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Late Effects of Treatment for Childhood Cancer (PDQ®): Treatment - Patient Information [NCI] - Second Cancers

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.

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Second cancers that occur after cancer treatment include the following:

  • 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 includes one of the following:
    • Alkylating agent such as cyclophosphamide, ifosfamide, mechlorethamine, melphalan, busulfan, carmustine, lomustine, chlorambucil, or dacarbazine.
    • Topoisomerase II inhibitor agent such as etoposide or teniposide.
  • Solid tumors may appear more than 10 years after primary cancer diagnosis and treatment including:
    • Breast cancer after high-dose chest radiation treatment for Hodgkin lymphoma. Treatment with low-dose chest radiation may also increase breast cancer risk.
    • Thyroid cancer after neck radiation treatment for Hodgkin lymphoma, acute lymphocytic leukemia, or brain tumors, after radioactive iodine therapy for neuroblastoma, or after total-body irradiation (TBI) as part of a stem cell transplant.
    • Brain tumors after radiation treatment to the head for a primary brain tumor or for acute lymphocytic leukemia or non-Hodgkin lymphoma. When intrathecal methotrexate chemotherapy and radiation therapy are given together, the risk of a brain tumor is even higher.
    • Bone tumors after radiation treatment for retinoblastoma, Ewing sarcoma, and other cancers of the bone. Treatment with an alkylating agent also increases the risk of a bone tumor.
    • Sarcomas after radiation therapy. The risk increases with higher doses of radiation. Chemotherapy with anthracyclines also increases the risk of sarcomas.
    • Lung cancer after radiation treatment to the chest for Hodgkin lymphoma, especially in patients who smoke.
    • Stomach, liver, or colorectal cancer after radiation therapy to the abdomen. The risk increases with higher doses of radiation. Treatment with chemotherapy alone or chemotherapy and radiation therapy combined also increases the risk of stomach, liver, or colorectal cancer.
    • Nonmelanoma skin cancer after radiation therapy; it usually appears in the area where radiation is given. Being exposed to UV radiation may increase this risk. Patients who develop nonmelanoma skin cancer after radiation therapy have an increased chance of developing other types of cancers in the future.
    • Malignant melanoma after radiation therapy or combination chemotherapy with alkylating agents and antimitotic drugs. Survivors of Hodgkin lymphoma, hereditary retinoblastoma, soft tissue sarcoma, and gonadal tumors are more likely to be at risk. Malignant melanoma as a second cancer is more rare after treatment than nonmelanoma skin cancer.
    • Oral cavity cancer after chemotherapy followed by stem cell transplant or a history of chronic graft-versus-host disease.
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