Second Cancers Caused by Cancer Treatment

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Non-Hodgkin lymphoma

Survivors of non-Hodgkin lymphoma (NHL) are at increased risk of developing some second cancers, but less so than patients who were treated for Hodgkin disease. Overall, NHL survivors get new cancers about 15% more often than most people (the general population).

Survivors of NHL are at risk for several cancers such as:

  • Melanoma (a type of skin cancer)
  • Lung cancer
  • Kidney cancer
  • Kaposi sarcoma
  • Cancers of the head/neck area (includes the lip, tongue, floor of the mouth, throat, salivary glands, and voice box)
  • Colon cancer
  • Thyroid cancer
  • Bone and soft tissue cancer
  • Bladder cancer
  • Leukemia and myelodysplastic syndrome
  • Hodgkin disease

Radiation therapy to the chest increases the risk of breast cancer in women who were treated before age 30. Mesothelioma, a rare cancer of the outer lining of the lung, is also increased in those who were treated with radiation.

A higher risk of bladder cancer has only been seen in those who were treated with chemotherapy. The drug cyclophosphamide (Cytoxan®), especially if used in higher doses, is linked to bladder cancer.

Low-dose total body irradiation (TBI), which was once used to treat NHL, has been linked to an increased risk of leukemia. The risk of leukemia is also higher in those treated with chemotherapy, with the highest risk seen in those treated with both radiation and chemotherapy.

Patients who had autologous bone marrow transplants (meaning the patient's own bone marrow was used – not someone else's) are also at increased risk for developing acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS). This may be related to the chemo given before transplant.

Treatment-related second cancer risk after NHL increases over time. Those who were diagnosed and treated at younger ages (20 years old and younger) are more likely to develop a second cancer than those who were older (70 or older) when they were found to have NHL.

Follow-up care

Since there is an increased risk for a second cancer following treatment for NHL, survivors should get careful follow-up. Your doctors should be looking for the development of any of the above mentioned cancers as well as the recurrence of NHL.

All patients should be encouraged to avoid tobacco smoke.

Women who were treated with chest radiation prior to the age of 30 have an increased risk of breast cancer and should consider beginning breast screening at an early age. The Children’s Oncology Group’s guidelines recommend that patients treated with radiation to the chest (as a child, teen, or young adult) start screening 5 to 8 years after finishing their treatment or at age 25, whichever is later. This screening should include regular breast exams, mammograms, and breast MRI. The American Cancer Society’s guidelines recommend yearly breast MRIs in addition to mammograms for women who were treated with chest radiation while they were aged 10 to 30.

Last Medical Review: 01/30/2012
Last Revised: 01/30/2012