Journal of Cranio-Maxillofacial Surgery (1997) 25, 153-157 © 1997 European Association for Cranio-Maxillofacial Surgery Quintuple cancers: report of a case with triple cancers in the head and neck R. Martin-Granizo 1, L. Naval 1, P. Castro 2, C. Goizueta 1, M. Mufioz 1 1Department of Oral & Maxillofacial Surgery (Head." F. J. Diaz), ZDepartment of OtoIaryngology (Head." A. Hinojar), University "Hospital de la Princesa', School of Medicine, Aut6noma University of Madrid, Spain SUMMARY. The incidence of multiple primary cancers is increasing. We report a case of quintuple cancers, two located in the genitourinary tract and three arising on the upper aerodigestive tract, two synchronous squamous cell carcinomas of the oral mucosa and another on the larynx. We also present a brief review of the literature. INTRODUCTION Finding more than one cancer in a patient's lifetime is not uncommon. Since Billroth (1879) in the last century first described a second primary cancer in the same patient, several authors have reported large series of multiple malignancies in different organs or even in the same area (Mallagray et al., 1987; Robinson et al., 1991; Choy et al., 1992; Jones et al., 1995; Nakahara et al., 1995; Sturgis and Miller, 1995; Suryanarayana, 1996). However, triple, quadruple and even quintuple cancers are extremely unusual, although some cases have been reported (Tanaka et al., 1994; Yoneyama et al., 1995; Sakashita et al., 1996). Some authors have pointed out an increasing incidence of these multiple primary tumours (Fijuth et al., 1992; Jones et al., 1995; Robinson and Neugut, 1995; Sturgis and Miller, 1995). CASE REPORT A 61-year-old male consulted the department of Oral & Maxillofacial Surgery at the University 'Hospital de la Princesa', Madrid, Spain, complaining of a lesion on the floor of his mouth. The patient had the following medical history: On physical examination, no cervical lymph nodes were detected, so diagnosis of a T4, No, M o (stage IV) SCC was made (American Joint Committee on Cancer, 1988). The patient underwent a total laryngectomy with an ipsilateral (right) selective supra-omohyoid neck dissection (levels I, II, and III) (Spiro et al., 1988; Shah, 1990), and the histological report on the specimen showed a moderately differentiated SCC with no metastatic cervical lymph node involvement. Second cancer The patient stopped smoking, and 3 years later presented to the emergency room complaining of dysuria for 15 days with haematuria. He was treated in the Urology Department at the same hospital. The blood analysis showed a haemoglobin of 9.39 gr/dl with a haematocrit of 27.29%. On urine analysis, 11-20 erythrocytes and 11-20 leucocytes per field were found. Ultrasonography was carried out, which revealed a vesical globus along with two masses located on the lateral left surface and over the neck of the urinary bladder. Therefore, the patient under- went resection of the masses transurethrally. The histopathological examination report showed vesical urothelial papillary carcinoma grade II (stage 0). First cancer Three years previously, the patient, with a 2 month history of slowly increasing hoarseness, consulted the Otolaryngology Department. The patient had been a heavy smoker (60 cigarettes per day) and drinker for many years and his father had died of a laryngeal cancer. Panendoscopy revealed oedema of both vocal cords with an ulcerated lesion on the right cord that invaded the laryngeal ventricle and surrounding tis- sues. A biopsy was obtained and the histological analysis showed a squamous cell carcinoma (SCC). 153 Third cancer At the postoperative follow-up examination, a pros- tatic enlargement was noticed. Biopsy revealed a well- differentiated prostatic adenocarcinoma. A computed tomography scan (CT) of the spinal cord was per- formed which revealed several radiodense bone lesions suggesting prostatic metastases inside the lumbar vertebra. As a result, the patient is under hormonal therapy with 750 mg/day oral flutamide, an antiandrogen drug, with an optimal response.