A CASE OF QUINTUPLE CANCER COMPOSED OF UTERINE CANCER, PAGET'S DISEASE, CECAL CANCER, CANCER OF THE BLADDER AND HEPATOMA

A case of quintuple cancer including uterine cancer, Paget's disease, cecal cancer, cancer of the bladder and hepatoma which metachronously occurred during period of 34 years in a 69-year-old woman is reported. The patient had undergone a hysterectomy, radiation therapy and blood transfusion for a uterine cancer at age 37, resection of perineal skin widely for Paget's disease at age 60 and abdominoperineal resection for recurrence of Paget's disease at age 66, when she was pointed out liver cirrhosis. This time she was seen at the hospital because of sever anemia and diagnosted as having cecal cancer, cancer of the bladder and hepatoma. We can consider several pathogenic factors for multiple primary malignant tumors including radiation therapy and hereditary factors. It was inferred that etiologic factor in this case might be irradiation for the first uterine cancer, because all tumors except hepatoma arose in the pelvic organs which were involved in the irradiation therapy. Immunohistorical study for anti-oncogene factors showed that p-53 gene was overexpression in the cecal canncer, but not in other cancers. Retinoblastoma gene was positive in the cecal cancer and part of Paget's disease, but any findings suggestive of gene abnormality were not revealed. With a recent expansion of aged population and an improving trend of therapeutic result of the first cancer with a favorable prognosis, multiple primary cancer tends to increase. It is important to take a careful attitude not only for recurrence but also for possible multiple cancer.