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Late Effects of Treatment for Childhood Cancer (PDQ®)

Patient Version
Last Modified: 01/11/2012

Second Cancers

Key Points for This Section


Childhood cancer survivors have an increased risk of a second cancer later in life.

A different primary cancer that occurs at least two months after cancer treatment ends is called a second cancer. A second cancer may occur months or years after treatment is completed. The type of second cancer that occurs depends in part on the original type of cancer and the cancer treatment.

Second cancers that occur after cancer treatment include the following:

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

Some childhood cancer survivors may have an increased risk of developing a second cancer because they have a family history of cancer or an inherited genetic syndrome such as Li-Fraumeni syndrome. Problems with the way DNA is repaired in cells and the way anticancer drugs are used in the body may also affect the risk of second cancers.

Patients who have been treated for cancer need regular screening tests to check for a second cancer.

It is important for patients who have been treated for cancer to be checked for a second cancer before symptoms appear. This is called screening for a second cancer and may help find a second cancer at an early stage. When abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread.

It is important to remember that your doctor does not necessarily think you have cancer if he or she suggests a screening test. Screening tests are given when you have no cancer symptoms. If a screening test result is abnormal, you may need to have more tests done to find out if you have a second cancer. These are called diagnostic tests.

The kind of test used to screen for a second cancer depends on the kind of cancer treatment the patient had in the past.

All patients who have been treated for cancer should have a physical exam and medical history done once a year. A physical exam of the body is done to check general signs of health, including checking for signs of disease, such as lumps, changes in the skin, or anything else that seems unusual. A medical history is taken to learn about the patient’s health habits and past illnesses and treatments.

If the patient was treated for leukemia, a complete blood count (CBC) may be done. The CBC is usually done every year for 10 years after treatment with an alkylating agent or topoisomerase II inhibitor ends.

  • Complete blood count (CBC) with differential: A procedure in which a sample of blood is drawn and checked for the following:

If the patient received radiation therapy, the following tests and procedures may be used:

  • Skin exam: A doctor or nurse checks the skin for bumps or spots that look abnormal in color, size, shape, or texture, especially in the area where radiation was given. It is suggested that a skin exam be done once a year to check for signs of skin cancer.
  • Mammogram: An x-ray of the breast. A mammogram may be done in women who had radiation to the chest and who do not have dense breasts. It is suggested that these women have a mammogram once a year starting 8 years after treatment or at age 25 years, whichever is later.
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). An MRI may be done in women who had radiation to the chest and who have dense breasts. It is suggested that these women have an MRI once a year starting 8 years after treatment or at age 25 years, whichever is later.
  • Breast self-exam: An exam of the breast by the patient. The patient carefully feels the breasts and under the arms for lumps or anything else that seems unusual. It is suggested that women treated with radiation therapy to the chest do a monthly breast self-exam beginning at puberty until age 25 years.
  • Clinical breast exam (CBE): An exam of the breast by a doctor or other health professional. The doctor will carefully feel the breasts and under the arms for lumps or anything else that seems unusual. It is suggested that women treated with radiation therapy to the chest have a clinical breast exam every 6 months beginning at puberty until age 25 years.
  • Colonoscopy: A procedure to look inside the rectum and colon for polyps, abnormal areas, or cancer. A colonoscope is inserted through the rectum into the colon. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a microscope for signs of cancer. It is suggested that childhood cancer survivors who had radiation to the abdomen, pelvis, or spine have a colonoscopy every 5 years. This begins at age 35 years or 10 years after treatment ended, whichever is later.


