Second Cancers

Although rare, the very treatment that saves a child’s life may cause a second cancer to develop later.

Everyone has some risk of developing cancer later in life. Several studies have shown that as childhood cancer survivors become older they have a slightly higher risk of developing a second cancer than the general public. Certain types of treatment for childhood cancer or a family history of cancer can increase the risk.

Treatments That Increase the Risk of Second Cancers

Certain chemotherapy drugs

Some survivors who were treated with chemotherapy may develop acute myeloid leukemia (AML). AML most commonly appears during the first 10 years after the completion of cancer treatment. The risk of developing a secondary leukemia is increased for people who were treated with:

Alkylating agents (such as cyclophosphamide and nitrogen mustard)
Epipodophyllotoxins (such as etoposide or teniposide)
Anthracyclines (such as daunorubicin or doxorubicin)

Radiation Therapy

Radiation therapy, especially at a young age and at high dose, increases the risk of developing a cancer of soft tissues or bone cancer later in life. The most common sites include the skin, breast, central nervous system, thyroid gland, and bones.

These second cancers most commonly appear more than 10 years after treatment for the original cancer.

Other Risk Factors

Family history of cancer.
Hereditary cancer-predisposing gene changes. They are relatively rare. A study by the St. Jude-Washington University Pediatric Cancer Genome Project found that only 8.5% of childhood cancers are hereditary. Providers will suspect an inherited cancer syndrome if there is a family history of cancer repeatedly occurring in children and young adults. Another clue is cancer developing in both sides of paired organs – kidneys, eyes, or lungs.
Increasing age. The chances of developing cancer grow as people get older.

What Survivors Can Do

Talk with your oncologist about your health risks. Inform your primary care provider. Share a copy of your Survivorship Care Plan, which includes a treatment summary.

In some cases, your doctor may recommend earlier or more frequent screenings.

Have a yearly physical examination. Have all cancer screenings appropriate for age, family history, and treatment.

Pay attention to your health and let your primary care provider know about certain symptoms:
Easy bruising and bleeding

Paleness of skin

Excessive fatigue

Bone pain

Changes in moles

Sores that do not heal

Lumps

Difficulty swallowing

Changes in bowel habits

Persistent abdominal pain
Blood in the stools

Blood in the urine

Painful urination or defecation

Persistent cough or hoarseness

Shortness of breath

Bloody sputum

Discolored areas or sores in the mouth that do not heal

Persistent headaches

Vision changes

Persistent early morning vomiting
Certain lifestyle habits can reduce the risk of developing cancer:

Don’t smoke

Smoking is the most preventable cause of cancer. Do not start smoking. If you currently smoke, stop. Many websites and apps have tools to help. The National Cancer Institute, the Centers for Disease Control, and the American Lung Association have reliable resources.

Limit alcohol

Studies have shown that heavy alcohol drinking can contribute to the development in the mouth, throat, and esophagus.

Protect your skin from sun exposure

UV rays from the sun can cause skin cancer. There are many ways to protect your skin:
- Wear protective clothing.
- Regularly wear sunscreen with an SPF of 30 or higher.
- Avoid the sun between 10 a.m. – 2 p.m.
Eat healthy and exercise
- Eat a healthy diet. Limit fat. Calories from fat should only make up 30% or less of total daily diet.
- Increase fiber. Eat whole grains and high-fiber vegetables and fruit.
- Avoid processed foods such as salt-cured and pickled vegetables.
- Get plenty of Vitamin C and A. Diets rich in these vitamins have been shown to reduce cancer in animal studies.
- Exercise regularly.
Get immunizations

Certain cancers are associated with viruses. Two of the most common are human papillomavirus (HPV) and hepatitis B. Vaccines are available to protect against both viruses.

Check with your provider to see if either vaccine is recommended for you.

Everyone should lead a healthy lifestyle, but it is especially important for cancer survivors.

—
Reviewed: June 2018

Treatments That Increase the Risk of Second Cancers

Certain chemotherapy drugs

Radiation Therapy

Other Risk Factors

What Survivors Can Do

Survivorship Care Plans

Medical Record Access

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