Skip to content

    Cancer Health Center

    Font Size
    A
    A
    A

    Late Effects of Treatment for Childhood Cancer (PDQ®): Treatment - Health Professional Information [NCI] - Subsequent Neoplasms

    Subsequent neoplasms (SNs), which may be benign or malignant, are defined as histologically distinct neoplasms developing at least 2 months after completion of treatment for the primary malignancy. Childhood cancer survivors have an increased risk of developing SNs that varies according to the following:

    • Host factors (e.g., genetics, immune function, hormone status).
    • Primary cancer therapy.
    • Environmental exposures.
    • Lifestyle factors.

    SNs are the leading cause of nonrelapse late mortality (standardized mortality ratio, 15.2; 95% CI, 13.9-16.6).[1] The Childhood Cancer Survivor Study (CCSS) reported the following 30-year cumulative incidence rates:[2]

    • All SNs-20.5% (95% confidence interval [CI], 19.1%-21.8%).
    • SNs with malignant histologies (excluding nonmelanoma skin cancer [NMSC])-7.9% (95% CI, 7.2%-8.5%).
    • NMSC-9.1% (95% CI, 8.1%-10.1%).
    • Meningioma-3.1% (95% CI, 2.5%-3.8%).

    This represents a sixfold increased risk of SNs among cancer survivors, compared with the general population.[2]

    The risk of SNs remains elevated for more than 30 years from diagnosis of the primary cancer. Moreover, prolonged follow-up has established that multiple SNs are common among aging childhood cancer survivors.[3]

    The development of an SN is likely multifactorial in etiology and results from a combination of influences including gene-environment and gene-gene interactions. Outcome after the diagnosis of an SN is variable, as treatment for some histological subtypes may be compromised if childhood cancer therapy included cumulative doses of agents and modalities at the threshold of tissue tolerance.[4]

    The incidence and type of SNs depend on the following:

    • Primary cancer diagnosis.
    • Type of therapy received.
    • Presence of genetic conditions.

    Unique associations with specific therapeutic exposures have resulted in the classification of SNs into the following two distinct groups:

    Therapy-Related Myelodysplastic Syndrome and Leukemia

    Therapy-related myelodysplastic syndrome and acute myeloid leukemia (t-MDS/AML) has been reported after treatment of Hodgkin lymphoma (HL), acute lymphoblastic leukemia (ALL), and sarcomas, with the cumulative incidence approaching 2% at 15 years after therapy.[5,6,7,8]

    1 | 2 | 3 | 4 | 5 | 6
    1 | 2 | 3 | 4 | 5 | 6
    Next Article:

    Today on WebMD

    man holding lung xray
    What you need to know.
    stem cells
    How they work for blood cancers.
     
    woman wearing pink ribbon
    Separate fact from fiction.
    Colorectal cancer cells
    Symptoms, screening tests, and more.
     
    Jennifer Goodman Linn self-portrait
    Blog
    what is your cancer risk
    HEALTH CHECK
     
    colorectal cancer treatment advances
    Video
    breast cancer overview slideshow
    SLIDESHOW
     
    prostate cancer overview
    SLIDESHOW
    lung cancer overview slideshow
    SLIDESHOW
     
    ovarian cancer overview slideshow
    SLIDESHOW
    Actor Michael Douglas
    Article