FaCD Online Syndrome Fact Sheet

Last updated: 25 Jan 2008

Name: Hepatocellular Cancer, Multiple Primary Malignancies in Patients with

Tumor features

hepatocellular cancer (hepatoma)
leukemia, chronic lymphocytic (CLL)
multiple myeloma (Kahler's disease)
non-Hodgkin lymphoma

Tumor features (possible)

colon cancer
gastric cancer

Comment

In a consecutive series of 317 Italian patients with hepatocellular carcinoma, Di Stasi et al. observed that 10% had extra hepatic primary malignant neoplasms. B-lymphocyte-derived neoplasms (7 non-Hodgkin's lymphoma, 2 multiple myeloma, and 1 chronic lymphocytic leukemia) constituted half of the synchronous or metachronous cancers[1]. In a consecutive series of 146 Japanese patients with hepatocellular carcinoma 6.8% were found to have one or two extrahepatic malignancies (EHM)[2]. The associated malignancies included eight cases of gastric cancer and four cases of colon cancer. Among the 12 lesions, eight were in the early stage. All the 10 patients were hepatitis B surface antigen negative. The incidence of coexisting liver cirrhosis and the retention rate of indocyanin green in 15 minutes among HCCs with EHM were significantly lower than those among HCC alone. These results suggested to the authors that the etiology of HCC with EHM is different from the etiology of HCC alone in Japan.

General aspects to consider with respect to multiple primary tumors:
- Shared genetic (immune response, metabolic/hormonal/DNA-repair pathways) or non-genetic (chemical carcinogens, radiation, viruses, life-style) risk factors
- Therapy (radiation, chemotherapy, hormonal) related effects
- Possible bias because of increased surveillance and autopsy findings.

References

[1] Di Stasi M, Sbolli G, Fornari F, Cavanna L, Rossi S, Buscarini E, Civardi G, Vallisa D, Berte R, Buscarini L. Extrahepatic primary malignant neoplasms associated with hepatocellular carcinoma: high occurrence of B cell tumors. Oncology 1994; 51(5):459-464.
[2] Onitsuka A, Hirose H, Ozeki Y, Hino A, Senga S, Iida T. Clinical study on hepatocellular carcinoma with extrahepatic malignancies. Int Surg 1995; 80(2):128-130.