SUBSEQUENT NEOPLASMS: GENERAL

Subsequent (also called second) cancer: general

As you know, people diagnosed with cancer need cancer treatments to recover. Cancer treatments damage and kill cancer cells, but they also damage healthy cells. When healthy cells get damaged, this may increase the risk of developing a completely new cancer in the future.

When someone who has had cancer before develops a new cancer, this is called second, or subsequent cancer. A subsequent cancer is not the same as cancer recurrence, or relapse, which is when the first cancer comes back. A subsequent cancer is a completely new cancer.

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

There are a number of things everyone can do to lower the risk of having certain types of subsequent cancer.

Am I at higher risk of subsequent cancer?

Your risk of developing subsequent cancer, and which type of cancer, depends mainly on the cancer treatment you received:

  • Some cancer treatments do not increase your risk of subsequent cancer.
  • For some cancer treatments we are not sure whether they can increase your risk of subsequent cancer – more research is needed to find out.
  • We know that some cancer treatments can increase your risk of subsequent cancer.

It can be difficult to estimate your exact risk of subsequent cancer. Your risk is influenced by factors beyond your treatment, like your age and genetics.

The following treatments can increase the risk of subsequent cancer:

Type of subsequent cancer Cancer treatment(s) that increase the risk
Bladder cancer
  • Radiotherapy to the bladder or an area that includes the bladder.
  • Cyclophosphamide or ifosfamide, types of chemotherapy drugs. They particularly increase the risk if you had severe bleeding of the bladder (haemorrhagic cystitis) during treatment.
Blood cancer: acute myeloid leukaemia (AML) or myelodysplasia
  • 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)
Bone cancer
  • Radiotherapy. The part of the body treated with radiotherapy is at higher risk of developing bone cancer.
Bowel cancer
  • Radiotherapy to the colon and rectum or an area that includes the colon and rectum 
Brain or spinal cord cancer
  • Radiotherapy to the head, brain or spinal cord or an area that includes the head, brain or spinal cord
Breast cancer (in women)
  • Radiotherapy (10 Gy or more) to the chest or upper abdomen, when the breast area is included
Lung cancer
  • Radiotherapy to the lungs or an area that includes the lungs 
Oral (mouth) cancer
  • Radiotherapy to the mouth or an area that includes the mouth
  • A history of graft versus host disease (GvHD) in the mouth after stem cell transplantation 
Skin cancer
  • Radiotherapy. The part of the body treated with radiotherapy is at higher risk of developing skin cancer.
  • Stem cell transplantation, especially with a history of skin graft versus host disease (GvHD)
Thyroid cancer
  • Radiotherapy to the neck or an area including the thyroid
  • Therapeutic radioactive iodine (131I-MIBG), a type of internal radiotherapy used to treat neuroblastoma

There are also other types of subsequent cancer you might be at higher risk of, such as cervical cancer, endometrial cancer, prostate cancer, testicular cancer and breast cancer in men. Currently, there are no guidelines or PLAIN summaries for these secondary cancer types.

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 subsequent cancer, it does not always mean that this is caused by the treatment used for your first cancer. Subsequent cancer may have other causes, such as smoking, drinking (too much) alcohol, using recreational drugs, (too much) sun exposure and older age. Some people with cancer suffer from hereditary cancer syndrome. This is a condition where you (and sometimes other family members) are at greater risk of having cancer, often at an unusually early age.

What are the symptoms and signs of subsequent cancer?

There are symptoms and signs that can tell you if you might have subsequent cancer. For each type of subsequent cancer, the signs and symptoms can be different. Please check in the table above for which subsequent cancer type(s) you may have an increased risk of. For each of these types of cancer, a sequel brochure is available that includes a list of signs and symptoms to look out for. 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.

There are some general symptoms and signs that may suggest that you have subsequent cancer:

  • Feeling (very) tired
  • Losing weight without trying
  • Loss of appetite
  • Fever and sweating (a lot)

These symptoms and signs are often caused by something else. However, early diagnosis and treatment of subsequent cancer 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 subsequent cancer. What tests should I have and when?

Independent of your risk of subsequent cancer, your follow-up care specialist may ask about your family history of cancer at least every 5 years.

In case you (might) have hereditary cancer syndrome, your follow-up care specialist may refer you to a clinical geneticist (physician specialised in genetic diseases).

Depending on the type of subsequent cancer you may be at risk for, more tests may be needed.

What happens if I (might) have subsequent cancer?

If you (might) have subsequent cancer, your general practitioner or follow-up care specialist will refer you to a specialist.

The specialist 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.

To lower your risk of subsequent cancer, adopting or maintaining a healthy lifestyle is extremely 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 also important to avoid the use of recreational drugs. Additionally, (too much) sun exposure should be avoided, especially in the middle of the day.

The vaccination recommendations for survivors are generally in line with those for the general population. It is of particular importance for survivors (both male and female) to be vaccinated against the human papillomavirus (HPV). This vaccination can greatly reduce the risk of developing certain types of cancers, such as cervical cancer, womb cancer and cancer of the genital organs. It may also protect against cancer of the mouth and throat.

Unless your treating doctor advises you to have tests for subsequent cancer more often, it is highly recommended to take part in the national cancer screening programmes that are available within your country.

It is important that you are aware of the possibility of developing subsequent cancer 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 (subsequent) cancer 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:

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.

[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.