Glossary Terms

abdomen (AB-doh-men)
The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.
abnormal (ab-NOR-mul)
Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).
acute lymphoblastic leukemia (uh-KYOOT LIM-foh-BLAS-tik loo-KEE-mee-uh)
An aggressive (fast-growing) type of leukemia (blood cancer) in which too many lymphoblasts (immature white blood cells) are found in the blood and bone marrow. Also called acute lymphocytic leukemia and ALL.
acute lymphocytic leukemia (uh-KYOOT LIM-foh-SIH-tik loo-KEE-mee-uh)
An aggressive (fast-growing) type of leukemia (blood cancer) in which too many lymphoblasts (immature white blood cells) are found in the blood and bone marrow. Also called acute lymphoblastic leukemia and ALL.
acute myeloid leukemia (uh-KYOOT MY-eh-loyd loo-KEE-mee-uh)
An aggressive (fast-growing) disease in which too many myeloblasts (immature white blood cells that are not lymphoblasts) are found in the bone marrow and blood. Also called acute myeloblastic leukemia, acute myelogenous leukemia, acute nonlymphocytic leukemia, AML, and ANLL.
alkylating agent (AL-kuh-LAY-ting AY-jent)
A type of drug that is used in the treatment of cancer. It interferes with the cell's DNA and inhibits cancer cell growth.
blood (blud)
A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
brain tumor (brayn TOO-mer)
The growth of abnormal cells in the tissues of the brain. Brain tumors can be benign (not cancer) or malignant (cancer).
breast (brest)
Glandular organ located on the chest. The breast is made up of connective tissue, fat, and breast tissue that contains the glands that can make milk. Also called mammary gland.
breast cancer (brest KAN-ser)
Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.
breast self-exam (brest self-eg-ZAM)
An exam by a woman of her breasts to check for lumps or other changes.
busulfan (byoo-SUL-fan)
An anticancer drug that belongs to the family of drugs called alkylating agents.
cancer (KAN-ser)
A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
carmustine (kar-MUS-teen)
An anticancer drug that belongs to the family of drugs called alkylating agents.
cell (sel)
The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
chemotherapy (KEE-moh-THAYR-uh-pee)
Treatment with drugs that kill cancer cells.
chlorambucil (klor-AM-byoo-sil)
A drug used to treat several types of leukemias and lymphomas. It blocks cell growth by damaging the cell’s DNA and may kill cancer cells. It is a type of alkylating agent. Also called Leukeran.
clinical breast exam (KLIH-nih-kul brest eg-ZAM)
A physical exam of the breast performed by a health care provider to check for lumps or other changes. Also called CBE.
colon (KOH-lun)
The longest part of the large intestine, which is a tube-like organ connected to the small intestine at one end and the anus at the other. The colon removes water and some nutrients and electrolytes from partially digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus.
colonoscope (koh-LAH-noh-SKOPE)
A thin, tube-like instrument used to examine the inside of the colon. A colonoscope has a light and a lens for viewing and may have a tool to remove tissue.
colonoscopy (KOH-luh-NOS-koh-pee)
Examination of the inside of the colon using a colonoscope, inserted into the rectum. A colonoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.
colorectal cancer (KOH-loh-REK-tul KAN-ser)
Cancer that develops in the colon (the longest part of the large intestine) and/or the rectum (the last several inches of the large intestine before the anus).
complete blood count (kum-PLEET blud kownt)
A test to check the number of red blood cells, white blood cells, and platelets in a sample of blood. Also called blood cell count and CBC.
cyclophosphamide (SY-kloh-FOS-fuh-mide)
A drug that is used to treat many types of cancer and is being studied in the treatment of other types of cancer. It is also used to treat some types of kidney disease in children. Cyclophosphamide attaches to DNA in cells and may kill cancer cells. It is a type of alkylating agent. Also called CTX and Cytoxan.
dacarbazine (duh-KAR-buh-zeen)
A drug that is used to treat Hodgkin lymphoma and malignant melanoma and is being studied in the treatment of other types of cancer. It attaches to DNA in cells and may kill cancer cells. It is a type of alkylating agent. Also called DTIC-Dome.
diagnosis (DY-ug-NOH-sis)
