1. Case Series of Dual Malignancies

Case 1: Synchronous Breast and Renal Cancer
  • A 64-year-old woman was diagnosed with left breast cancer.
  • Staging with PET-CECT revealed an incidental right renal mass, suggestive of renal cell carcinoma (RCC).
  • She underwent modified radical mastectomy (MRM) for breast cancer and radical nephrectomy for RCC.
  • Histopathology (HPR) confirmed pT2N0 breast cancer and clear cell RCC.
  • Due to a high Ki-67 index, she received adjuvant chemotherapy and is now on hormonal therapy for breast cancer management.
Case 2: Cervical Cancer with Incidental Thyroid and Colonic Lesions
  • A 62-year-old woman was diagnosed with Stage IIb cervical cancer.
  • Staging PET-CECT revealed an incidental thyroid nodule and colonic polyps.
  • Thyroid FNAC confirmed Papillary Thyroid Carcinoma (PTC), and colonoscopy revealed high-grade dysplasia in the polyps.
  • She underwent colonoscopic polypectomy, followed by definitive chemoradiation for cervical cancer.
  • After completing radiation, she underwent total thyroidectomy, which confirmed classic PTC with no high-risk features.
  • Follow-up PET-CT and colonoscopy after six months showed no residual disease and no precancerous polyps.
  • Genetic testing identified a germline RAD51D mutation, indicating a predisposition to multiple malignancies.
    • Watch the patient testimonial here:
    Case 3: Dual Primary - Rectal and Prostate Cancer
  • A 66-year-old man presented with oligometastatic rectal cancer with lung nodules and locally advanced prostate cancer.
  • He received total neoadjuvant therapy (TNT) for rectal cancer and radical radiotherapy with hormonal therapy for prostate cancer.
  • Response scans and tumor markers showed remarkable response at the primary sites and complete resolution of lung nodules.
  • He underwent a laparoscopic low anterior resection (challenging due to post-radiation fibrosis) and bilateral scrotal orchidectomy.
  • HPR findings: Residual moderately differentiated adenocarcinoma with negative margins and complete total mesorectal excision.

    • 2. Successful Uniportal VATS Left Lower Lobectomy

  • A 65-year-old man with hypertension and diabetes, previously treated for squamous cell carcinoma of the upper esophagus with definitive chemoradiation, presented with a left lower lobe lung mass.
  • PET-CECT confirmed a non-metastatic lung tumor, and biopsy revealed adenosquamous carcinoma.
  • After discussion in a tumor board, it was classified as a second primary malignancy, and he underwent Uniportal VATS Left Lower Lobectomy.
  • Postoperatively, he demonstrated excellent recovery with:
    • Pain-free ambulation and good spirometry effort within 24 hours.
    • Full lung expansion on X-ray.
    • Chest drain removal by post-op day 4 and discharge readiness.
  • Lung resections require exceptional precision, and Uniportal Video-Assisted Thoracoscopic Surgery (VATS) enhances patient recovery compared to multiportal VATS or open thoracotomy.
  • Uniportal VATS has significantly improved patient outcomes and recovery times.
  • This is likely one of the first such procedures in our region.

    • 3. Total Gastrectomy with D2 Lymphadenectomy and Jejunal Pouch Reconstruction

    • A 59-year-old man, with no significant comorbidities, was diagnosed with locally advanced gastric cancer.
    • He received four cycles of FLOT regimen (perioperative chemotherapy) before surgery.
    • He underwent Total Gastrectomy with D2 Lymphadenectomy and reconstruction using a Jejunal Pouch with Roux-en-Y Esophagojejunostomy.
    • HPR confirmed an R0 resection (negative margins).
    • He successfully completed adjuvant chemotherapy.
    Benefits of the Jejunal Pouch Reconstruction
    • Reduced Post-Gastrectomy Symptoms: Helps minimize early dumping syndrome, reflux, and postprandial discomfort.
    • Enhanced Quality of Life: The patient reported better meal tolerance, reduced postprandial bloating, and improved weight maintenance compared to traditional Roux-en-Y alone.
    • This approach significantly enhanced the patient’s postoperative recovery and long-term nutritional well-being.
    Dr. Harshit Srivastava

    Associate Director

    Institute Of Chest Surgery, Chest

    Onco-Surgery & Lung Transplantation

    Medanta, Sector 38, Gurugram

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    Apollomedics Hospital, Sector B, Bargawan, LDA Colony, Lucknow, Uttar Pradesh 226012


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