Second cancer: Blood cancer

What is blood cancer (as a second cancer)?

This page is part of Second cancer. We recommend reading that information first.

Second cancer: blood cancer

The bone marrow inside the bones produces stem cells that develop into blood cells: red blood cells that transport oxygen, white blood cells that fight infections, and platelets that help blood clot. Sometimes immature white blood cells in the bone marrow start dividing uncontrollably. There is then no space left for healthy blood cells to develop. This is called blood cancer.

The most common forms are:

• Myelodysplastic syndrome (MDS)

• Acute myeloid leukemia (AML)

The chance of developing blood cancer after childhood cancer is very small.

Do I have an increased risk of blood cancer?

Anyone, including people who have never had cancer, can develop blood cancer. However, some cancer treatments can increase the risk.

The following treatments can increase the risk of blood cancer:

• Alkylating chemotherapy, such as cyclophosphamide and procarbazine

• Chemotherapy with anthracyclines, such as doxorubicin, daunorubicin and mitoxantrone

• Chemotherapy with etoposide or teniposide

• Autologous stem cell transplantation (using your own stem cells)

You can check your treatment summary to see whether you received one or more of these treatments. If you do not have a summary, you can contact the LATER clinic or the hospital where you were treated.

Blood cancer does not always result from cancer treatment. There may also be other causes.

What are symptoms and signs of blood cancer?

Certain symptoms and signs may indicate AML or MDS. Even if you do not currently have these symptoms, it is important to recognize them in case they occur in the future.

The following symptoms and signs may indicate blood cancer:

• Bruising easily or bleeding quickly

• Pale appearance

• Red or purple spots on the skin

• Swollen glands in the neck, armpits and/or groin

• Fever

• Excessive sweating

These symptoms often have another cause. Early diagnosis and treatment of blood cancer are very important. If you notice one or more of these symptoms, contact your general practitioner immediately.

I have an increased risk of blood cancer. What tests are needed and when?

If you have an increased risk of blood cancer, regular check-ups are not required. If symptoms or signs occur, contact your general practitioner immediately. They will usually perform:

• A physical examination

• A blood test

What happens if I (may) have blood cancer?

The risk of a second cancer mainly depends on the treatment you received and the age at which you received it.

• Some cancer treatments do not increase the risk

• For some treatments it is not yet clear whether they increase the risk

• Other treatments are known to increase the risk

It is impossible to determine the exact risk of developing a second cancer. In addition to treatment, other factors such as age and genetic predisposition play a role.

The following treatments can increase the risk of a second cancer:

• Bladder cancer: radiation therapy to the bladder or surrounding area; chemotherapy with cyclophosphamide or ifosfamide

• Blood cancer (AML or MDS): alkylating chemotherapy; anthracyclines; etoposide or teniposide; autologous stem cell transplantation

• Breast cancer (women): radiation therapy (10 Gy or more) to the chest or upper abdomen

• Bone tumors: radiation therapy to the affected body area

• Colorectal cancer: radiation therapy to the intestines or surrounding area

• Brain or spinal cord tumors: radiation therapy to the head, brain or spinal cord

• Skin cancer: radiation therapy to the affected skin area; allogeneic stem cell transplantation with skin graft-versus-host disease

• Lung cancer: radiation therapy to the lungs or surrounding area

• Oral cancer: radiation therapy to the mouth; graft-versus-host disease in the mouth after allogeneic stem cell transplantation

• Thyroid cancer: radiation therapy to the neck; treatment with radioactive iodine (131I-MIBG)

Some treatments are also associated with an increased risk of cancers of the uterus (cervix), prostate, testicles and breast cancer in men. LATER information on these risks is not yet available.

A second cancer does not always result from cancer treatment. Other factors such as smoking, alcohol use, drug use, excessive sun exposure, ageing and genetic predisposition may also play a role.

What else can I do?

Living with an increased risk of blood cancer can be difficult. Talking with friends and family may help. Contact with others in a similar situation can also be helpful, for example through a patient organisation such as VOX, part of the Dutch Childhood Cancer Society.

Take good care of yourself. Although it is not certain that it reduces the risk of blood cancer, a healthy lifestyle is important. Also pay attention to your mental health. Small changes can already have a positive effect on your physical and mental well-being.

If you have questions or feel worried after reading this information, contact your general practitioner or LATER doctor.

Where can I find more information?

This LATER website also contains information about:

• Healthy lifestyle

• Mental health

The PanCare Plain Language Summaries