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Multiple primary tumours: challenges and approaches, a review
  1. Alexia Vogt1,2,
  2. Sabine Schmid1,
  3. Karl Heinimann3,4,
  4. Harald Frick5,
  5. Christian Herrmann5,
  6. Thomas Cerny1,
  7. Aurelius Omlin1,2
  1. 1 Department of Oncology and Haematology, Kantonsspital St. Gallen, St.Gallen, Switzerland
  2. 2 Oncology, Inselspital and University of Berne, Berne, Switzerland
  3. 3 Medizinische Genetik, Universittsspital Basel, Basel, Switzerland
  4. 4 Research Group Human Genomics, Zentrum für Lehre und Forschung, Labor 317/319, Department Biomedizin, University of Basel, Basel, Switzerland
  5. 5 Cancer Registry St. Gallen and Appenzell, St. Gallen, Switzerland
  1. Correspondence to Aurelius Omlin, Department of Oncology and Haematology, Kantonsspital St.Gallen, Rorschacherstrasse 959007 St .Gallen, Switzerland; aurelius.omlin{at}


When in a patient more than one tumour in the same or a different organ is diagnosed, multiple primary tumours may be present. For epidemiological studies, different definitions of multiple primaries are used with the two main definitions coming from the project Surveillance Epidemiology and End Results and the International Association of Cancer Registries and International Agency for Research on Cancer. The differences in the two definitions have to be taken into consideration when reports on multiple primaries are analysed. In this review, the literature on multiple primaries is reviewed and summarised. Overall, the frequency of multiple primaries is reported in the range of 2–17%.

Aetiological factors that may predispose patients to multiple primaries can be grouped into host related, lifestyle factors and environmental influences. Some of the most common cancer predisposition syndromes based on a clinical presentation are discussed and the relevant genetic evaluation and testing are characterised.

Importantly, from a clinical standpoint, clinical situations when multiple primaries should be suspected and ruled out in a patient are discussed.

Furthermore, general principles and possible treatment strategies for patients with synchronous and metachronous multiple primary tumours are highlighted.

  • Multiple primary cancer
  • second cancer
  • multiple primaries
  • secondary primary
  • epidemiology
  • genetic predisposition

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors We confirm that all co-authors have contributed to the generation of the manuscript.

  • Competing interests AO: advisory role (compensated, institutional): Astellas, Bayer, Sanofi, Roche, Janssen. Research support (institutional): Teva, Janssen. Travel support: Astellas, Bayer, Sanofi, Roche. SS: advisory role (compensated institutional): Böhringer Ingelheim, BMS. AV, KH, HF, CH and TC report no competing interests.

  • Provenance and peer review Commissioned; externally peer reviewed.

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