SUBSEQUENT NEOPLASMS: BLOOD CANCER

This page is part of the PanCare PLAIN summaries about late effects and recommendations for long-term follow-up care for survivors of childhood, adolescent, and young adult cancer. Click here, for more information on the PLAIN summaries.

This brochure is a sequel to the brochure Subsequent neoplasms: general. Please read that brochure first before you continue.

This PLAIN summary is based on the PanCareFollowUp guideline about “Subsequent neoplasms” [1], which is based on the consensus of different national guidelines.

PLAIN version 2.1: 27/05/2024

Subsequent cancer: blood cancer

Our blood contains a variety of blood cells. Some are important for carrying nutrients and oxygen around the body (red blood cells). Others are responsible for fighting off infections (white blood cells) or wound healing (platelets). All blood cells are made in the bone marrow, and when they are ready and mature, they enter the bloodstream.

Sometimes, immature white blood cells in the bone marrow can become malignant. This means that they do not work properly any more and multiply uncontrollably. Because of this, there is no room for healthy blood cells to develop. When this happens, this is called blood cancer.

Only a very few people who have had cancer before develop blood cancer.

Due to treatment of the first cancer, survivors sometimes have a higher risk of two types of blood cancer: acute myeloid leukaemia (AML) and myelodysplasia (MDS).

Am I at higher risk of AML or MDS?

Anyone, including people who have never had cancer treatment, may develop AML or MDS. However, there are some cancer treatments that may increase the risk of having AML or MDS as a subsequent cancer later in life.

The following treatments can increase the risk of AML or MDS:

  • A group of chemotherapy drugs called alkylating agents such as cyclophosphamide and procarbazine.
  • A group of chemotherapy drugs called anthracyclines such as doxorubicin, daunorubicin and mitoxantrone.
  • A group of chemotherapy drugs called epipodophyllotoxins such as etoposide and teniposide.
  • Stem cell transplantation with your stem cells (autologous)

You can find out if you have received any of these treatments by looking at your treatment summary. If you do not have a treatment summary or if you have any questions, do contact your treating hospital.

If you develop AML or MDS, it does not always mean that this is caused by treatment for your first cancer. AML and MDS may have other causes.

What are the symptoms and signs of AML and MDS?

There are symptoms and signs that can tell you if you might have AML or MDS. You might not have these symptoms and signs at the moment, but it is important to be aware of them in case they may develop in the future.

These symptoms and signs may suggest that you have AML or MDS:

  • Bruising and bleeding easily
  • Pale looking skin
  • Red or purple spots on the skin
  • Swollen glands in the neck, armpit and/or groin
  • Fever
  • (Excessive) sweating

These symptoms and signs are often caused by something else. However, early diagnosis and treatment of AML or MDS is very important. If you experience any of these symptoms or signs, please contact your general practitioner or follow-up care specialist soon.

I am at higher risk of AML or MDS. What tests should I have and when?

If you are at higher risk of AML or MDS, we do not recommend regular testing at this point. However, it is important that you are aware of the symptoms and signs of AML or MDS. If you have any of these symptoms or signs, your general practitioner or follow-up care specialist may:

  • Do a physical exam.
  • Request a blood test.

What happens if I (might) have AML or MDS?

If you (might) have AML or MDS, your general practitioner or follow-up care specialist will refer you to a:

  • Haematologist (physician specialised in blood disorders).

The haematologist may discuss different treatment options with you.

What else can I do?

Knowing that you may be at increased risk of subsequent cancer can be difficult. Talking to friends and family can be helpful as well as specialist counselling and/or contact with support groups, such as patient organisations. For more information on taking care of your mental health, please read: Mental health problems.

Although we are not sure of its effect on your risk of AML and MDS, adopting or maintaining a healthy lifestyle is important. Taking care of your mental health may be beneficial; even small changes to your lifestyle can have a positive impact on both your physical and mental health. For more information on taking up a healthier lifestyle, please read: Health promotion.

It is important that you are aware of the possibility of developing AML or MDS and that you know the symptoms and signs. If you have any further questions or if the information in this brochure concerns you, please contact your general practitioner or follow-up care specialist.

Where can I find more information?

You may find more information about AML and MDS online. However, it is important to be aware that this information is not always up to date or accurate.

Some sources of further information are:

  • NHS: Here you can find more information about AML in general
  • NHS: Here you can find more information about MDS in general

On this website, you can also find more information related to this topic:

Please note

This PLAIN summary is based on the PanCareFollowUp guideline about “Subsequent neoplasms” [1], which is based on the consensus of different national guidelines.

While the PanCare PLAIN information group strives to provide accurate and complete information that is up-to-date as of the date of publication, you can check with your general practitioner or follow-up care specialist if this summary reflects the most up-to-date information available and whether it is relevant for you.

Please do not rely solely on this information. It is best to also seek the advice of a qualified medical practitioner if you have questions regarding a specific medical condition, disease, diagnosis or symptom.

No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information. PanCare has produced the English version and PanCare is not responsible for the translated versions of this summary.

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.

[1] van Kalsbeek, R. et al. (2021) European PANCAREFOLLOWUP recommendations for surveillance of late effects of childhood, adolescent, and Young Adult Cancer, European journal of cancer. Available at: https://www.ejcancer.com/article/S0959-8049(21)00368-3/fulltext.