The process of identifying a disease, such as cancer, from its signs and symptoms.
diagnostic procedure (DY-ug-NAH-stik proh-SEE-jer)
A type of test used to help diagnose a disease or condition. Mammograms and colonoscopies are examples of diagnostic procedures. Also called diagnostic test.
DNA
The molecules inside cells that carry genetic information and pass it from one generation to the next. Also called deoxyribonucleic acid.
dose (dose)
The amount of medicine taken, or radiation given, at one time.
drug (drug)
Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.
etoposide (ee-toh-POH-side)
A drug used to treat testicular and small cell lung cancers. It is also being studied in the treatment of several other types of cancer. Etoposide blocks certain enzymes needed for cell division and DNA repair, and it may kill cancer cells. It is a type of podophyllotoxin derivative and a type of topoisomerase inhibitor. Also called Toposar and Vepesid.
Ewing sarcoma (YOO-ing sar-KOH-muh)
A type of cancer that forms in bone or soft tissue. Also called peripheral primitive neuroectodermal tumor and pPNET.
family history (FA-mih-lee HIH-stuh-ree)
A record of the relationships among family members along with their medical histories. This includes current and past illnesses. A family history may show a pattern of certain diseases in a family. Also called family medical history.
genetic (jeh-NEH-tik)
Inherited; having to do with information that is passed from parents to offspring through genes in sperm and egg cells.
hemoglobin (HEE-moh-GLOH-bin)
The substance inside red blood cells that binds to oxygen in the lungs and carries it to the tissues.
Hodgkin lymphoma (HOJ-kin lim-FOH-muh)
A cancer of the immune system that is marked by the presence of a type of cell called the Reed-Sternberg cell. The two major types of Hodgkin lymphoma are classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma. Symptoms include the painless enlargement of lymph nodes, spleen, or other immune tissue. Other symptoms include fever, weight loss, fatigue, or night sweats. Also called Hodgkin disease.
ifosfamide (i-FOS-fuh-mide)
A drug that is used with other drugs to treat germ cell testicular cancer that did not respond to previous treatment with other drugs. It is also being studied in the treatment of other types of cancer. Ifosfamide attaches to DNA in cells and may kill cancer cells. It is a type of alkylating agent and a type of antimetabolite. Also called Ifex.
inherited (in-HAYR-ih-ted)
Transmitted through genes that have been passed from parents to their offspring (children).
intrathecal (IN-truh-THEE-kul)
Describes the fluid-filled space between the thin layers of tissue that cover the brain and spinal cord. Drugs can be injected into the fluid or a sample of the fluid can be removed for testing.
lens (lenz)
A clear disk that focuses light, as in a camera or microscope. In the eye, the lens is a clear, curved structure at the front of the eye behind the pupil. It focuses light rays that enter the eye through the pupil, making an image on the retina (light-sensitive layers of nerve tissue at the back of the eye).
leukemia (loo-KEE-mee-uh)
Cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of blood cells to be produced and enter the bloodstream.
Li-Fraumeni syndrome (lee-FRAH-meh-nee SIN-drome)
A rare, inherited predisposition to multiple cancers, caused by an alteration in the p53 tumor suppressor gene.
lomustine (loh-MUS-teen)
An anticancer drug that belongs to the family of drugs called alkylating agents.
lung cancer (lung KAN-ser)
Cancer that forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.
mammogram (MA-muh-gram)
An x-ray of the breast.
medical history (MEH-dih-kul HIH-stuh-ree)
A record of information about a person’s health. A personal medical history may include information about allergies, illnesses, surgeries, immunizations, and results of physical exams and tests. It may also include information about medicines taken and health habits, such as diet and exercise. A family medical history includes health information about a person’s close family members (parents, grandparents, children, brothers, and sisters). This includes their current and past illnesses. A family medical history may show a pattern of certain diseases in a family.
melphalan (MEL-fuh-LAN)
