FaCD Online Syndrome Fact Sheet

Last updated: 26 Jan 2011

Name: Brain Tumors, Multiple Primary Malignancies in Patients with

Tumor features

breast cancer
colorectal cancer
glioblastoma (multiforme)
glioma of the brain
lymphoma, malignant (Non-Hodgkin and/or Hodgkin)
melanoma, cutaneous
non-Hodgkin lymphoma
primitive neuroectodermal tumor (PNET)
urinary bladder cancer


Ahsan et al.[1] used SEER data to calculate relative risks (RR) of primary brain tumors following other tumors. Significant associations were: bladder cancer in men (RR 1.7, 95% CI 1.2-2.3), sarcoma in men (4.4, 1.8-9.0), leukemia in men (2.9, 1.6-4.8) and colorectal cancer in women(1.8, 1.3-2.4). The highest RR observed was for CNS lymphoma following any first primary tumor in men (7.9, 5.5-11.0).
Schoenberg et al.[2] studied 135 Connecticut residents with multiple primary tumors and at least one CNS tumor. Only the combination of brain and breast tumor significantly exceeded expected numbers.
Salminen et al.[3] studied the risk of primary cancer following brain tumors in patients from the Finnish cancer registry. A significant excess risk of tumors in the central nervous system (including meningeomas) (SIR 2.6, 95% CI 1.7-3.8), non-Hodgkin's lymphoma (2.6, 1.6-4.1) and skin melanoma (1.9, 1.0-3.1) was observed. The authors concluded that brain tumors are associated with an increased risk of both CNS second tumors and non-CNS second cancers, especially non-Hodgkin's lymphoma and melanoma. A moderately increased risk of second tumors in the CNS was observed among brain tumor patients treated with surgery only and a larger excess among those treated with radiotherapy.

General aspects to consider with respect to multiple primary tumors:
- Shared genetic (immune response, metabolic/hormonal/DNA-repair pathways) or non-genetic (chemical carcinogens, radiation, viruses, life-style) risk factors
- Therapy (radiation, chemotherapy, hormonal,...) related effects
- Possible bias because of increased surveillance and autopsy findings.


[1] Ahsan H, Neugut AI, Bruce JN. Association of malignant brain tumors and cancers of other sites. J Clin Oncol 1995; 13(12):2931-2935.
[2] Schoenberg BS, Christine BW, Whisnant JP. Nervous system neoplasms and primary malignancies of other sites. The unique association between meningiomas and breast cancer. Neurology 1975; 25(8):705-712.
[3] Salminen E, Pukkala E, Teppo L. Second cancers in patients with brain tumours--impact of treatment. Eur J Cancer 1999; 35(1):102-105.
[4] Neglia JP, Robison LL, Stovall M, Liu Y, Packer RJ, Hammond S, Yasui Y, Kasper CE, Mertens AC, Donaldson SS, Meadows AT, Inskip PD. New primary neoplasms of the central nervous system in survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Journal of the National Cancer Institute 2006; 98(21):1528-37.