Synchronous dual malignancies: Carcinoma larynx and hepatocellular carcinoma

Abstract

Synchronous cancers are defined as two or more primary cancers diagnosed in the same patient at the same time or within 6 months of diagnosis of each other. The diagnosis of multiple primary malignancies is not uncommon. A 70-year-old male reported to our hospital with chief complaints of change in voice and difficulty in swallowing solid food for 2 months accompanied anorexia since 20 days. The patient revealed occasional consumption of alcohol for 3 years and bidi smoking for 50 years (10 bidis per day). The patient was conscious, cooperative, and well oriented to time, place and person with an Eastern Cooperative Oncology Group of 0. On physical examination, the oral cavity and oropharynx were unremarkable. Direct laryngoscopy revealed ulceroproliferative growth in right-sided vallecula, right-sided aryepiglottic fold, right side arytenoid and pyriform sinus, and right vocal cord. Biopsy from this growth turned out to be poorly differentiated squamous cell carcinoma. Computed tomography (CT) scan of the neck and thorax revealed 1.5 cm × 2.6 cm heterogeneously contrast enhancing lesion involving right aryepiglottic fold, pyriform fossa, posterior hypopharyngeal wall, and posterior aspect of both false vocal cords. Few subcentimeter lymph nodes were noted in right side Level II. The CT scan also showed some mass lesion abnormality in the upper section of liver images which could not be properly made out. Hence, triple-phase CT scan of the liver was done which to a great surprise showed 7.7 cm × 6.5 cm × 5.5 cm lesion in segment V and VIII, it showed enhancement on arterial phase, became prominent on portovenous phase and a delayed phase washout. Similar lesion measuring 4.4 cm × 4.1 cm was seen in segment VIII of liver; which was diagnosed radiologically as a multicentric hepatocellular carcinoma. Serum alpha fetoprotein was markedly elevated to a value of 28,600 ng/mL. A multidisciplinary tumor board discussion was done, and an intense literature review was done, and a decision was taken keeping in mind the overall performance score of the patient to commence with a high palliative radiotherapy for laryngeal cancer to a dose of 45 Gray in 15 fractions at a dose of 3 Gray per fraction and tablet tamoxifen at a dose of 60 mg/day till the end of radiation followed by switching over to tablet sorafenib. The patient ultimately developed uremia due to liver failure and died. The patient survived for a period of 3 months from the time of diagnosis of malignancy. Such cases need a meticulous approach for the diagnosis as well as treatment approaches. Keeping in mind the general condition of the patient and available therapeutic options, a patient-based specific approach could be developed.