Primary multiple cancer: a combination of gynecological and other types of cancer. Results of 5-year survival rate.

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Introduction. Malignant neoplasms are a serious problem in the world. According to statistics, in Russia every year more than four hundred thousand newly registered oncological diseases, while the mortality rate remains high. The clinical significance of primary multiple malignant tumors of the female genital organs is becoming increasingly important in the context of increasing morbidity and the absence of a noticeable trend towards a decrease in mortality from genital cancer. Studies show that in women who have had one oncological disease, the probability of developing a new malignant process can reach 20-30% of cases. Modern oncology is faced with the problem of the growth of malignant polyneoplasia - the simultaneous or sequential development of two or more tumors of different genesis in the same patient. This phenomenon, known as primary multiple tumors, is becoming more common, which is directly related to the general trend towards an increase in oncological morbidity. Of particular interest for this work is the increase in the number of cases among the female population, in which there is a significant increase in the incidence of hormone-dependent tumors, which is especially relevant for primary multiple pathology of the female reproductive system.
The aim of the work is to analyze the results of five-year survival of patients among the female population with malignant polyneoplasia.
Materials and methods of research. During the study, a retrospective analysis of the case histories of 32 women aged 36 to 85 years (mean age 61.3 ± 9.6 years) with established malignant polyneoplasia (synchronous and metachronous) for 2019-2024 was carried out. This study included patients with different degrees, as well as forms of the cancer process, namely with stages I, II, III and IV. The selection criteria for patients were the following oncogynecological pathologies: cancer of the cervix, uterine body, vagina, ovaries, fallopian tube in combination with oncological pathology of other organs. The selection of material was carried out on the basis of the budgetary healthcare institution of the Voronezh region "Voronezh Regional Clinical Oncology Dispensary".
During the study, a clinical analysis of the results of five-year survival of patients with malignant polyneoplasia was carried out.
The results of the study were statistically processed using standard methods of variation statistics. The median (Me) was used as a measure of central tendency, and the interquartile range (Q1-Q3) was used as a measure of variability. Differences were considered significant at a confidence level of at least 95%.
Study results. The survival of women with primary multiple cancer depends on several factors, including the type of cancer, the stage of the disease, the general health of the patient, as well as how quickly and effectively treatment was started. Hormone-dependent tumors account for a significant number of all cancer cases in women and often have a higher incidence and detection rate in certain age groups, especially postmenopausal women.
The study, based on case histories, yielded the following results.

Table 1
Average age of patients with primary multiple cancer.
Ovarian cancer Uterine body cancer Cervical cancer Vulvar cancer
57.5 years 65 years
56 years 67 years

It should be noted that the average age of patients with pathology of the female reproductive system in combination with neoplasms of other organs is from 56 to 67 years in certain subgroups. This suggests that this problem often occurs in the postmenopausal age.
Among the cancer pathologies of the female genital organs, the following act as the primary tumor: ovarian cancer, uterine body cancer, cervical cancer, vulvar cancer.
Table 2.
Incidence of primary multiple cancer
Localization of the first tumor

Localization of the second tumor Ovarian cancer
Breast cancer 5
Skin melanoma 2
Uterine body cancer 4
Colon cancer 2
Kidney cancer 1

Ovarian cancer took the leading place among primary cancer pathologies in women, which amounted to 14 cases (43.75%). The most frequent localization of the secondary tumor is breast cancer (35.71%), uterine body cancer (28.57%) and, in a lesser frequency, skin melanoma (14.3%), colon cancer (14.3%) and kidney cancer (7.14%). Of the hormone-dependent variants, a combination of ovarian cancer with breast and uterine body cancer is observed, which is 64.29% of the total number of patients in this group.
Table 3
Incidence of primary multiple cancer
Location of the first tumor

Location of the second tumor Uterine body cancer
Breast cancer 6
Primary peritoneal carcinoma 1
Rectal cancer 1
Retinal melanoma 2
Thyroid cancer 1
Kidney cancer 1

