Second Cancers Caused by Cancer Treatment

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Testicular cancer

The most common cancer seen in testicular cancer survivors is a second testicular cancer. Overall, 2% to 5% of men who have had cancer in 1 testicle will eventually have it in the other testicle. The second cancer is not from treating the first cancer with radiation or chemotherapy. In fact, those treated with surgery alone still have an increased risk of a second testicular cancer. The chance of getting a second testicular cancer is actually lower in men who were treated with chemotherapy. The rest of this section is about second cancers other than testicular cancer.

Risk of solid tumors

Compared with most men in the general population, testicular cancer survivors are up to twice as likely to develop a new cancer outside the testicle. The chance of a second cancer changes over time and depends on which treatments were used and how old the patient was when he was treated.

The risk of a solid tumor cancer starts going up within 5 years and doubles after 10 years in those men who were treated with radiation alone. The risk is highest for cancers in the area that received radiation (the radiation field). This risk remains high and doesn’t seem to go down with time.

The most common cancers seen after abdominal radiation for testicular cancer are cancers of the bladder, colon, pancreas, and stomach. Radiation to the abdomen also increases the risk of cancers of the rectum, kidney, and prostate. If the radiation field includes the chest, the risks of lung cancer, esophagus cancer, mesothelioma (cancer of the outer lining of the lung), and thyroid cancer are increased. Radiation treatments also increase the risk of melanoma skin cancer and connective tissue cancer (sarcoma). The risks are generally greater with higher radiation doses or if the patient got both chemotherapy and radiation.

In recent years, radiation therapy for testicular cancer has changed. Lower doses of radiation are used, and preventive treatment to the chest has been stopped. Long-term follow-up studies are needed to see if these changes have lowered the cancer risks.

Chemotherapy is linked with an increased risk of solid tumor cancers that is slightly less than what is seen after radiation.

Risk of leukemia

The risk of leukemia (and myelodysplastic syndrome or MDS) after treatment for testicular cancer is also increased. Use of the chemotherapy drug cisplatin is linked most often to leukemia and MDS, although high doses of etoposide (VP-16, Etopophos®, or Vepesid®) are sometimes also a factor (doses higher than what are normally used today). Radiation given with chemotherapy seems to increase risk even more. Leukemia and MDS are both uncommon cancers normally, so even though the risk of these cancers is higher than average, very few patients develop them from their treatment.

Follow-up care

Standard follow-up for survivors of testicular cancer includes frequent doctor visits, exams, and imaging tests for a number of years. Over time, follow-up becomes less intense, but they should see a doctor at least once a year or sooner if any problems develop.

Because the most common cancer seen is a second testicular cancer, survivors should perform regular testicular self-exams.

All patients should be encouraged to avoid tobacco smoke.

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