{"slug":"second-cancers","tag":"second-cancers","variants":["second-cancers"],"description":"No description yet","count":19,"kinds":{"technology":1,"term":18},"related":[{"slug":"rejuvenation","tag":"rejuvenation","shared":19},{"slug":"survivorship","tag":"survivorship","shared":19},{"slug":"radiotherapy","tag":"radiotherapy","shared":8},{"slug":"screening","tag":"screening","shared":6},{"slug":"blood","tag":"blood","shared":5},{"slug":"chemotherapy","tag":"chemotherapy","shared":4},{"slug":"breast","tag":"breast","shared":2},{"slug":"late-effects","tag":"late-effects","shared":2},{"slug":"smoking","tag":"smoking","shared":2},{"slug":"biological-ageing","tag":"biological-ageing","shared":1},{"slug":"biomarker","tag":"biomarker","shared":1},{"slug":"bladder","tag":"bladder","shared":1}],"records":[{"id":"rejuv-age-clonal-haematopoiesis-after-therapy","kind":"technology","name":"Clonal haematopoiesis after cancer treatment","route":"/technologies/rejuv-age-clonal-haematopoiesis-after-therapy/","status":"established","tldr":"Chemotherapy and radiotherapy do not select blood stem cells at random. They favour the ones carrying mutations in DNA-damage genes, which then expand. Most people with such a clone never develop a blood cancer, but the clone is a measurable mark of what treatment did, and in a minority it is the seed of a later leukaemia."},{"id":"rejuv-second-cancers-overview","kind":"term","name":"Second cancers after treatment: what the risk is, and what is done about it","route":"/terms/rejuv-second-cancers-overview/","tldr":"A second cancer is a brand new cancer, not the first one coming back. Most are found by the ordinary routes, and some have a screening programme attached, which is the part worth asking about by name. The risk comes from three things that add together: the treatment, the thing that caused the first cancer and has not gone away, and simply having lived longer."},{"id":"rejuv-second-alkylating-agents-and-myeloid-neoplasms","kind":"term","name":"Alkylating agents and therapy-related myeloid neoplasms","route":"/terms/rejuv-second-alkylating-agents-and-myeloid-neoplasms/","tldr":"Alkylating chemotherapy can damage a blood stem cell in a way that shows up years later as myelodysplastic syndrome or acute myeloid leukaemia. It is uncommon, it depends on the total dose, and the risk falls away after about ten years. Knowing the cumulative dose you were given is the single most useful thing on your treatment summary."},{"id":"rejuv-second-topoisomerase-inhibitors-short-latency","kind":"term","name":"Topoisomerase II inhibitors and the shorter latency","route":"/terms/rejuv-second-topoisomerase-inhibitors-short-latency/","tldr":"Etoposide and the anthracyclines can cause a leukaemia too, but a different one: it arrives after about two years rather than six, it starts as acute leukaemia without a myelodysplastic phase, and it carries a balanced break in a chromosome rather than a missing piece. So the first two or three years after this chemotherapy are when a blood count matters most."},{"id":"rejuv-second-platinum-and-parp-inhibitors","kind":"term","name":"Platinum drugs and PARP inhibitors: the newer leukaemia risk","route":"/terms/rejuv-second-platinum-and-parp-inhibitors/","tldr":"The leukaemia risk after chemotherapy was described in the era of mustards and etoposide, and it did not stay there. Platinum drugs carry it, PARP inhibitors raise it about two and a half times against placebo, and lenalidomide with oral melphalan raises it nearly fivefold against melphalan alone. The absolute numbers are small, but the choice of partner drug is sometimes a real decision."},{"id":"rejuv-second-radiotherapy-dose-field-and-age","kind":"term","name":"Radiotherapy and second cancers: field, dose and age at exposure","route":"/terms/rejuv-second-radiotherapy-dose-field-and-age/","tldr":"A radiation-induced cancer appears in or at the edge of the treated area, usually more than ten years later, and the risk rises with the dose the organ received and falls with the age at which the person was treated. Which organs sat in the field is therefore the question that decides everything that follows, and it is answerable from the radiotherapy record."},{"id":"rejuv-second-age-smoking-and-inherited-risk","kind":"term","name":"Age, smoking and inherited predisposition: what the treatment risk is added to","route":"/terms/rejuv-second-age-smoking-and-inherited-risk/","tldr":"Treatment is rarely the only cause of a second cancer, and in adults it is usually not the main one. Smoking is the clearest example: after chest radiotherapy for Hodgkin lymphoma, the risks from tobacco and from treatment appeared to multiply rather than add, which makes stopping smoking the largest single lever a survivor has over this particular risk."},{"id":"second-primary-breast-after-chest-radiotherapy","kind":"term","name":"Breast cancer after chest radiotherapy given young","route":"/terms/second-primary-breast-after-chest-radiotherapy/","tldr":"This is the second cancer with a real screening programme attached, and the one most worth asking about by name. A woman who had radiotherapy to breast tissue between the ages of 10 and 35, most often for Hodgkin lymphoma, is eligible in England for annual magnetic resonance imaging from age 25 or 30, and being missed from that list has happened often enough that asking is reasonable."},{"id":"second-primary-lung-after-chest-radiotherapy","kind":"term","name":"Lung cancer after chest radiotherapy and after alkylating chemotherapy","route":"/terms/second-primary-lung-after-chest-radiotherapy/","tldr":"Lung cancer is the commonest cause of death among people who develop a second cancer, and chest radiotherapy raises the risk of it for more than twenty years. There is no screening programme aimed at survivors anywhere, although some survivor groups have a measured rate above the threshold at which lung screening was shown to save lives, so this is a gap rather than a settled answer."