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Other PLAIN summaries
- Asymptomatic coronary artery disease
- Bone problems
- Cancer-related fatigue
- Central precocious puberty – CPP
- Chronic pain
- Craniofacial growth problems
- Dental and oral problems
- Dyslipidemia
- Eye problems
- Gastro-intestinal problems
- Hair loss
- Health promotion
- Hearing problems
- Heart problems
- Higher risk groups
- HP axis problems
- Hypertension
- Impaired glucose metabolism and diabetes
- Kidney problems
- Liver problems
- Lower urinary tract problems
- Lung problems
- Male fertility problems, testosterone deficiency and sexual dysfunction
- Mental health problems
- Neurocognitive problems
- Obstetric problems
- Overweight and obesity
- Peripheral neuropathy
- Premature ovarian insufficiency
- Psychosocial problems
- Spine scoliosis and kyphosis
- Spleen problems
- Stroke
- Subsequent neoplasms:
- Thyroid problems
SUBSEQUENT NEOPLASMS: GENERAL
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.
On this page you can find:
- Subsequent (also called second) neoplasms
- Am I at higher risk of subsequent neoplasms?
- What are the symptoms and signs of subsequent neoplasms?
- I am at higher risk of subsequent neoplasms. What tests should I have and when?
- What happens if I (might) have subsequent neoplasms?
- What else can I do?
- Where can I find more information?
- 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.
PLAIN version 2.1: 27/05/2024
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.
Risk of subsequent cancer after cancer treatment
Created with BioRender.com
Hover over the numbers in the figure for more information.
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 |
|
| Blood cancer: acute myeloid leukaemia (AML) or myelodysplasia |
|
| Bone cancer |
|
| Bowel cancer |
|
| Brain or spinal cord cancer |
|
| Breast cancer (in women) |
|
| Lung cancer |
|
| Oral (mouth) cancer |
|
| Skin cancer |
|
| Thyroid cancer |
|
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.
Radiotherapy
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, do contact your treating hospital.
Radiotherapy is a treatment for cancer which uses high-energy radiation to destroy cancer cells and to shrink tumours. The radiation comes from a machine outside the body (external beam radiotherapy) or occasionally from radioactive material that is placed in the body near cancer cells (intracavitary or interstitial radiotherapy). The aim of radiotherapy is to treat only one area of the body, around and near the cancer or where the cancer was before it was removed by surgery and as far as possible to protect unaffected areas. For example, if you have cancer in your lung, you will have radiation only to your chest, not to your whole body.
External beam radiotherapy is painless and takes only a few minutes. It is given once or occasionally twice a day often for several weeks. A radiation beam is like an invisible light beam. The machines which produce the radiation beam can be moved so that the beam enters the body from different directions, ‘spotlighting’ on the area to be treated. This means that the tumour is given a high dose whilst normal areas get either a lower or no dose at all.
Since the early 1980’s computers and other technical advances have improved radiotherapy. Before this there were not many ways to protect normal tissues which were in the path of a radiation beam. Even now, whilst modern techniques allow doctors to target the cancer cells more precisely than older techniques, healthy cells may still get damaged. This can result in some of the late effects covered in the PLAIN summaries. It will help you and your follow up specialist to know what long term effects there might be after your radiotherapy if you and they have your treatment summary.
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, please contact your treating hospital.
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.
Symptoms and signs
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.
Healthy lifestyle
- Having a healthy diet
- Drinking less (or no) alcohol
- Exercising regularly
- Quitting smoking (if you smoke)
Your follow-up care specialist or general practitioner may give you additional advice tailored to your individual situation for maintaining a healthy lifestyle. For more information on taking up a healthier lifestyle, please read: Health promotion.
Survivors
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:
- Verywellhealth: Here you can find more information about subsequent neoplasms in general
- Macmillan Cancer Support: Here you can find more information about cancer and its risk factors
On this website, you can also find more information related to this topic:
- Health promotion
- Subsequent neoplasms: Blood cancer
- Subsequent neoplasms: Bladder cancer
- Subsequent neoplasms: Bone cancer
- Subsequent neoplasms: Lung cancer
- Subsequent neoplasms: Oral cancer
- Subsequent neoplasms: Skin cancer
- Subsequent neoplasms: Thyroid cancer
- Subsequent neoplasms: Brain or spinal cord cancer
- Subsequent neoplasms: Breast cancer
- Subsequent neoplasms: Colorectal cancer
- Mental health problems
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.