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Second cancer

The risk of developing a second form of cancer depends mainly on the treatment you have had and the age at which you received this treatment. It is important that you recognize and recognize symptoms and signs that may indicate a second form of cancer.

What is a second cancer?

Childhood cancer is treated with chemotherapy, radiotherapy (radiation), and/or surgery. These treatments can cause permanent damage to organs, tissues, or bones. This can increase the risk of developing a new type of cancer later in life. A second cancer does not mean that the original cancer has returned (recurrence); it is a completely different type of cancer.

The chance of developing a second cancer is very small. There are things you can do to reduce the risk of certain second cancers.

Do I have an increased risk of a second 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 cancer treatments, we are not sure whether they increase the risk.

  • For other cancer treatments, we do know that they can increase the risk.

It is impossible to estimate exactly how high the risk of a second cancer is. In addition to treatment, other factors play a role, such as age and genetic predisposition.

Treatments that can increase the risk of a second cancer

Bladder cancer

  • Radiation to the bladder or to an area where the bladder is located

  • Chemotherapy with cyclophosphamide or ifosfamide

Blood cancer (AML or myelodysplasia)

  • Alkylating chemotherapy such as cyclophosphamide and procarbazine

  • Chemotherapy with anthracyclines (doxorubicin, daunorubicin, mitoxantrone)

  • Chemotherapy with etoposide or teniposide

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

Breast cancer

  • Radiation (10 Gy or more) to the chest, upper abdomen, or an area where the chest is located

Bone tumor

  • Radiation: the irradiated part of the body has an increased risk of a bone tumor

Colorectal cancer

  • Radiation to the intestines or to an area where the intestines are located

Brain or spinal cord tumor

  • Radiation to the head, brain, spinal cord, or an area where these are located

Skin cancer

  • Radiation: increased risk of skin cancer in the irradiated area

  • Allogeneic stem cell transplantation, especially with graft-versus-host disease (GvHD) of the skin

Lung cancer

  • Radiation to the lungs or to an area where the lungs are located

Oral cancer

  • Radiation to (part of) the mouth

  • Graft-versus-host disease (GvHD) in the mouth after allogeneic stem cell transplantation

Thyroid tumor

  • Radiation to the neck or to an area where the thyroid gland is located

  • Treatment with radioactive iodine (131I-MIBG)

For cervical cancer, endometrial cancer, prostate cancer, and testicular tumors, no guidelines are currently available.

A second cancer does not always have to be caused by treatment. Other causes may include smoking, alcohol, drugs, sun exposure, aging, or genetic predisposition.

What are the symptoms and signs of a second cancer?

Symptoms differ by cancer type. General symptoms that may indicate a second cancer include:

  • Feeling (very) tired

  • Unexplained weight loss

  • Loss of appetite

  • Fever and excessive sweating

These symptoms are usually caused by something else, but early diagnosis and treatment are important. Contact your general practitioner if you recognize any of these symptoms.

I have an increased risk of a second cancer. Which tests are needed and when?

  • Visit the LATER clinic at least every five years.

  • If a hereditary predisposition is suspected, you will be referred to a clinical geneticist.

  • Additional tests may be performed depending on your risk.

What happens if I (might) have a second cancer?

Your general practitioner or LATER doctor will refer you to a specialist for further examinations and discussion of treatment options if necessary.

What else can I do?

Living with an increased risk of a second cancer can be difficult. Support from friends, family, or patient organizations such as VOX can help.

  • Do not smoke

  • Drink no or as little alcohol as possible

  • Do not use drugs

  • Protect your skin from the sun

  • Get vaccinated against HPV if you have not done so before

  • Participate in population screening programs for cervical, breast, and colorectal cancer

Where can I find more information?

  • Healthy lifestyle

  • Mental health

  • Second cancer: bladder cancer

  • Second cancer: blood cancer

  • Second cancer: breast cancer

  • Second cancer: bone tumor

  • Second cancer: colorectal cancer

  • Second cancer: brain tumors

  • Second cancer: skin cancer

  • Second cancer: lung cancer

  • Second cancer: oral cancer

  • Second cancer: thyroid tumor

Disclaimer

This information is based on plain-language summaries from the PanCare Plain Information Group and adapted to the Dutch LATER guideline. Always consult your general practitioner, LATER doctor, or specialist if you have symptoms or concerns.