Learning about the risk of developing a second cancer can be frustrating and anxiety provoking. After a battle with children’s cancer, the last thing someone wants to think about is the risk of developing a second cancer during adulthood.

However, several studies have shown that as children’s cancer survivors become older, they have a slightly higher risk of developing cancer compared to people their same age in the general population. Factors that can contribute to this risk are the person’s age during therapy, their specific treatment, and their genetic and family history.

Who is at Risk for Secondary Cancer?

People who received certain chemotherapy drugs.

Some treatments for children’s cancer increase the risk of secondary cancers. Rarely, people can develop acute myeloid leukemia after treatment. If secondary leukemia occurs, it is usually within the first 10 years following treatment of the original cancer. The risk of developing a secondary leukemia is higher for people treated with high doses of alkylating agents (such as cyclophosphamide or nitrogen mustard), epipodophyllotoxins (such as etoposide or teniposide), and anthracycline chemotherapy drugs (such as doxorubicin or daunorubicin).

People who received radiation therapy, especially at a young age.

Radiation therapy given for children’s cancer increases the risk of developing a secondary solid tumor as a person ages. The most common sites include the skin, breast, central nervous system (the brain and spine), thyroid gland, and bones. In contrast to secondary leukemias, secondary solid tumors most commonly appear 10 or more years after treatment. The risk of developing a secondary solid tumor is increased when radiation was delivered at high doses and over large fields to children at a young age. Newer equipment and techniques allow radiation oncologists to treat just the areas involved by cancer and shield normal tissues.

People who have a history of cancer in their family.

Some cancer patients have inherited gene changes (mutations) that increase the chances of getting a second cancer. But overall, these inherited changes are relatively uncommon and account for less than 10 percent of patients with cancer. Doctors suspect the presence of a cancer gene when a family history shows multiple cancers among young people in every generation, or when cancer occurs in both sides of paired organs (such as the eyes, breasts, kidneys, etc.). If you have any questions or think that cancer may run in your family, talk to your healthcare provider. A review of your family medical history will tell whether genetic counseling or testing is needed.

For those Who are High Risk

You can find out if you are at high risk for developing a second cancer by going over your cancer treatment and family history with your healthcare provider or a cancer specialist. In some cases, early or more frequent screening may be recommended to increase the likelihood that secondary cancers are detected early.

Monitoring for Secondary Cancer

By practicing health maintenance behaviors, you can improve your awareness of changes in your body and increase the likelihood that problems will be detected at earlier stages. All children’s cancer survivors should have a yearly comprehensive health check-up. These patients should also have cancer screening evaluations based on age, sex, and treatment history. Knowing the details of previous medical history, including exposures to chemotherapy, radiation, and surgery, is vital to future health. This information should be available to patients and their healthcare providers from the hospital or clinic where cancer treatment occurred.

Be sure to report any new or persistent symptoms to your healthcare provider promptly. Types of symptoms that you should report include:

• Easy bruising or bleeding
• Paleness of the skin
• Excessive fatigue
• Bone pain
• Changes in moles
• Sores that do not heal
• Lumps
• Difficulty swallowing
• Changes in bowel habits
• Persistent abdominal pain
• Blood in the stools
• Blood in the urine
• Painful urination or defecation
• Persistent cough or hoarseness
• Shortness of breath
• Bloody sputum
• Discolored areas or sores in the mouth that do not heal
• Persistent headaches
• Vision changes
• Persistent early morning vomiting

Lowering the Risk of Secondary Cancer

Avoid Cancer-Promoting Habits

Survivors should not smoke or chew tobacco and should avoid exposure to second-hand smoke when at all possible. Because skin cancers are one of the most common secondary cancers after treatment for children’s cancer, especially for those treated with radiation therapy, take extra care to protect skin from sun exposure. This includes regularly using sunscreen with sun protection factor (SPF) of 15 or more, wearing protective clothing, avoiding outdoor activities from 10 am to 2 pm when the sun’s rays are most intense, and not going to tanning salons.

Drink Alcohol only in Moderation

Heavy drinkers, especially those who use tobacco, have a high risk of cancer of the mouth, throat, and esophagus. The risk of breast cancer may be increased in women who drink alcohol. Limiting the use of alcohol can reduce these cancer risks and decrease the chances of other alcohol-related problems, such as liver disease.

Eat Right

A high intake of dietary fat has been linked to the risk of several common adult cancers. People who eat high-fat diets have a greater risk of getting colon cancer; this may also be true for breast and prostate cancers. High-fat diets are also associated with obesity, heart disease, and other health problems. To reduce all of these risks, daily fat intake should be limited to 30% or less of your total calories.

Eating cruciferous vegetables also helps reduce cancer risk. Cruciferous vegetables include cabbage, Brussels sprouts, broccoli, and cauliflower. Eating these vegetables is thought to protect against cancer by blocking the effects of cancer-causing chemicals in other foods. Cruciferous vegetables are also high in fiber and low in fat. These foods should be included frequently in the diet.

Some chemicals used to preserve foods are cancer-promoting (carcinogenic) in large quantities. Diets high in salt-cured and pickled foods, and lunchmeats that contain preservatives like nitrites can increase the risk of cancer in the stomach and esophagus. Some of these foods, especially lunchmeats, are also high in fat. Foods of this kind should be eaten rarely and in small portions.

Diets rich in vitamins C and A have been shown to reduce cancer risk in animal studies. People whose diets are rich in vitamin C appear less likely to get cancer, especially cancer of the stomach and esophagus. The best way to get these nutrients is to eat a variety of fresh fruits and vegetables every day. Citrus fruits, melons, cruciferous vegetables, and greens are high in vitamin C. Good sources of vitamin A are dark green and deep yellow vegetables and certain fruits. If your diet is low in vitamins, a vitamin supplement may help, but avoid extra high doses, since these can cause serious side effects.