Multiple Primary Lung Cancers:One Case Report And Review Of The Literatures

Objective:To improve the knowledge of mutiple primary lung cancer in pathogenesis, diagnosis, differential diagnosisi and treatment methods.Materials and methods:A case of mutiple primary lung cancer patient is reported in QiLu hospital of shandong university. Relevant literatures-64patients with mutiple primary lung cancer are reviewed.Results:Multiple primary lung cancer is a rare disease in clinic.It’s incidence is1%-10%n all lung cancers. Double primary lung cancer is the most common. The50-70years old men are prone to get the disease than women. Smoking, radical and chemical therapy, carcinoma family history are the most dangerous elements. The pathogenesis is unclear, now the majority of experts agree with the hypothesis of field cancerization, and the p53plays an imprortant role in the field cancerization of mutiple primary lung cancer. The continuing effects duing to smoking and other carcinogenic factors cause the genetic mutation of the airway epithelium,the first mutation of p53alleles in a locus, which is also the earliest to start, makes the lungs having muticentric field cancerization simultaneously.When the alleles mutate entirely, it causes epithelial cell proliferation abnormalities and apoptosis obstacles. Due to the disorder of the regulation mechanism in tumor progression, other proto-oncogenes can also be activated, so there is a higher proportion of second primary cancer after treatment of early stage lung cancer. The manifestations of the disease are nonspecific compared with single lung cancer, such as Cough, blood-stained sputum, fever, chest pain, chest tightness. In later period, it can violate or oppress the neighboring tissues, organs, or metastasis to cause the corresponding symptoms.The most common diagnosing standard used in clinic is the Martini and Melamed standard, but it is very diffcult to make a preoperative diagnosis correctly. Conventional detection is not specific and the disease is easy to misdiagnosis. The diagnosis is determined mainly by postoperative pathologic detection, only a few cases can be diagnosed by fiberoptic bronchoscopic biopsy preoperatively.It is difficult to distinguish the multiple primary lung cancer, pulmonary metastasis and recurrence. Mutiple primary lung cancer does not have the guideline of treatment for its own, the total principle of treatment is similar to the single lung cancer. The treatment is given priority to surgical treatment with chemotherapy, radiotherapy, targeted therapy, traditional Chinese medicine and immune therapy. Those who is elder, in advanced stage or can not tolerate surgery may be used the nonoperative treatment method to control the illness.Conclusion:Mutiple primary lung cancer is rare in clinic. Although it has the diagnosis standard, it is difficult to diagnose and distinguish with pulmonary metastasis and recurrence, especially when they have the same histologic type. Mutiple primary lung cancer does not have the guideline of treatment for its own, the total principle of treatment is similar to the single lung cancer. There are still many problems needed to be solved in diagnosis and treatment, so the right diagnosis and reasonble choice of the individual treatment scehemes play an important role in the prognosis of the multiple pirmary lung cancer.