Can I Get Another Cancer After Having Hodgkin Disease?
Cancer survivors can be affected by a number of health problems, but often their greatest 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. No matter what type of cancer you have had, it’s still possible to get another (new) cancer, even after surviving the first. In fact, certain types of cancer and cancer treatments can be linked to a higher risk of certain second cancers.
People who have had Hodgkin disease can get any type of second cancer, but research has found they have an increased risk of:
- 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.
Over time, treatment for Hodgkin disease has changed. For example, chemotherapy with alkylating agents (certain chemo drugs that are more strongly liked to leukemia) has become much less common. Radiation is given in lower doses, and often only the areas directly affected by Hodgkin disease are treated. These changes seem to have helped lower the risks of some cancers after treatment, but long-term follow-up studies are still needed to be sure.
Leukemia and myelodysplastic syndrome (MDS)
The most common type of leukemia seen after Hodgkin disease is acute myeloid leukemia (AML), but acute lymphocytic and chronic myeloid leukemias are also seen. Myelodysplastic syndrome (MDS) can develop before acute leukemia. The increased risk of leukemia is mainly linked to treatment with chemotherapy (chemo), and is highest if an alkylating agent was used. The combination of drugs known as MOPP (mechlorethamine, vincristine/Oncovin, prednisone, and procarbazine), when used as the main chemo regimen, is linked to a high risk of leukemia and MDS. However, MOPP is rarely used as the main treatment now. Leukemia and MDS are much less common in people treated with more modern regimens such as the combination known as ABVD (doxorubicin/Adriamycin, bleomycin, vinblastine, and dacarbazine).
Some people with Hodgkin disease are treated with a stem cell transplant. Most often, this is used for Hodgkin disease that has come back after treatment (or never went away in the first place). People who have had a stem cell transplant have a higher risk of leukemia and MDS that seems to be related to the additional chemo that is given prior to transplant.
Treating Hodgkin disease with radiation alone doesn’t have much of an effect on leukemia risk, and it isn’t clear if adding radiation to chemo increases the risk from the chemo even further.
The chance of getting leukemia after Hodgkin disease is related to the patient’s age when they were treated, with the highest risk seen in those who were 35 or older during treatment. The risk also seems to go up as the amount of chemo used increases.
The risk of non-Hodgkin lymphoma (NHL) is higher in people who have had Hodgkin disease. This risk does not seem to change based on the type of treatment used.
This is the most common second cancer in female survivors of Hodgkin disease. The risk is highest in those who had radiation to an area in the center of the chest between the lungs (the mediastinum) before age 30. In the past, many patients got radiation to this area as a part of mantle field radiation. (Mantle field radiation covers the area of the neck, chest, and armpits.)
The risk of breast cancer from radiation can be affected by chemo and its side effects. Chemotherapy that includes drugs called alkylating agents causes some women to go through menopause early. In women who went through menopause before age 35 because of Hodgkin disease treatment, the risk of breast cancer isn’t increased – it’s actually lower than expected.
The higher risk of lung cancer is related to chest radiation treatments as well as chemotherapy with alkylating agents. Patients who have both chemo and radiation are even more likely to develop lung cancer. Smoking further increases the risk. The risk of lung cancer goes up if the patient smoked before treatment, but the risk gets even higher if the patient keeps smoking after treatment.
The risk of thyroid cancer is increased in Hodgkin disease patients who were treated with radiation to the neck.
Follow-up care after treatment
After completing treatment for Hodgkin disease, you should still see your doctor regularly and may have tests to look for signs that the cancer has come back. Let your doctor 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 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.
For other patients, experts don’t recommend any additional testing to look for second cancers unless they have symptoms.
Survivors of Hodgkin disease should follow the American Cancer Society guidelines for the early detection of cancer and should stay away from tobacco products. Smoking increases the risk of many cancers and might further increase the risk of some of the second cancers seen in people who have had Hodgkin disease.
To help maintain good health, 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 some cancers.
See Second Cancers in Adults for more information about causes of second cancers.
Last Medical Review: July 10, 2014 Last Revised: May 23, 2016