Two to three decades ago, multiple primary malignancies (MPM) were considered to be simply a clinical curiosity, with sporadic reports, mostly single case descriptions, found in the literature. While in the last few years, analyses of larger series have been published, the number of cases has still been relatively small and most of the reports have addressed a single type of primary tumor and its associations.

With the improved prognosis and survival of cancer patients, MPM is becoming increasingly prevalent in this population, necessitating a better understanding of the characteristics and associations of the malignancies involved. Thus, as a prerequisite, a universal definition and an internationally accepted classification system, based on chronological, pathological, clinical, and other parameters, are needed. Moreover, much remains to be learned about the etiology of MPM, whether genetic, iatrogenic, or environmental.

Several of the hereditary syndromes, such as familial adenomatous polyposis, hereditary non-polyposis colorectal cancer, hereditary breast-ovarian cancer, and multiple endocrine neoplasia, are already well-known and their characteristics in relation to MPM must be kept in mind. Nonetheless, along with these syndromes, there are sporadic and apparently casual associations between primary neoplasms that can involve almost any part of the body.

This volume points out the clinical aspects of MPM and discusses the diagnostic and therapeutic problems that are encountered in treating these patients. "DNA-guided" surgery, currently confined to the treatment of patients with hereditary syndromes, will, along with other novel treatment strategies, no doubt play an increasingly greater role in the therapy of MPM.

This work presents state-of-the-art information about MPM that is aimed at a broad range of medical specialists, including surgeons, endoscopists, oncologists, and geneticists,. The goal is to improve our understanding of this group of diseases as well the treatment of these patients.

Zusammenfassung
In 2006, when my colleague Andrea Renda proposed multiple primary malignancies (MPM) as the subject of the Biennial Report to the 2008 Congress of the Italian - ciety of Surgery, I, together with the Steering Committee, quickly agreed. Recent progress in our understanding of the etiopathology of these neoplasms has led to - novative and significant progress on the clinical level. Importantly, the incidence of the onset of two or more tumors in the same patient suggests a more than casual - lationship. Furthermore, the occurrence of MPM derives from several different me- anismsviral, iatrogenic, immunologic, environmental, and hereditarysuch that any form of treatment must take into account the etiology of these tumors. After an epidemiological introduction, this monograph analyzes various aspects of multitumoral syndromes based on the experience of the Department of Surgical Sciences, along with that of other clinical departments of the University Federico II of Naples. In the discussion of inherited tumors, reference is made to the series of patients treated at the Department of Surgery at the University of Siena. The many topics that comprise this volume range from carcinogenesis to diagnostic strategies, and from epidemiology to innovations in imaging and endoscopic techniques. Among the clinical aspects, particular emphasis is given to sporadic and hereditary syndromes, as these patients are frequently treated by general surgery departments.

Inhalt
Nosography.- Epidemiology: Data from Cancer Registries.- Bioinformatics in MPM: Using Decision Trees To Predict a Second Tumor Site.- Carcinogenesis.- Iatrogenic Second Tumors.- Immunodeficiency and Multiple Primary Malignancies.- Multiple Primary Malignancies and Human Papilloma Virus Infections.- The Hereditary Syndromes.- Multifocal and Multicentric Tumors.- The Cancer Spectrum Related to Hereditary and Familial Breast and Ovarian Cancers.- The Role of Genetic Predisposition and Environmental Factors in the Occurrence of Multiple Different Solid Tumors. The Experience of the University Hospital of Sienna.- Sporadic Colorectal Tumors in Multiple Primary Malignancies.- Multiple Primary Malignancies: Non-codified Associations.- Laboratory for Patients at Risk of Multiple Primary Malignancies.- Multiple Primary Malignancies: Role of Advanced Endoscopy To Identify Synchronous and Metachronous Tumors of the Digestive Tract.- Diagnostic Imaging Techniques for Synchronous Multiple Tumors.- DNA-Guided Therapy.- Chemoprevention.- Conclusions.