Second Cancers

A second cancer is a different type of cancer from your original cancer diagnosis. Knowing some of the causes of second cancers can help you reduce your risk of getting a second cancer.

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Second Cancers: Detailed Information

This information is meant to be a general introduction to this topic. The purpose is to provide a starting point for you to become more informed about important matters that may be affecting your life as a survivor and to provide ideas about steps you can take to learn more. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Suggestions and Additional Resources documents for questions to ask and for more resources

A second cancer is a different type of cancer than the original cancer. It is diagnosed after you have completed treatment for the first cancer. Second cancers occur in only one to three percent of survivors. The level of risk is very small. In general, greater numbers of cancer survivors are living longer due to improvements in treatment. However, even thinking about the possibility of having a second cancer can be stressful.

Taking the following steps can help manage anxiety about second cancers. They can also help give you the best opportunity for early detection and treatment:

• Know your own cancer history treatment you received
• Learn about the symptoms of cancer
• Have regular check-ups and follow-up health care

Who is at risk for second cancers?

There is not yet a lot of specific information about how likely it is that survivors of specific cancer types will have second cancers. Current research shows that cancer survivors in general have an increased chance of developing cancer compared to people of the same age and gender who have not had cancer. This means that it is even more important for cancer survivors to be aware of the risk factors for second cancers and maintain good follow-up health care.

Whether or not you will have a second cancer depends on many different things. This may include your age when treated, the treatment you received, and your genetic make-up and family history. Even if you find you are at a higher risk, it does not mean that you will develop cancer again. Keep in mind that, although the risk is higher, the actual number of people who will get a second cancer is relatively small. Each cancer survivor's experience is unique.

The following is an overview of some of the risks for developing second cancers:

• Type of cancer

  The type of original cancer you had may affect your risk for a second cancer because some cancers require treatment with radiation or high doses of certain types of chemotherapy. It is not yet clear to researchers if the second cancer is caused by the treatment or by the original cancer, or by a combination of the two. Another possibility is that both the original cancer and a second cancer share certain risk factors such as an underlying cause, environmental exposure, or genetic predisposition.

• Age at time of treatment

  Children and young adults have a higher risk of second cancers related to treatment with radiation or chemotherapy than older adults have. Younger survivors have more at-risk years for second cancers. Generally, you should always be alert for symptoms of a second cancer.

  With age, the risk of cancer increases even among those who have never had cancer. Researchers continue to study second cancers in survivors. They hope to develop treatment methods that reduce the risk of developing cancer again. Generally, a healthy lifestyle may help minimize this risk.

• Type of chemotherapy

  High doses of chemotherapy medicines are associated with a small number of second cancers in some survivors.

  Types of chemotherapy that may make you more likely to have a second cancer include:

  • Procarbazine
  • Mechlorethamine
  • Chlorambucil
  • BCNU (bischloroethylnitrosourea)
  • Nitrogen mustard
  • Cyclophosphamide
  • Ifosfamide
  • Epipodophyllotoxins
  • Anthracyclines
    
• Type of radiation

  The higher the dose of radiation received, the more risk for developing a second cancer. In general, the risk of having a second cancer from radiation is very low, and much depends on the amount of radiation given during treatment. For survivors of childhood cancer, radiation therapy is the most important risk factor for second cancers.

• Bone marrow transplant

  With longer follow-up of increasing numbers of survivors after hematopoietic stem cell transplant (SCT), an increased risk of second cancer is being seen. This may be related to treatments of chemotherapy and radiation, to effects on the immune system, and to genetic predisposition.

• Family history

  When cancer "runs in the family," survivors have a higher chance of developing second cancers than those who do not have a family history of cancer. Survivors from families who have "predisposing conditions" that increase the possibility of cancer should know their family history. They should also participate in specialized follow-up care that can help with early detection.

• Lifestyle

  Smoking, excessive alcohol use, lack of exercise, and poor diet are some of the unhealthy behaviors that might be risk factors for second cancers. These are the only known risk factors for a second cancer that you can personally avoid by choosing to change some of the habits that put you at risk.

  Sometimes second cancers happen in survivors who were not affected by any of the risk factors mentioned above. Second cancer risk factors can be very confusing. To learn more, ask your doctor to discuss your risk factors for a second cancer based on your cancer type, treatment received, and your general medical history.

What are some symptoms of second cancers?

Knowing the general symptoms of cancer is a great way to help you detect a second cancer early. The earlier a second cancer is diagnosed, the more likely it can be successfully treated. In some cases, second cancers cannot be prevented from happening.

Some types of cancer may not present any symptoms. Health care including regular check-ups and screenings can help detect problems early. Screening may include blood tests and imaging such as x-rays, CT scans, PET scans.

A second cancer can present one or more symptoms such as:

• Changes in bowel or bladder habits
• A sore that does not heal
• Unusual bleeding or discharge
• Thickening or lump in the breast or other parts of your body
• Indigestion or difficulty swallowing
• Noticeable change in a wart or mole
• Nagging cough or hoarseness
• Fatigue
• Bone pain
• Changes in vision
• Constant or severe headaches

Keep in mind that having some of these symptoms does not mean that you have cancer. However, it is best to talk with your doctor if you notice these or other symptoms.

