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Though it happens very infrequently, sometimes people develop a second type of cancer in addition to the first. This could be due to a number of factors, including:
- genetic mutations that can predispose someone to developing certain cancers,
- hereditary cancer syndromes that make people more likely to develop multiple cancers
- side effects of the therapies patients receive to treat their initial cancer diagnoses, and
- lifestyle choices, such as alcohol or tobacco use.
To learn more about why secondary cancers occur, which ones to look out for, and what patients can do to catch them early, we spoke with two experts: Sajad Khazal, M.D., who specializes in pediatric cancers, and J. Andrew Livingston, M.D., who treats both osteosarcoma and soft-tissue sarcoma in adults and children. Here’s what they had to say.
How common are secondary cancers, in general?
Livingston: That’s a very good question. Unfortunately, there’s not a really good, simple answer. Statistically, patients who’ve already had cancer or cancer treatment once do have a higher chance of developing it again over the course of their lifetimes. But it’s important to note that it’s still very, very rare. The chance of developing a chemotherapy-induced leukemia, for instance, is probably less than 1%.
Khazal: Agreed. Among children and young adults, the odds are very low. I’d say less than 2% of all pediatric and young adult patients will develop a secondary cancer.
Which secondary cancers are the most commonly diagnosed?
Livingston: Leukemias, lymphomas and sarcomas. But there are others, such as breast cancer, lung cancer, and thyroid cancer, too. It really depends on a patient’s prior treatment and how it was administered. People who receive radiation therapy to the chest for Hodgkin lymphoma, for instance, are at a higher risk of developing breast cancer one day. But how much depends on several factors, including their age at the time of diagnosis, the dosage they received, and the areas of their body that received radiation.
Khazal: Yes. Usually, they’re blood cancers like Dr. Livingston mentioned, but again, it depends on the initial disease and its treatment. Someone who received radiation treatment in a particular area could theoretically develop skin cancer there as a result many years later. But again, it’s not very common, and the risk is really quite low, so it doesn’t prevent us from using these therapies to treat our patients. You have to weigh the risks and benefits, of course, but the benefits of getting rid of the cancer are usually far greater than the very small risk of potentially causing another cancer down the line.
Do secondary cancers occur more frequently with certain types of therapies than others?
Khazal: Any time someone is given chemotherapy, it puts them at higher risk of developing a secondary cancer. It’s more common with some medications, though, such as etoposide, which is used to treat testicular cancer and lung cancer, and cyclophosphamide, which is used to treat breast cancer and ovarian cancer.
What kind of follow-up care is needed to monitor patients for secondary cancers?
Khazal: Long-term guidelines depend on the type of someone’s primary cancer and its treatment. But the purpose of getting blood tests regularly is to look for signs of secondary cancers. Even if you’ve been cured of your original cancer, there could still be long-term side effects from your treatment.
Are there any special screenings survivors should have to detect secondary cancers early?
Livingston: Yes. Screening for secondary cancers is a very important part of cancer care that every patient should have as part of their survivorship.
Khazal: The type of cancer you had initially and the treatment you received for it will determine what doctors look for and how often. Patients with hereditary cancer syndromes like Li Fraumeni, for instance, will have a full-body MRI done at least once a year as a part of their regular screening. That’s because we know they will likely develop several different types of cancer during their lives. Similarly, patients who receive radiation therapy for a brain tumor will likely be screened for meningioma, a type of benign brain growth that can sometimes develop as a side effect of that therapy.
What symptoms should patients who’ve recovered from a primary cancer watch for, and alert their care team to?
Khazal: With blood cancers, I’d say looking pale, bruising easily, excessive nose or gum bleeds, and persistent fever. All of these are early indicators that your marrow might be failing or not producing enough red or white blood cells. With skin cancers resulting from radiation therapy, I’d say to watch for any new lesion or mole that’s not going away or is getting worse, and is bleeding or itching.
Livingston: The only thing I’d add to that list is a new lump, mass, or pain in an area that was previously irradiated. Those would also be cause for concern. Other, more non-specific symptoms include new or worsening fatigue and frequent infections. All of these could be signs of a secondary blood cancer and should be checked out immediately.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
Breast cancer treatment took a toll on Debbie Mendoza, but she regained her strength and energy with the help of Active Living After Cancer, an MD Anderson program for cancer survivors.
The retired bilingual teacher was diagnosed with metastatic breast cancer in February 2019. At her family’s urging, she traveled from her Austin, Texas home to seek a second opinion at MD Anderson. Here, she met with a multidisciplinary team of experts who recommended a treatment plan involving chemotherapy, a mastectomy and radiation therapy.
Between side effects from the cancer and treatment, Debbie was using a walker and supplementary oxygen daily by the time she completed breast cancer treatment in March 2020.
“My energy felt sapped, the lowest it has ever been,” Debbie says. “If I attempted to do anything physical, I would find myself needing to rest the next day. I wanted to do things, but my body was unable to keep up.”
