Second Cancers After Hodgkin Lymphoma
Cancer survivors can be affected by a number of health problems, but often a major concern is facing cancer again. If a cancer comes back after treatment it is called a recurrence. But some cancer survivors may develop another type of cancer later. This is called a second cancer.
People who have had Hodgkin lymphoma can get any type of second cancer, but research has found they have an increased risk of certain cancers, including:
- Leukemia and myelodysplastic syndrome (MDS)
- Non-Hodgkin lymphoma
- Breast cancer (in women)
- Lung cancer
- Thyroid cancer
- Cancer of the lip and tongue
- Salivary gland cancer
- Stomach cancer
- Colon cancer
- Liver cancer
- Bone cancer
- Soft tissue cancer
- Anal cancer
- Cancer of the uterus
- Cancer of the ureter (the tube that connects the kidney and the bladder)
- Melanoma of the skin
- Kaposi sarcoma
The increased risk of many of these cancers seems to be linked to treatment with radiation. For example:
- Women who have had chest radiation (especially before age 30) have been found to have a higher risk of breast cancer.
- Radiation to the neck has been linked to a higher risk of thyroid cancer.
- Radiation to the chest has been linked to a higher risk of lung cancer.
But over time, the use of radiation to treat Hodgkin lymphoma has changed. Radiation is now given in lower doses, and often only to the areas directly affected by Hodgkin lymphoma. The risks with modern radiation treatment are likely to be lower, although long-term studies are needed to be sure
Chemotherapy (chemo), especially with drugs called alkylating agents (such as mechlorethamine) has been linked with a higher risk of several types of cancer, including leukemias. Treatment with alkylating agents has become much less common, so these risks are probably not as high as they were in the past, but long-term follow-up studies are needed to be sure.
Follow-up care after Hodgkin lymphoma treatment
After completing treatment for Hodgkin lymphoma, you should still see your doctor regularly and may have tests to look for signs that the cancer has come back. Let them know about any new symptoms or problems, because they could be caused by the lymphoma coming back or by a new disease or second cancer.
Women who were treated with radiation therapy to the chest (such as mantle field radiation therapy) before age 30 have an increased risk of breast cancer. The American Cancer Society recommends yearly breast MRIs in addition to mammograms and clinical breast exams beginning at age 30 for these women.
The Children’s Oncology Group has guidelines for the follow-up of patients treated for cancer as a child, teen, or young adult, including screening for second cancers. These can be found at www.survivorshipguidelines.org.
Survivors of Hodgkin lymphoma should also follow the American Cancer Society guidelines for the early detection of cancer, such as those for colorectal and lung cancer. Most experts don’t recommend any other testing to look for second cancers unless you have symptoms.
Can I lower my risk of getting a second cancer?
There are steps you can take to lower your risk and stay as healthy as possible. For example, it’s important to stay away from tobacco products. Smoking increases the risk of many cancers, including some of the second cancers seen in people who have had Hodgkin lymphoma.
To help maintain good health, Hodgkin lymphoma survivors should also:
- Get to and stay at a healthy weight
- Be physically active
- Eat a healthy diet, with an emphasis on plant foods
- Limit alcohol to no more than 1 drink per day for women or 2 per day for men
These steps may also lower the risk of other health problems.
See Second Cancers in Adults for more information about causes of second cancers.
Aisenberg AC. Problems in Hodgkin's disease management. Blood. 1999;93:761-779.
Children’s Oncology Group. Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers. 2014. Accessed at www.survivorshipguidelines.org on April 20, 2016.
Dores GM, Coté TR, Travis LB. New Malignancies Following Hodgkin Lymphoma, Non-Hodgkin Lymphoma, and Myeloma. In: Curtis RE, Freedman DM, Ron E, Ries LAG, Hacker DG, Edwards BK, Tucker MA, Fraumeni JF Jr. (eds). New Malignancies Among Cancer Survivors: SEER Cancer Registries, 1973-2000. National Cancer Institute. NIH Publ. No. 05-5302. Bethesda, MD, 2006. Accessed at http://seer.cancer.gov/archive/publications/mpmono/MPMonograph_complete.pdf on April 20, 2016.
Dores GM, Melayer C, Curtis RE, et al. Second malignant neoplasms among long-term survivors of Hodgkin’s disease: A population-based evaluation over 25 years. J Clin Oncol. 2002;20:3484–3494.
Hemminki K, Lenner P, Sundquist J, Bermejo JL. Risk of subsequent solid tumors after non-Hodgkin's lymphoma: effect of diagnostic age and time since diagnosis. J Clin Oncol. 2008;26:1850-1857.
Last Medical Review: February 10, 2017 Last Revised: March 30, 2017