- Childhood cancer survivors have an increased risk of a second cancer later in life.
- Certain genetic patterns or syndromes may increase the risk of a second cancer.
- Patients who have been treated for cancer need regular screening tests to check for a second cancer.
- The kind of test used to screen for a second cancer depends in part on the kind of cancer treatment the patient had in the past.
Childhood cancer survivors have an increased risk of a second cancer later in life.
A different primary cancer
that occurs at least two months after cancer
treatment ends is called a second cancer. A second cancer may occur months or years after treatment is completed. The type of second cancer that occurs depends in part on the original type of cancer and the cancer treatment. Benign tumors
(not cancer) may also occur.
Second cancers that occur after cancer treatment include the following:
that may appear more than 10 years after primary cancer diagnosis
and treatment include the following:
- Breast cancer
chest radiation treatment
for Hodgkin lymphoma. Treatment with low-dose chest radiation
may also increase breast cancer risk.
- Breast cancer in patients who were treated with alkylating agents
but not with chest radiation. The risk is highest in sarcoma
and increases with higher doses of radiation.
- Thyroid cancer
after neck radiation treatment for Hodgkin lymphoma, acute lymphocytic leukemia, or brain tumors
; after radioactive iodine
; or after total-body irradiation
(TBI) as part of a stem cell transplant.
- Brain tumors
after radiation treatment to the head and/or intrathecal chemotherapy
for a primary brain tumor or for cancer that has spread to the brain or spinal cord, such as acute lymphocytic leukemia or non-Hodgkin lymphoma. When intrathecal chemotherapy using methotrexate and radiation treatment are given together, the risk of a brain tumor is even higher.
- Bone and soft tissue
tumors after radiation treatment for retinoblastoma, Ewing sarcoma, and other cancers of the bone. Chemotherapy
or alkylating agents
also increases the risk of bone and soft tissue tumors.
- Lung cancer
after radiation treatment to the chest for Hodgkin lymphoma, especially in patients who smoke.
- Stomach, liver, or colorectal cancer
after radiation treatment to the abdomen. The risk increases with higher doses of radiation. Treatment with chemotherapy alone or chemotherapy and radiation treatment combined also increases the risk of stomach, liver, or colorectal cancer.
- Nonmelanoma skin cancer
(basal cell carcinoma
or squamous cell carcinoma) after radiation treatment; it usually appears in the area where radiation was given. Being exposed to UV radiation
may increase this risk. Patients who develop nonmelanoma skin cancer after radiation treatment have an increased chance of developing other types of cancers in the future.
- Malignant melanoma
after radiation or combination chemotherapy
with alkylating agents and antimitotic drugs
(such as vincristine
and vinblastine). Survivors
of Hodgkin lymphoma, hereditary
retinoblastoma, soft tissue sarcoma, and gonadal
tumors are more likely to be at a higher risk of having malignant melanoma. Malignant melanoma as a second cancer is less common after treatment than nonmelanoma skin cancer.
- Oral cavity cancer
after stem cell transplant and a history
- Kidney cancer
after treatment for neuroblastoma, radiation treatment to the middle of the back, or chemotherapy such as cisplatin
- Bladder cancer
after chemotherapy with cyclophosphamide.
Myelodysplastic syndrome and acute myeloid leukemia may appear less than 10 years after a primary cancer diagnosis of Hodgkin lymphoma, acute lymphoblastic leukemia, or sarcoma
and treatment with chemotherapy that included the following:
Certain genetic patterns or syndromes may increase the risk of a second cancer.
Some childhood cancer survivors may have an increased risk of developing a second cancer because they have a family history
of cancer or an inherited
such as Li-Fraumeni syndrome. Problems with the way DNA
is repaired in cells
and the way anticancer drugs
are used by the body may also affect the risk of second cancers.
Patients who have been treated for cancer need regular screening tests to check for a second cancer.
It is important for patients who have been treated for cancer to be checked for a second cancer before symptoms
appear. This is called screening
for a second cancer and may help find a second cancer at an early stage. When abnormal
or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread.
It is important to remember that your child's doctor does not necessarily think your child has cancer if he or she suggests a screening test. Screening tests are given when your child has no cancer symptoms.
If a screening test result is abnormal, your child may need to have more tests done to find out if he or she has a second cancer. These are called diagnostic tests.
The kind of test used to screen for a second cancer depends in part on the kind of cancer treatment the patient had in the past.
All patients who have been treated for cancer should have a physical exam
and medical history
done once a year. A physical exam of the body is done to check general signs
of health, including checking for signs of disease, such as lumps, changes in the skin, or anything else that seems unusual. A medical history is taken to learn about the patient’s health habits and past illnesses and treatments.
If the patient received radiation therapy, the following tests and procedures may be used to check for skin, breast, or colorectal cancer:
Skin exam: A doctor or nurse
checks the skin for bumps or spots that look abnormal in color, size, shape, or texture, especially in the area where radiation was given.
It is suggested that a skin exam be done once a year to check for signs of skin cancer.
Breast self-exam: An exam of the breast
by the patient. The patient carefully feels the breasts and under the arms for lumps or anything else that seems unusual. It is suggested that women treated with a higher dose of radiation therapy to the chest do a monthly breast self-exam beginning at puberty
until age 25 years. Women who were treated with a lower dose of radiation to the chest may not need to begin checking for breast cancer at puberty. Talk to your doctor about when you should begin breast self-exams.
Clinical breast exam
(CBE): An exam of the breast by a doctor or other health professional. The doctor will carefully feel the breasts and under the arms for lumps or anything else that seems unusual.
It is suggested that women treated with a higher dose of radiation therapy to the chest have a clinical breast exam every year beginning at puberty until age 25 years. After age 25 years or 8 years after radiation treatments end (whichever is first), clinical breast exams are done every 6 months. Women who were treated with a lower dose of radiation to the chest may not need to begin checking for breast cancer at puberty. Talk to your doctor about when you should begin clinical breast exams.
Mammogram: An x-ray
of the breast. A mammogram may be done in women who had a higher dose of radiation to the chest and who do not have dense breasts.
It is suggested that these women have a mammogram once a year starting 8 years after treatment or at age 25 years, whichever is later. Talk to your doctor about when you should begin to have mammograms to check for breast cancer.
(magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of the breast. This procedure is also called nuclear magnetic resonance imaging (NMRI). An MRI may be done in women who had a higher dose of radiation to the chest and who have dense breasts. It is suggested that these women have an MRI once a year starting 8 years after treatment or at age 25 years, whichever is later. If you had radiation to the chest, talk to your doctor about whether you need an MRI of the breast to check for breast cancer.
Colonoscopy: A procedure to look inside the rectum
for polyps, abnormal areas, or cancer. A colonoscope
is inserted through the rectum into the colon. A colonoscope is a thin, tube-like instrument with a light and a lens
for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope
for signs of cancer. It is suggested that childhood cancer survivors who had a higher dose of radiation to the abdomen, pelvis, or spine
have a colonoscopy every 5 years. This begins at age 35 years or 10 years after treatment ended, whichever is later. If you had radiation to the abdomen, pelvis, or spine, talk to your doctor about when you should begin to have a colonoscopies to check for colorectal cancer.
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