On this page you can find:

• Who is at risk for and should be aware of subsequent neoplasms?
• What general advise should be given?
• What subsequent neoplasms might occur?
• What surveillance modality should be used and at what frequency should it be performed?
• What should be done if abnormalities are identified?

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 allogeneic HSCT, especially with a history of skin GvHD))
• 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

Disclaimer

While PanCare strives to provide accurate and complete information that is up-to-date as of the date of publication, we acknowledge that the sequence of referral and diagnostic tests might vary according to the local and national healthcare system logistics.

It is recognised that survivors and their healthcare professionals have the final responsibility for making decisions concerning their long-term follow-up care. As such, they may choose to either adopt these recommendations or not to do so after individual informed discussion. It is good practice to document this decision.

In addition to regular surveillance, real-time awareness and prompt reporting of new symptoms and signs is essential to the early detection and timely treatment of late effects.

No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information.

The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.