The Second Type of Cancer

Summarize

A second primary cancer that develops at least two months after the initial cancer treatment is referred to as a second cancer. This can occur several months or years after the initial treatment. The type of second cancer depends on the original cancer and the treatment received. Benign tumors (non-cancerous) may also develop.

1. Children who recover from cancer have an increased risk of developing a second cancer later in life;
2. Certain genetic patterns or syndromes may increase the risk of developing a second cancer;
3. Patients who have had cancer treatment need regular check-ups to see if they have a second cancer;
4. Tests for screening the second type of cancer depend in part on how a patient has been treated for the first type in the past.

Epidemiological

not have

Etiology & Risk Factors

risk factor

1. Chemotherapy

Alkylating agents such as cyclophosphamide, ifosfamide, methchloramine, melphalan, busulfan, carmustine, lomustine, chlorobutryl, or dacarbazine. Topoisomerase II inhibitors such as etoposide or epirubicin.

2. Certain genetic patterns or syndromes may increase the risk of developing a second cancer

Some children who recover from cancer may be at higher risk for a second cancer because they have a family history of cancer or genetic cancer syndromes such as Li-Fraumeni syndrome. Problems with DNA repair and the way anticancer drugs are used can also affect the risk of a second cancer.

Classification & Staging

The second type of cancer category

The second cancers that occur after cancer treatment include:

1. Solid tumor

Solid tumors that occur more than 10 years after diagnosis and treatment of primary cancer include:

1.1, breast cancer

After high-dose chest radiation therapy for Hodgkin's lymphoma, the risk of developing breast cancer increases. If the radiation is administered above the diaphragm, excluding the axillary lymph nodes, the risk of subsequent breast cancer is lower. Chest radiation therapy for cancers that have spread to the chest or lungs may also increase the risk of breast cancer. Patients who have received alkylating agents and anthracyclines but not chest radiation therapy also have an increased risk of breast cancer. Recipients of sarcoma and leukemia treatment have the highest risk of developing breast cancer later in life.

1.2 Thyroid cancer

Thyroid cancer may occur after radiation therapy for Hodgkin's lymphoma, acute lymphoblastic leukemia or brain tumors; after radioactive iodine treatment for neuroblastoma; or after whole-body irradiation (TBI, part of stem cell transplantation therapy).

1.3 Brain tumor

Brain tumors may develop after radiotherapy and/or intrathecal chemotherapy to the head. Intrathecal chemotherapy involves using methotrexate to treat primary brain tumors or cancers that have spread to the brain or spinal cord, such as acute lymphoblastic leukemia or non-Hodgkin's lymphoma. The risk of developing a brain tumor is even higher when methotrexate is used for intrathecal chemotherapy alongside radiotherapy.

1.4 Bone and soft tissue tumors

The risk of bone and soft tissue tumors is increased after radiotherapy for retinoblastoma, Ewing's sarcoma and other bone tumors. Chemotherapy with anthracyclines or alkylating agents also increases the risk of bone and soft tissue tumors.

1.5 Lung cancer

For Hodgkin's lymphoma, the risk of lung cancer after chest radiation therapy increases, especially in patients who smoke.

1.6 Gastric, liver or rectal cancer

Gastric, liver, or rectal cancer may occur after radiation therapy to the abdomen or chest. High doses of radiation increase the risk, as does the risk of colorectal polyps. Chemotherapy alone or in combination with radiotherapy also increases the risk of gastric, liver, or rectal cancer.

1.7 Non-melanoma skin cancer (Basal cell carcinoma or squamous cell carcinoma)

The risk of developing non-melanoma skin cancer increases after radiation therapy; it usually appears where the radiation was applied. Exposure to UV light increases this risk. Patients who develop non-melanoma skin cancer after radiation therapy are more likely to develop other types of cancer in the future.

1.8 Malignant melanoma

Malignant melanoma can develop after radiotherapy or chemotherapy with alkylating agents and mitosis inhibitors, such as vincristine and vinblastine. Individuals who have recovered from Hodgkin's lymphoma, hereditary retinoblastoma, soft tissue sarcoma, and gonadal tumors are more likely to develop malignant melanoma. As a second cancer, malignant melanoma is less common than non-melanoma skin cancer.

1.9 Oral cancer

Oral tumors may occur in stem cell transplant recipients and in cured patients with a history of chronic graft-versus-host disease.

1.10 Kidney cancer

The risk of developing kidney cancer is increased after treatment for neuroblastoma, radiation to the middle of the back and chemotherapy with drugs such as cisplatin or carboplatin.

1.11 Bladder cancer

Bladder cancer may occur after chemotherapy with cyclophosphamide.

