CASE STUDY

Triple Primary Lung Cancer : A Case of Multiple Primary Lung Cancer (MPLC)

Abstract

This case study presents a 76 year-old male parking attendant diagnosed with triple primary lung cancer of different histologic types. The patient had a long history of smoking, chronic obstructive pulmonary disease (COPD) and occupational exposure to automobile exhaust fumes, he developed three distinct lung cancers, over time. Each cancer requiring a different treatment approaches, including stereotactic radiosurgery (SRS) and chemoradiation. This highlighting  the importance of early detection and continuous monitoring in high risk individuals.

Introduction 

Multiple primary lung cancer (MPLC) is a condition in which two or more independent primary lung cancer are seen in the same individual. Differentiating MPLC from metastatic lung cancer is significant for determining the most efficient treatment method. Smoking, exposure to environmental carcinogen and pre-existing lung diseases such as COPD, contributes to the increased risk of developing MPLC. In this case  the importance of early detection, continuous monitoring, and personalized treatment strategies have been highlighted to play a crucial role in managing MPLC.

Case Presentation

Patient Information

• Age & Gender : 76-year-old male 

• Occupation : Parking attendant

• Smoking History : 50-pack-year smoking history

• Medical History : Chronic obstructive pulmonary disease 

• Exposure History : Long -term occupational exposure to automobile exhaust fumes.

• Family History : No significant history of lung cancer

• Treatment Preference : Previously refused surgical treatment

Diagnosis 

Over a period of time, the patient was diagnosed with 3 separate lung cancers are listed below:

• First Tumor (Adenocarcinoma, Right upper lobe-RUL) : Detected through CT Scan imaging & biopsy.

• Second Tumor (Squamous cell carcinoma, RLL) : Found 22 months later on follow-up imaging.

• Third Tumor (small cell lung cancer, LLL) : Identified 29 months after initial diagnosis, confirmed by imaging & histopathology due to aggressive progression.

Treatment Plans

• First tumor which is adenocarcinoma treated with stereotactic  radiosurgery (SRS) as surgery was refused.

• Squamous cell carcinoma which is second tumor detected 22 months later and treated with SRS.

• In tumor-free period there is no active tumors detected between treatments.

• Small cell lung cancer found 29 months after initial diagnosis and then treated with chemoradiation.

• Outcome : Cancer managed with continuous treatment, emphasizing the need for regular follow-ups and early detection.

Discussion

This case study highlights the occurrence of three separate primary lung cancers instead of metastatic spread, supporting the MPLC concept. In this patient smoking, COPD, and exposure to automobile exhaust these are the major risk factors. Regular CT screening played a key role in detecting tumors early, which is crucial for high-risk individuals. Treatment decisions were made based on tumor type, location, and patient preference, emphasizing the importance of personalized cancer management. 

Conclusion 

MPLC is a highly complicated condition which requires to be carefully distinguish from metastatic lung cancer for accurate detection and treatments. Managing the risk factors, early detection and making the patient aware about a condition plays an extremely important role in improving the results. Quitting the habit of smoking, minimizing exposure to environmental pollutants and regular follow-ups are crucial for preventing and managing lung cancer effectively.