A drug that is used to treat multiple myeloma and ovarian epithelial cancer and is being studied in the treatment of other types of cancer. It belongs to the family of drugs called alkylating agents. Also called Alkeran.
methotrexate (meh-thuh-TREK-sayt)
A drug used to treat some types of cancer, rheumatoid arthritis, and severe skin conditions, such as psoriasis. Methotrexate stops cells from making DNA and may kill cancer cells. It is a type of antimetabolite. Also called amethopterin, MTX, and Rheumatrex.
microscope (MY-kroh-SKOPE)
An instrument that is used to look at cells and other small objects that cannot be seen with the eye alone.
MRI
A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or x-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints, and the inside of bones. Also called magnetic resonance imaging, NMRI, and nuclear magnetic resonance imaging.
myelodysplastic syndromes (MY-eh-loh-dis-PLAS-tik SIN-dromz)
A group of diseases in which the bone marrow does not make enough healthy blood cells. Also called preleukemia and smoldering leukemia.
non-Hodgkin lymphoma (non-HOJ-kin lim-FOH-muh)
Any of a large group of cancers of lymphocytes (white blood cells). Non-Hodgkin lymphomas can occur at any age and are often marked by lymph nodes that are larger than normal, fever, and weight loss. There are many different types of non-Hodgkin lymphoma. These types can be divided into aggressive (fast-growing) and indolent (slow-growing) types, and they can be formed from either B-cells or T-cells. B-cell non-Hodgkin lymphomas include Burkitt lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), diffuse large B-cell lymphoma, follicular lymphoma, immunoblastic large cell lymphoma, precursor B-lymphoblastic lymphoma, and mantle cell lymphoma. T-cell non-Hodgkin lymphomas include mycosis fungoides, anaplastic large cell lymphoma, and precursor T-lymphoblastic lymphoma. Lymphomas that occur after bone marrow or stem cell transplantation are usually B-cell non-Hodgkin lymphomas. Prognosis and treatment depend on the stage and type of disease. Also called NHL.
nurse (nurs)
A health professional trained to care for people who are ill or disabled.
oxygen (OK-sih-jen)
A colorless, odorless gas. It is needed for animal and plant life. Oxygen that is breathed in enters the blood from the lungs and travels to the tissues.
pelvis (PEL-vus)
The lower part of the abdomen, located between the hip bones.
physical examination (FIH-zih-kul eg-ZA-mih-NAY-shun)
An exam of the body to check for general signs of disease.
platelet (PLAYT-let)
A tiny piece of a cell found in the blood that breaks off from a large cell found in the bone marrow. Platelets help wounds heal and prevent bleeding by forming blood clots. Also called thrombocyte.
polyp (PAH-lip)
A growth that protrudes from a mucous membrane.
primary tumor (PRY-mayr-ee TOO-mer)
The original tumor.
protein (PROH-teen)
A molecule made up of amino acids that are needed for the body to function properly. Proteins are the basis of body structures such as skin and hair and of substances such as enzymes, cytokines, and antibodies.
puberty (PYOO-ber-tee)
The time of life when a child experiences physical and hormonal changes that mark a transition into adulthood. The child develops secondary sexual characteristics and becomes able to have children. Secondary sexual characteristics include growth of pubic, armpit, and leg hair; breast enlargement; and increased hip width in girls. In boys, they include growth of pubic, face, chest and armpit hair; voice changes; penis and testicle growth, and increased shoulder width.
radiation (RAY-dee-AY-shun)
Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).
radiation therapy (RAY-dee-AY-shun THAYR-uh-pee)
The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.
rectum (REK-tum)
The last several inches of the large intestine closest to the anus.
red blood cell (red blud sel)
A cell that carries oxygen to all parts of the body. Also called erythrocyte and RBC.
retinoblastoma (REH-tih-noh-blas-TOH-muh)
Cancer that forms in the tissues of the retina (the light-sensitive layers of nerve tissue at the back of the eye). Retinoblastoma usually occurs in children younger than 5 years. It may be hereditary or nonhereditary (sporadic).
sarcoma (sar-KOH-muh)
A cancer of the bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue.
screening (SKREE-ning)