2. Myelodysplastic syndromes and acute myeloid leukemia

Myelodysplastic syndromes and acute myeloid leukemia may occur less than 10 years after the primary cancer diagnosis of Hodgkin lymphoma, acute lymphoblastic leukemia or sarcoma.

Clinical Manifestations

not have

Clinical Department

not have

Examination & Diagnosis

not have

Clinical Management

Screen

1. The need for screening

For patients who have already undergone cancer treatment, it is crucial to undergo a second cancer screening before symptoms appear. This is known as a second cancer screening, which can help detect a second cancer at an early stage. When abnormalities or cancer are detected, treatment is more likely to be effective. By the time symptoms appear, cancer may have already spread.

It's important to remember that if your child's doctor recommends a screening test, it doesn't necessarily mean they suspect cancer. Screening can start before any symptoms of cancer appear. If the test results are abnormal, your child may need additional tests to determine if they have a second type of cancer. These are known as diagnostic tests.

2. Frequency and items of screening

Tests for screening the second type of cancer depend in part on how a patient has been treated for the first type in the past.

2.1 All patients undergoing cancer treatment should have an annual physical and medical history examination

Physical exam: Used to check for general signs of health, including signs of disease such as lumps, changes in the skin, or anything that seems unusual.

Medical history examination: used to learn about the patient's health habits and past illnesses and treatments.

2.2 The following tests and procedures may be used to examine the skin, breast or colorectal cancer if the patient is receiving radiotherapy

Skin exam: A doctor or nurse examines lumps or spots on the skin that look abnormal in color, size, shape or texture, especially in areas exposed to radiation. It is recommended to have a skin exam once a year to check for symptoms of skin cancer.

Breast self-examination: This involves the patient carefully feeling for lumps or other abnormalities in the breasts and under the armpits. It is recommended that women who have received high-dose radiation therapy start monthly breast self-examinations from puberty until age 25. Women who have had low-dose radiation therapy may not need to start these exams during puberty. Discuss with your doctor when you should begin breast self-examinations.

Clinical Breast Examination (CBE): This is a routine examination of the breasts conducted by a doctor or other healthcare professional. The doctor will carefully examine the breasts and armpits for any lumps or other abnormalities. It is recommended that women who have received high-dose radiation therapy start annual clinical breast examinations from puberty until they turn 25. After turning 25 or 8 years after radiation therapy, whichever comes first, these examinations should be conducted every 6 months. Women who have received low-dose radiation therapy to the chest may not need to start breast cancer screenings from puberty. Discuss with your doctor when you should begin your clinical breast examination.

Breast X-ray examinations can be performed on women who have received high radiation doses to the chest and whose breasts are not dense. It is recommended that these women undergo a breast X-ray examination 8 years after treatment or at age 25, with the later example being the latter. Discuss with your doctor when to start breast X-ray examinations to check for breast cancer.

Magnetic Resonance Imaging (MRI) of the breast: This process uses magnets, radio waves, and computers to create detailed images of the breast. It is also known as Nuclear Magnetic Resonance Imaging (NMR Imaging). MRI is recommended for women who have had high-dose radiation exposure to the chest or have dense breasts. These women are advised to undergo a NMR Imaging examination 8 years after treatment or at age 25, whichever is later. If you have been exposed to radiation to your chest, you should discuss with your doctor whether an MRI of the breast is necessary to check for breast cancer.

Colonoscopy: A colonoscope is inserted through the rectum into the colon to detect polyps, abnormal areas, or signs of cancer in the rectum and colon. Studies indicate that children who have recovered from cancer should undergo a colonoscopy every five years if they received high doses of radiation to the abdomen, pelvis, or spine. Colonoscopy should begin at age 35 or 10 years after treatment, whichever is later. If you have been exposed to radiation to your abdomen, pelvis, or spine, discuss with your doctor when to start the colonoscopy to check for colorectal cancer.

Colonoscopy is a thin, tubular instrument with light and lenses for observation. It may also use a tool to remove polyps or take tissue samples to examine under a microscope for signs of cancer.

Prognosis

not have

Follow-up & Review

not have

Daily Care

not have

Cutting-edge therapeutic and clinical Trials

not have

References

data source ：

PDQ Pediatric Treatment Editorial Board. PDQ Late Effects of Treatment for Childhood Cancer. Bethesda, MD: National Cancer Institute. Website: https://www.cancer.gov/types/childhood-cancers/late-effects-pdq. Date accessed: July 24,2018. [PMID: 26389365]

Translated by Qian Yueping (Senior Manager, Medical Device Industry, Medical Clinical Affairs Department, PhD in Biology)