Quadruple Primary Malignancies in an Old Male Smoker Treated with Cooperative Surgery

The patients with head and neck cancers are frequently elderly with history of smoking that may harbor possibilities of multiple primary malignancies. Recent use of PET-CT as an initial diagnostic tool facilitates the finding of unexpected primary malignancies. Here we present a case of quadruple primary malignancies treated with cooperative surgery. A 66 year-old male presented with sore throat. He was identified as a current smoker and had a history of alcohol ingestion. Physical examination followed by office-based biopsy revealed supraglottic squamous cell carcinoma. Imaging studies including PET-CT found multiple suspicious malignant lesions involving thyroid gland, esophagus, sigmoid colon as well as the larynx. Further multidisciplinary consultation suggested that all of the evaluation lesions were primary malignancies without evidence of systemic spread. The patient underwent cooperative surgery ; supraglottic partial laryngectomy with neck dissection for supraglottic cancer, left hemithyroidectomy for thyroid cancer, Ivor Lewis operation for esophageal cancer, lower anterior resection for colon cancer. Careful postoperative care was provided without a complication. Office-based observation has been ongoing without an evidence of recurrence. (J Clinical Otolaryngol 2015;26:312-316)