Open communication with your health care team may help them recognize signs or symptoms that are not always easy to see on your own. Also, talking with your doctor about concerns you have about second cancers may help relieve some of the anxiety that you might have.

Why does treatment for cancer sometimes cause second cancers?

No one knows exactly why survivors who have been treated for cancer develop a second cancer. Yet, there are some theories about why cancer and its treatment sometimes cause second cancers including:

• Some research suggests that chemotherapy and radiation may weaken the immune system making it easier for second cancers to develop.
• Sometimes chemotherapy that is used to treat the original cancer may cause the bone marrow to make abnormal cells. This might lead to second cancers in some survivors.
• Radiation destroys cancer cells and may cause damage to healthy cells. This damage may contribute to second cancers.

These theories do not mean that chemotherapy or radiation should not be used as treatment methods for the original cancer. Your health care team has a primary goal of treating the cancer the best way they can. Research is ongoing to create treatment options for survivors that decrease the risk of long-term effects and improve the quality of life for survivors.

Keep in mind that, in the past, some second cancers were caused by treatments that are no longer given today. Newer treatments for cancer generally use less toxic medicine than was used years ago. Research may show that this will ultimately result in a decrease in the number of second cancers that develop in survivors.

When do second cancers usually occur?

A second cancer can appear at any time during survivorship. Some studies show that a common time for cancers to develop is from five to nine years after completion of treatment.

Generally speaking for childhood cancer survivors, secondary leukemia is most likely to occur less than ten years after treatment of the original cancer. Solid tumors related to radiation may occur more than ten years afterward.

However, because the exact causes of second cancers are not yet known, it is difficult to predict when they might appear. Lifetime monitoring by health care providers who are knowledgeable about survivorship care is recommended--even years after completing treatment for the original cancer.

What can be done to minimize the risk of second cancers?

One of the most important things you can do is to follow-up with a health care team that is well-informed about survivorship care. Good medical care and screening can help detect second cancers early.

Other things that can be done to minimize the risk of second cancers include:

• Trying to find balance with a healthy lifestyle
• Knowing if your family has a history of cancer
• Using a health journal to prepare for your next visit with a member of your health care team

This document was produced in collaboration with:

Patricia C. Buchsel, RN, MSN, FAAN
Clinical Instructor, University of Washington School of Nursing, Seattle, WA

Works Cited

Castellino, S., Melissa & Hudson, M. "Health issues in survivors of childhood cancer." Southern Medical Journal 95 (2002): 977-984.

Deeg, H. J., Schwartz, J L. Friedman, D., & Lessening, W. "Secondary malignancies after hemopoietic stem cell transplantation." Perspectives in Medical Science (September 29, 2003).

Hudson, M. M., Merten, A. C., Yasui, Y, Hobbie, W., Chen, H. Gurney, et al . "Health status of adult long-term survivors of childhood cancer: A report from the childhood cancer survivor study." Journal of American Medical Association 290 12 (2003): 1583-1592.

Moore, I. K. & Hobbie, W. (2000). "Late effects of cancer treatment." Cancer Nursing: Principles and Practices, 5th edition Eds. C. H. Yarbro, M. H. Frogge, M. Goodman & S. Groenwald.

Morrison, C. H., Olsen, S. J. & Ashely, B. W. "Screening and early detection of cancer." Core Curriculum of Oncology Nursing. Eds. J. K. Itano & K. N. Talka. Philadelphia: W. B. Saunders Company, 1998. pp. 695-710.

"Secondary cancers: Incidence, risk factors, and management." Cancer.org. S. R. Rheingold, A. Neugut & N. T. Meadows. 29 September 2003 http://www.cancer.org/downloads/PUB/DOCS/SECTION40/156.pdf

Hieb BA, Ogle SK, Meadows AT. "Second malignancies following treatment for childhood cancer." Survivors of Childhood and Adolescent Cancer 2nd edition Eds. C.L. Schwartz, W.L. Hobbie, L.S. Constine, K.S. Ruccione. Berlin: Springer, 2005, pp. 283-294.

Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers, Version 2.0 (including "Health Link: Reducing the Risk of Second Cancers") http://www.survivorshipguidelines.org/

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Second Cancers: Suggestions

The suggestions that follow are based on the information presented in the Detailed Information document. They are meant to help you take what you learn and apply the information to your own needs. This information is not intended nor should it be interpreted as providing professional medical, legal and financial advice. You should consult a trained professional for more information. Please read the Additional Resources document for links to more resources.

• Try to find balance and live a healthy lifestyle.

  Take steps to maintain a healthy balance in your lifestyle:

  • Know your treatment history. This includes an understanding about your specific type of cancer and the amount of chemotherapy you received. It is also important to know about the location of the radiation treatment you received.
  • Work with your doctor to develop a survivorship care plan with recommendations for follow-up care.
  • Develop a schedule for screening exams and regular screening and check-ups with your health care team.
    
