Survivorship: Cancer After Cancer

Autor: OncoLink Team
Última Vez Revisión: 2 de octubre de 2019

Research has found that cancer survivors have a higher chance of getting another cancer (different from the first one) than someone who has not had cancer. It seems really unfair that someone who has gone through cancer treatment could have to face another cancer diagnosis. It is important to remember that this risk is still quite low. Knowing about your risk and taking steps to reduce it can help you feel in control.

There are a few ways a cancer survivor might experience cancer again:

  • A secondary cancer: these cancers are caused by the treatment for an earlier cancer. This is quite rare, but some treatments have a higher risk of this happening.
  • A new, unrelated cancer. Just because you had one type of cancer does not mean you cannot get another type of cancer too.
  • Lastly, the original cancer can come back. This is called a recurrence.

What treatments can put a survivor at risk of developing a secondary cancer?

A secondary cancer is one that is caused by cancer treatment for another cancer. This is quite rare, but you should be aware of the risk. This can be caused by certain chemotherapy medicines or radiation therapy.

  • Chemotherapy medicines with this risk can include:
    • Anthracyclines (adriamycin, daunorubicin, doxorubicin, epirubicin, idarubicin, and mitoxantrone).
    • Alkylating agents (nitrogen mustard, cyclophosphamide, ifosfamide, melphalan, chlorambucil, carmustine, lomustine, busulfan, dacarbazine, bendamustine, BCNU, thiotepa).
    • Etoposide (VP-16) and teniposide.
    • Cisplatin, Carboplatin.
    • Radiolabeled monoclonal antibodies (Zevalin, Azedra, and Bexxar).
    • Arsenic trioxide, thalidomide, and lenalidomide.
    • PARP Inhibitors (niraparib, rucaparib, olaparib, talazoparib).

Radiation therapy increases the risk of cancer developing in or near the treatment field. This occurs as a result of healthy tissue being exposed to the radiation. Radiation is the most common cause of secondary cancer in people treated for childhood cancers. Modern radiation techniques are designed to limit this exposure, but it is not always possible to prevent all exposure and still achieve the desired outcomes.

What types of secondary cancers can occur?

  • Certain chemotherapy medications can cause damage to the blood cells in the bone marrow. In rare cases, this damage can lead to leukemia or myelodysplasia (MDS) years after treatment.
  • Blood cancer caused by chemotherapy or radiation therapy typically occurs 4-10 years after treatment but can occur even later.
  • One exception is those cancers caused by etoposide (VP-16) or teniposide (two types of chemotherapy), which tend to occur within 1-3 years after therapy.
  • The medication bendamustine can lead to secondary blood cancers. This medication may also cause secondary lung cancers.
  • Radiation therapy has a risk of causing cancer in the areas included in the treatment field. These are often "solid tumors" or those affecting organs or tissues/bone. For example, women who received chest radiation for Hodgkin lymphoma are at a high risk of developing breast cancer later in life.

What other things can increase the risk of developing a secondary cancer?

The same things you may think of as increasing the risk of cancer can also increase the risk of a secondary cancer. These can include genetic risk in you or your family, a family history of cancer, an unhealthy lifestyle or smoking.

What symptoms should I report to my provider?

You should report any new, unusual or persistent symptoms to your provider. These can include: 

  • more tired or weaker than usual.
  • shortness of breath.
  • loss of appetite.
  • weight loss.
  • chills, fever, night sweats.
  • painless swelling of a lymph node.
  • easily bruising, nose bleeds, bleeding from the gums.

Do I need to have screening for other types of cancer?

As discussed, cancer survivors are at higher risk of developing a second cancer than someone who has never had cancer. For this reason, it is important to participate in any cancer screenings appropriate for your age and personal and family history. Talk with your provider about which tests are right for you and at what age you should begin having them. These can include screening for breast, cervical, prostate, colon, and lung cancers. In addition, during routine health or dental exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth, and thyroid.

You can learn more about cancer screening tests on OncoLink.

It can be scary to learn about the late effects of cancer treatment. Understand that these complications are not common but knowing about them helps you stay healthy. You can learn more about caring for your health after cancer treatment by creating an OncoLife survivorship care plan.

 

Referencias

American Cancer Society. Second cancers caused by cancer treatment. Found at: http://www.cancer.org/acs/groups/cid/documents/webcontent/002043-pdf.pdf

National Comprehensive Cancer Network. Understanding your risk of developing secondary cancers. Found at: http://www.nccn.org/patients/resources/life_after_cancer/understanding.aspx

AICR.org Staying Healthy After Treatment. https://www.aicr.org/patients-survivors/staying-healthy-after-treatment/index.html

Burt, L. M., Ying, J., Poppe, M. M., Suneja, G., & Gaffney, D. K. (2017). Risk of secondary malignancies after radiation therapy for breast cancer: comprehensive results. The Breast35, 122-129.

Conway, J. L., Connors, J. M., Tyldesley, S., Savage, K. J., Campbell, B. A., Zheng, Y. Y., ... & Pickles, T. (2017). Secondary breast cancer risk by radiation volume in women with Hodgkin lymphoma. International Journal of Radiation Oncology* Biology* Physics97(1), 35-41.

Ezoe, S. (2012). Secondary leukemia associated with the anti-cancer agent, etoposide, a topoisomerase II inhibitor. International journal of environmental research and public health9(7), 2444-2453.

Inamoto, Y., Shah, N., Savani, B., Shaw, B., Abraham, A., Ahmed, I., … Majhail, N. (2015). Secondary solid cancer screening following hematopoietic cell transplantation. Bone Marrow Transplantation50(8), 1013–1023.

LoConte, N. K., Gershenwald, J. E., Thomson, C. A., Crane, T. E., Harmon, G. E., & Rechis, R. (2018). Lifestyle modifications and policy implications for primary and secondary Cancer prevention: diet, exercise, sun safety, and alcohol reduction. American Society of Clinical Oncology Educational Book38, 88-100.

Morton, L. M., Dores, G. M., Schonfeld, S. J., Linet, M. S., Sigel, B. S., Lam, C. J., ... & Curtis, R. E. (2019). Association of chemotherapy for solid tumors with development of therapy-related myelodysplastic syndrome or acute myeloid leukemia in the modern era. JAMA oncology5(3), 318-325.

Nasioudis, D., Lontos, K., Tsagianni, A., Boyiadzis, M., & Ko, E. M. (2018). Acute Myeloid Leukemia Following Gynecologic Cancer in the Era of Platinum-Based Chemotherapy. International Journal of Gynecologic Cancer28(8), 1639-1642. 

Sanford, N. N., Miao, R., Wang, H., Goldberg, S., Jacobson, A., Brunner, A. M., ... & Jee, K. W. (2019). Characteristics and Predictors for Secondary Leukemia and Myelodysplastic Syndrome in Ewing and Osteosarcoma Survivors. International Journal of Radiation Oncology* Biology* Physics103(1), 52-61.

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