Checking for disease when there are no symptoms. Since screening may find diseases at an early stage, there may be a better chance of curing the disease. Examples of cancer screening tests are the mammogram (breast), colonoscopy (colon), Pap smear (cervix), and PSA blood level and digital rectal exam (prostate). Screening can also include checking for a person’s risk of developing an inherited disease by doing a genetic test.
second primary cancer (SEH-kund PRY-mayr-ee KAN-ser)
Refers to a new primary cancer in a person with a history of cancer.
skin cancer (skin KAN-ser)
Cancer that forms in the tissues of the skin. There are several types of skin cancer. Skin cancer that forms in melanocytes (skin cells that make pigment) is called melanoma. Skin cancer that forms in the lower part of the epidermis (the outer layer of the skin) is called basal cell carcinoma. Skin cancer that forms in squamous cells (flat cells that form the surface of the skin) is called squamous cell carcinoma. Skin cancer that forms in neuroendocrine cells (cells that release hormones in response to signals from the nervous system) is called neuroendocrine carcinoma of the skin. Most skin cancers form in older people on parts of the body exposed to the sun or in people who have weakened immune systems.
solid tumor (SAH-lid TOO-mer)
An abnormal mass of tissue that usually does not contain cysts or liquid areas. Solid tumors may be benign (not cancer), or malignant (cancer). Different types of solid tumors are named for the type of cells that form them. Examples of solid tumors are sarcomas, carcinomas, and lymphomas. Leukemias (cancers of the blood) generally do not form solid tumors.
spine (spine)
The bones, muscles, tendons, and other tissues that reach from the base of the skull to the tailbone. The spine encloses the spinal cord and the fluid surrounding the spinal cord. Also called backbone, spinal column, and vertebral column.
stage (stayj)
The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.
stem cell transplant (stem sel tranz-plant)
A method of replacing immature blood-forming cells in the bone marrow that have been destroyed by drugs, radiation, or disease. Stem cells are injected into the patient and make healthy blood cells. A stem cell transplant may be autologous (using a patient’s own stem cells that were saved before treatment), allogeneic (using stem cells donated by someone who is not an identical twin), or syngeneic (using stem cells donated by an identical twin).
stomach cancer (STUH-muk KAN-ser)
Cancer that forms in tissues lining the stomach. Also called gastric cancer.
survivor (ser-VY-ver)
One who remains alive and continues to function during and after overcoming a serious hardship or life-threatening disease. In cancer, a person is considered to be a survivor from the time of diagnosis until the end of life.
symptom (SIMP-tum)
An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.
syndrome (SIN-drome)
A set of symptoms or conditions that occur together and suggest the presence of a certain disease or an increased chance of developing the disease.
teniposide (teh-NIH-puh-side)
An anticancer drug that is a podophyllotoxin derivative and belongs to the family of drugs called mitotic inhibitors.
thyroid cancer (THY-royd KAN-ser)
Cancer that forms in the thyroid gland (an organ at the base of the throat that makes hormones that help control heart rate, blood pressure, body temperature, and weight). Four main types of thyroid cancer are papillary, follicular, medullary, and anaplastic thyroid cancer. The four types are based on how the cancer cells look under a microscope.
tissue (TIH-shoo)
A group or layer of cells that work together to perform a specific function.
total-body irradiation (TOH-tul-BAH-dee ih-RAY-dee-AY-shun)
Radiation therapy to the entire body. It is usually followed by bone marrow or peripheral stem cell transplantation.
white blood cell (hwite blud sel)
A type of immune cell. Most white blood cells are made in the bone marrow and are found in the blood and lymph tissue. White blood cells help the body fight infections and other diseases. Granulocytes, monocytes, and lymphocytes are white blood cells. Also called leukocyte and WBC.
x-ray (EX-ray)
A type of radiation used in the diagnosis and treatment of cancer and other diseases. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.