SUBSEQUENT NEOPLASMS

Consensus-based recommendation for surveillance of subsequent neoplasmsa , b, c, d, e, f

This page is part of the PanCare follow-up recommendations for surveillance of late effects. Click here, for more information on these recommendations.

Who is at risk for and should be aware of subsequent neoplasms?

All CAYA cancer survivors are at a potential increased risk of subsequent neoplasms depending on the treatment that they have received and their genetic risk profile

What general advise should be given?

  • Discuss the importance of prompt reporting of new symptoms or masses
  • Discuss healthy lifestyle recommendations
  • Encourage reduction of risk behaviour (smoking, alcohol consumption, drug use, sun exposure)
  • Encourage HPV vaccination (according to national guidelines) and consider advising safe sexual practices
  • Encourage participation in the national cancer screening programmes, unless more intensive or earlier surveillance is specified in the guidelines b

What subsequent neoplasms might occur?

  • Acute myeloid leukaemia or myelodysplasia (after alkylating agents, anthracyclines, mitoxantrone, epipodophyllotoxins or autologous HSCT)
  • Bladder cancer c (after radiotherapy to a volume exposing the bladder, including TBI, and after cyclophosphamide or ifosfamide, particularly if they have a history of severe haemorrhagic cystitis)
  • Bone cancer d (after any radiotherapy, including TBI)
  • Breast cancer (after radiotherapy ≥10 Gy to a volume exposing the breasts or high abdominal field radiation above the diaphragm at a young age)
  • CNS neoplasms (after radiotherapy to a volume exposing the head or brain, including TBI)
  • Colorectal cancer (after radiotherapy to a volume exposing the colon and rectum, including TBI)
  • Lung cancer (after radiotherapy to a volume exposing the lungs, including TBI)
  • Oral cancer e (after radiotherapy to a volume exposing the oral cavity, including TBI, and after HSCT with a history of oral GvHD)
  • Melanoma and non-melanoma skin cancer (after any radiotherapy, including TBI, predominantly in the radiotherapy field or after HSCT)
  • Thyroid cancer (after radiotherapy to a volume exposing the thyroid gland, including TBI, or therapeutic 131I-MIBG)

What surveillance modality should be used and at what frequency should it be performed?

All survivors:

  • Perform a family history of malignancies
    at least every 5 years, starting at entry into long-term follow-up

Survivors with, or with a suspicion of, a hereditary cancer syndrome f:

  • Additional consultation by a clinical geneticist to determine individualised surveillance methods and frequency
    at entry into long-term follow-up

Survivors at risk for breast cancer, colorectal cancer, CNS neoplasms, skin cancer or thyroid cancer:

  • Consult the separate recommendations for breast cancer, colorectal cancer, CNS neoplasms, skin cancer or thyroid cancer b

What should be done if abnormalities are identified?

If there is a suspicion of a subsequent neoplasm:

  • Perform the appropriate diagnostic tests

  • Refer to the appropriate HCP

Survivors at risk for breast cancer, colorectal cancer, CNS neoplasms, skin cancer or thyroid cancer:

  • Consult the separate recommendations for breast cancer, colorectal cancer, CNS neoplasms, skin cancer or thyroid cancer b

a The working group considered guidelines for the following subsequent malignant neoplasms that can occur in CAYA cancer survivors: acute myeloid leukaemia, bladder cancer, breast cancer, bone cancer, cervical cancer, CNS neoplasms, endometrial cancer, gastro-intestinal cancer, lung cancer, melanoma and non-melanoma skin cancer, oral cancer, prostate cancer, thyroid cancer, and testicular cancer. No recommendations could be formulated for cervical, endometrial, prostate and testicular cancer. We acknowledge that there might also be an increased risk of other subsequent neoplasms, but no recommendations can be made for surveillance at this time.

b Surveillance tests are specified in the IGHG guidelines for subsequent breast cancer, thyroid cancer and CNS neoplasm surveillance, and in the consensus-based recommendations for colorectal cancer and melanoma and non-melanoma skin cancer surveillance.

c Further recommendations regarding lower urinary tract problems are specified in the Consensus-based recommendation for lower urinary tract problems.

d Further recommendations regarding surveillance of bone problems are specified in the Consensus-based recommendation for bone problems.

e Further recommendations regarding dental and oral exams are specified in the Consensus-based recommendation for dental and oral problems and the Consensus-based recommendation for health promotion.

f Further recommendations regarding dental and oral exams are specified in the Consensus-based recommendation for dental and oral problems and the Consensus-based recommendation for health promotion.