A physical activity program designed for cancer survivors
Eventually, Debbie was able to stop using additional oxygen, but she tired easily and found herself exhausted by cleaning up the kitchen and other household chores. That’s when she heard about Active Living After Cancer.
The free 12-week program is offered online through community organizations. It gives cancer survivors a virtual support group-like atmosphere as they learn how to increase their physical activity, build healthier habits and cope with the challenges of survivorship. MD Anderson researcher Karen Basen-Engquist, Ph.D., recently published a paper in Cancer that showed the program successfully improves physical functioning, physical activity and health-related quality of life for participants.
When Debbie enrolled, she wasn’t sure what to expect or how much she’d be able to do, but the facilitator for her group said that even starting small could have a big impact.
“When I learned that exercise would help keep my cancer away and improve my lungs, I was sold!” Debbie says. “But I still wasn’t sure how I was supposed to exercise if I didn’t have any energy.”
Yadi, the group facilitator, told her to start with two minutes of exercise a day. “I thought that was rather odd. What could two minutes possibly do?” Debbie recalls. But she listened and set a timer. Before she knew it, two minutes a day slowly crept up to 10 minutes, then 10 minutes turned into 20 minutes.
Gaining the tools to maintain a healthy lifestyle
Each week, Debbie’s Active Living After Cancer group would meet online to learn a new exercise and behavioral skill, and to share their experiences with each other. The group gave Debbie something she couldn’t get from family or friends or a traditional exercise class: a sisterhood of survivors who understood the joys and struggles of life after cancer.
“The camaraderie of talking to other cancer survivors really helped because they understood what I was going through,” Debbie says. “The motivation Yadi gave us also helped. She wouldn’t push us, but she wouldn’t take no for an answer either.”
By the end of the program, Debbie was taking daily walks around the neighborhood with her dog as a warmup to home exercise videos. She enrolled in a group exercise class at her gym and began to improve her diet as well. The goal-setting and resiliency skills she learned over the 12-week course – plus a continued group text chat with her friends from the program – have helped her keep up the healthy lifestyle changes since she finished the program in July.
While Debbie is now free from breast cancer, during treatment, her doctors found a papillary thyroid tumor. It’s not growing quickly or causing side effects, so her care team is monitoring it, but Debbie feels prepared to face it if the situation changes.
“If I do need to get surgery for my thyroid tumor, I’m stronger now to do that,” she says. “I feel so much better and my confidence is higher. I definitely have more energy now than I did a year ago.”
Learn more about Active Living After Cancer and see upcoming classes.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
To a cancer patient, one of the most magical words in the English language may be “remission.” For those fortunate enough to hear it, it imparts not only a much-hoped-for dose of good news, but also a profound sense of relief.
But what does the term “remission” actually mean? And how does it differ – if at all – from “no evidence of disease,” or even “cancer-free?”
We asked medical oncologist Phat Le, M.D., for insight.
What’s the difference between remission, cancer-free, and no evidence of disease?
A lot of people use those terms synonymously, but “remission” and “no evidence of disease” (also known as NEOD or NED) are probably the closest by definition. Officially, both mean that no cancer is currently detectable in the body. That may be based on scans, bloodwork or some other kind of test, such as a breast biopsy or a bone marrow biopsy.
“Cancer-free” is a little more complicated, because it’s not based on something we can measure. Instead, it implies that not only is there nothing detectable in your body as cancer, but we also believe no residual cancer is left anywhere, so there’s no chance of the cancer ever coming back. And that’s a lot trickier to say, because there’s always at least a very slight risk of recurrence, if you’ve ever had cancer before.
So, how do doctors determine which term to use with a particular patient?
That’s really based on the doctor and what they feel comfortable with. Personally, I tend to use “remission” and “no evidence of disease” the most.
Does the type of cancer influence which term you use?
No. But it will determine which type of surveillance testing your doctor chooses.
With solid tumors like lung cancer, for instance, doctors might order a CT scan. But with prostate cancer and ovarian cancer, doctors might use blood tests to look for tumor markers or certain proteins. Doctors also look for evidence of diseased cells in blood or bone marrow samples with leukemia, lymphoma and other blood cancers.
Does the length of time a cancer survivor has gone without a relapse affect which term doctors use?
No. Not really. There are no special terms used for going 5, 10 or any other number of years without a recurrence.
But sometimes, doctors will declare a patient “cancer-free” after a certain amount of time has passed without a relapse. It usually coincides with the transition from active surveillance into survivorship, when patients begin needing fewer or less frequent check-ups.
What’s the one thing people should know about this topic?
Though all of these terms are sometimes used interchangeably, it’s important to ask your oncologist specifically what they mean. Because I may use it one way, and another physician might use it another.
It’s also important for all cancer survivors to be on some type of surveillance program. Some cancers are considered very low-risk, so if you’ve already gone 5 or 10 years without a recurrence, it’s highly unlikely that you’ll ever have one. But it’s still not impossible. So, you need to keep an eye on it, just to make sure that if the cancer ever does come back, you catch it as soon as possible.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
I've got a beautiful life to look forward to after cancer, and I plan to make the most of it.