Uterine body cancer ranks second among the identified primary oncological pathologies in women and accounts for 12 cases (37.5%). The most common localization of the secondary process was breast cancer (50%), which is a hormone-dependent variant. Less frequent in occurrence are retinal melanoma (16.67%), primary peritoneal carcinoma (8.33%), rectal cancer (8.33%), thyroid cancer (8.33%), and kidney cancer (8.33%). Table 4
Incidence of primary multiple cancer
Location of the first tumor

Location of the second tumor Cervical cancer
Skin cancer 2
Fallopiate tube cancer 1
Cecum cancer 1
Bladder cancer 1
Cervical cancer is observed in only 5 cases, which is 15.63% of the total number of patients. Skin cancer as a secondary process occurs in 2 cases (40%), fallopian tube cancer - 1 case (20%), cecum cancer - 1 case (20%), bladder cancer - 1 case (20%).
Table 5
Incidence of primary multiple cancer
Location of the first tumor

Location of the second tumor Vulvar cancer
Kidney cancer 1
Vulvar cancer took the last place among women with primary multiple cancer - 1 case, which was 3.13% in combination with kidney cancer.
Table 6
Time interval between the occurrence of primary and secondary processes
Ovarian cancer Uterine body cancer Cervical cancer Vulvar cancer
Breast cancer - 9 years Breast cancer - 8.5 years Skin cancer - 6 years Kidney cancer - 4 months
Skin melanoma - 2 years Primary peritoneal carcinoma - 4 years Fallopian tube cancer - 3 months
Uterine body cancer - 2 years Rectal cancer - 3 years Cecum cancer - 1 year
Colon cancer - 8 years Kidney cancer - 1 year Bladder cancer - 25 years
Kidney cancer - 1 year Retinal melanoma - 9 years
Thyroid cancer - 7 years
The average time interval between the occurrence of the primary and secondary process was 5.6 years, which indicates the metachronous nature of the tumor process. But there is also a case of bladder cancer developing 25 years later (metachronous variant) and fallopian tube cancer just 3 months after the primary lesion was detected in the cervix (synchronous variant).
Table 7
Five-year survival results for different stages of gynecologic oncology pathology.
Ovarian cancer Uterine body cancer Cervical cancer Vulvar cancer
71.43% 75%
60% 100%

Table 5 presents the five-year survival results for primary multiple cancer in women. Based on the data obtained, we can say that the average survival rate is 76.6%, of which 71.43% is ovarian cancer, 75% is uterine body cancer, 60% is cervical cancer, and 100% is vulvar cancer.
It should also be noted that the most common primary cancer pathology of the female reproductive system was stage III-IV, namely 62.5% (20 patients). In ovarian cancer, death occurred in four patients, three of them with stage III of the primary process. In uterine body cancer, 3 patients died, but with stages I and II of the process. Slightly lower survival statistics are observed in cervical cancer - 60%. In vulvar cancer, survival was 100% (1 case).

Conclusion. Thus, after conducting a retrospective analysis, it was found that primary multiple cancer in women is a truly serious problem in modern oncology.
The most common variants of localization of the primary (gynecological) and secondary process were studied. It was noted that most often the primary variant was ovarian cancer, and the secondary one was breast cancer, and then colon cancer, skin melanoma, etc. Moreover, the prevailing number of women were observed with cancer pathology of stage III-IV.
It should be noted that the analysis of five-year survival rates demonstrated a fairly high level, amounting to 76.6%. The average time interval between the detection of the first and second tumors was 5.6 years, which indicates the need for long-term dynamic monitoring of patients, especially postmenopausal age. This study, despite the relatively small sample (n = 32), makes a significant contribution to understanding the features of the course and prognosis of primary multiple malignant neoplasms in women.

About the authors

Viktoria Sergeevna Samokhina

Author for correspondence.
Email: viktoria.samokhina.ss@mail.ru
ORCID iD: 0000-0002-9202-4397
Russian Federation, 10 Studencheskaya str., Voronezh, 394036, Russia.

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