},{"id":"second-primary-thyroid-after-neck-radiotherapy","kind":"term","name":"Thyroid cancer after neck radiotherapy, and whether to look for it","route":"/terms/second-primary-thyroid-after-neck-radiotherapy/","tldr":"The thyroid is among the most radiation-sensitive tissues there is, and neck or upper chest radiotherapy raises the risk of thyroid cancer for decades. Whether to look for it is genuinely unsettled: the international guideline panel compared ultrasound against feeling the neck, found neither better, and wrote a decision aid instead of a recommendation."},{"id":"second-primary-sarcoma-in-the-treated-field","kind":"term","name":"Sarcoma in the radiotherapy field, and angiosarcoma of the treated breast","route":"/terms/second-primary-sarcoma-in-the-treated-field/","tldr":"A sarcoma arising in tissue that was irradiated is uncommon, appears after about seven years or more, and is recognised by where it is rather than by any test. In the treated breast it most often takes the form of angiosarcoma, and because it can look like a bruise or a cluster of reddish-blue nodules it is the one second cancer a person might reasonably mistake for something harmless."},{"id":"second-primary-bowel-after-abdominal-radiotherapy","kind":"term","name":"Bowel cancer after abdominal and pelvic radiotherapy","route":"/terms/second-primary-bowel-after-abdominal-radiotherapy/","tldr":"Radiotherapy to the abdomen or pelvis raises the risk of cancer in the bowel that sat in the field, and the risk is confined to the irradiated segment. For adults no country runs an organised colonoscopy programme afterwards, so bleeding or a change in bowel habit years later should be investigated rather than put down to the old treatment."},{"id":"second-primary-bladder-after-cyclophosphamide","kind":"term","name":"Bladder cancer after cyclophosphamide","route":"/terms/second-primary-bladder-after-cyclophosphamide/","tldr":"Cyclophosphamide is one of the few cancer drugs that has been shown to cause a specific solid cancer, in the bladder, and the risk depends steeply on the total dose given. Blood in the urine years after treatment with it is a reason to be investigated rather than reassured, and the cumulative dose on your treatment summary is what tells you where you sit."},{"id":"second-primary-skin-cancer-after-cancer-treatment","kind":"term","name":"Skin cancer after cancer treatment","route":"/terms/second-primary-skin-cancer-after-cancer-treatment/","tldr":"Skin cancer is the commonest second cancer after almost any treatment, and the commonest one left out of the counts, because registries record non-melanoma skin cancers inconsistently or not at all. Most are basal cell carcinomas, most are curable when treated, and the practical answer is to look at irradiated skin and to have anything that bleeds, crusts or does not heal in six weeks examined."},{"id":"rejuv-second-uk-very-high-risk-breast-screening","kind":"term","name":"The UK very high risk breast screening protocol after chest radiotherapy","route":"/terms/rejuv-second-uk-very-high-risk-breast-screening/","tldr":"England runs a named screening programme for women who had radiotherapy to breast tissue when young, with exact ages and tests set out in its own documents. Surveillance begins at 25 or 30 depending on your age when irradiated, or eight years after the radiotherapy, whichever is later, and referral runs through a national dataset."},{"id":"rejuv-second-screening-after-treatment-compared","kind":"term","name":"Screening survivors: where the UK, American and European answers differ","route":"/terms/rejuv-second-screening-after-treatment-compared/","tldr":"Three systems have built screening for survivors and they do not agree. England runs an organised programme with fixed ages and automatic referral; the United States issues a guideline and leaves the arranging to the patient; the Netherlands runs a national survivorship clinic network. They differ on when to start and whom to include."},{"id":"rejuv-second-from-clone-to-disease","kind":"term","name":"From a clone in the blood to a leukaemia: what is known, and what is done","route":"/terms/rejuv-second-from-clone-to-disease/","tldr":"Chemotherapy and radiotherapy select for blood stem cells carrying particular mutations, and in a small minority one of those clones becomes a leukaemia. The useful question is not whether a clone is there but whether it will progress: most never do, and nothing has been shown to stop one that does."},{"id":"rejuv-second-what-is-not-a-second-cancer","kind":"term","name":"What is not a second cancer: recurrence, metastasis and field cancerisation","route":"/terms/rejuv-second-what-is-not-a-second-cancer/","tldr":"Four different things get called the same thing in conversation and in the news, and the difference changes what the news means. A second cancer is a new disease with its own stage and its own chance of cure. A recurrence is the first one back. A metastasis is the first one somewhere else. Field cancerisation is a whole area of tissue that was already changed before any of them."},{"id":"rejuv-second-choices-made-at-treatment","kind":"term","name":"Choices made at the time of treatment that change the second cancer risk","route":"/terms/rejuv-second-choices-made-at-treatment/","tldr":"Some of this risk is a decision rather than a fate. Where two treatments cure equally well and one carries less late risk, that is a conversation to have before treatment starts. Trials have settled several: a different partner drug in myeloma, a lower cyclophosphamide dose in breast cancer, brachytherapy rather than external beam."}]}