,

15 XX Contributors Loredana Nugnes Department of Biomorfological and Functional Sciences, Unit of Pathology, Gianclaudio Orabona Antonio Pastore Luigi Pelosio Matilde Pensabene Stefano Pepe Mario Perone Pierluca Piselli Department of Epidemiology, INMI L. Spallanzani IRCCS, Rome, Italy Andrea Renda Centre of Excellence for Innovative Technologies in Surgery Luigi Ricciardelli Gennaro Rizzo

16 Contributors XXI Eliana Rotaia Department of Systematic Pathology, Faculty of Medicine, Federico II University, Simona Ruggiero Enrico Russo Molecular Imaging Ph.D. Course, Federico II University, Naples Massimo Sabbatini Department of Systematic Pathology, Faculty of Medicine, Federico II University, Marco Salvatore Department of Biomorfological and Functional Sciences, Unit of Diagnostic Imaging and Radiotherapy, Michele Santangelo Alessandro Scotti Diego Serraino SOC Epidemiology & Biostatistics, CRO - IRCCS, Aviano (PN), Italy Giuseppe Spadaro Department of Clinical Medicine, Cardiovascular ed Immunologic Sciences, Ilaria Spagnoletti Sergio Spiezia

17 XXII Contributors Giuseppe Spinosa Stefania Staibano Department of Biomorfological and Functional Sciences, Unit of Pathology, Vincenzo Tammaro Gioacchino Tedesco Loredana Vecchione Medical Oncology, Department of Clinical and Experimental Medicine F. Magrassi A. Lanzara, Second University of Naples, Marius Yabi Massimiliano Zuccaro