• Make choices to contribute to your health such as:
  
  
  • Avoiding tobacco products
  • Working with your health care team to develop an exercise plan
  • Maintaining a healthy body weight
  • Eating five to seven servings of fruits and vegetables a day
  • Performing regular breast or testicular self-exams and skin exams each month
  • Using sunscreen and avoiding exposure to the sun, particularly on irradiated skin
  • Getting enough rest and sleep
    
• Keep track of the history of cancer in your family.

  If there is a history of cancer in your family, it is especially important to understand risk factors and have regular screenings. Your health care team can help you decide if genetic counseling or testing is recommended.

  If you do not know about your genetic background, start talking with relatives or friends who know your family's medical history. In many cases, no one has written down the information and only an oral history is known. You can begin to develop these records for yourself. It may also be helpful to other members of your family.

  "My Family Health Portrait" is a useful online tool for recording your family health history. This free tool helps organize information. You can then print it out to share with the doctor and other family members. Go online to https://familyhistory.hhs.gov.

• Use a health journal to write down important information.

  A health journal can help you prepare for your next visit with a member of your health care team. It can also help you to keep all of your team members informed about medications, treatments, and other important information.

  Take the following steps as you keep track of your health care:

  • Write down everything you want to ask your health care team. You can make notes and keep track of questions between visits.
  • Make a list of your medications. Bring this information to the visit along with all of your medication bottles. This will help the health care team keep track of all the medications you are taking, including vitamins and over-the-counter medications.
  • Take notes during health care appointments.
  • Keep all of your health records together and bring this information with you to health care appointments.
  • Bring extra copies of important documents to give to appropriate health care team members. You can also fax or mail these before your appointment. Having the health care team read your documents may be an easier way for you to communicate.
  • Store pamphlets, information about medication side effects and important phone numbers in your notebook so that everything is in one place.

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Second Cancers: Additional Resources

The resources listed below provide more detailed information and support services to help you with second cancers.  Please read the Detailed Information and Suggestions document for more information and questions to ask.

LIVESTRONG Care Plan
www.livestrongcareplan.org

This free online tool was created to help you develop a personalized plan for post-treatment care. It can help you work with your oncologist and primary health care provider to address medical, emotional and social challenges that may arise after cancer treatment is completed. By answering some questions related to your cancer treatment, you will receive information about your follow-up care. This information includes symptoms to watch for in the future and steps you can take to stay healthy.

LIVESTRONG SurvivorCare Program
www.livestrong.org/survivorcare

Email: Send email through the LIVESTRONG website.
Phone: 1-866-673-7205
1-866-927-7205 (Spanish)
Intake Coordinator is available for calls Monday through Friday, 9:00 a.m. to 5:00 p.m. (Central Time). Voicemail is available after hours.

LIVESTRONG SurvivorCare offers assistance to anyone affected by cancer, including the person diagnosed, loved ones, caregivers and friends. The program provides information about treatment options and matching to clinical trials or treatments in development. Counseling services and assistance with financial, employment and insurance issues are also available. To provide these services, LIVESTRONG SurvivorCare has partnered with several organizations including CancerCare, Patient Advocate Foundation and EmergingMed.

American Cancer Society (ACS)
www.cancer.org

Email: Submit questions in English or Spanish from the "Contact Us" page.
Phone: 1-800-227-2345
TTY for deaf or hard of hearing callers: 1-866-228-4327

The American Cancer Society (ACS) offers information about many of the challenges of cancer and survivorship. You can search for information by cancer type or by topic. ACS provides a list of support groups in your area. You can join online groups and message boards. Some information on the website is available in Spanish, Chinese, Korean and Vietnamese. ACS specialists can answer questions 24 hours a day by phone or email.

U.S. Institutes of Health - National Cancer Institute (NCI)
www.cancer.gov

Online: Online assistance is available in English or Spanish through the LiveHelp instant messaging system. This service is available Monday-Friday, 9:00 a.m. to 11:00 p.m. (EST)
Email: Send an email through the "Need Help?" section of the website
Phone: 1-800-422-6237
TTY for deaf and hard of hearing callers: 1-800-332-8615
Information specialists answer calls Monday-Friday, 9:00 a.m. to 4:30 p.m. local time.

The National Cancer Institute's website provides accurate information about the challenges cancer can bring. You can search for information by cancer type or topic. You can find information about treatment, financial and insurance matters. You can also learn how treatments in development work and search for a clinical trial in your area. This site also has a good dictionary of cancer terms, drug information and other publications. Cancer information specialists can answer your questions about cancer and help you with quitting smoking. They can also help you with using this Web site and can tell you about NCI's printed and electronic materials. The knowledgeable and caring specialists have access to comprehensive, accurate information on a range of cancer topics, including the most recent advances in cancer treatment. The service is confidential, and information specialists spend as much time as needed for thorough and personalized responses.

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