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Second Malignancy QuickFact

Childhood cancer survivors can be at risk for developing the following secondary cancers. 

  • Treatment-related Acute Myeloid Leukemia, myelodisplasia, and lymphoma
  • Solid tumors within the field(s) of radiation including, but not limited to:              
      • Skin Cancer
      • Bone Malignancies
      • Brain Tumors
      • Thyroid Cancer
      • Breast Cancer
      • Colorectal Cancer
      • Bladder Malignancies

If your patient does not have a Survivor Health Plan (SHP), please refer him/her to the appropriate survivor clinic. 

 

Important factors in determining risk for secondary malignancies:

 

    • Length of time since treatment
      • AML/Myelodisplasia most common within 10 years of treatment
      • Solid tumor risk increases with time
    • Total dose of chemotherapy/radiation
    • Radiation received prior to1970
    • Age at radiation treatment
    • Environmental/lifestyle factors (smoking, sun exposure, diet, alcohol use etc.)
    • Genetics/family history

Chemotherapy

Table 1

 

Acute Myeloid Leukemia

Myelodisplasia

Bladder Malignancy

Alkylating Agents

Busulfan

Carmustine

    BCNU    

Chlorambucil Cyclophosphamide

   Cytoxan

Ifosphamide

Lomustine

   CCNU

Mechlorethamine

Melphalan

Procarbazine

Thiotepa

 

Dacarbazine

    DTIC

Temozolomide

X

X

X

(Cyclophosphamide only)

Heavy Metals

Carboplatin

Cisplatin

 

X

X

 

Antimetabolites

Cytarabine

   Ara-C

Mercaptopurine

   6MP

Thioguanine

   6TG

Methotrexate

 

 

 

 

Anthracycline antibiotics

Daunorubicin

Doxorubicin

   Adriamycin

Epirubicin

Idarubicin

Mitoxantrone

 

X

 

 

Chemotherapy

Table 2

Acute Myeloid Leukemia

Myelodisplasia

Bladder Malignancy

Anti-tumor antibiotics            

Bleomycin

Dactinomycin

 

 

 

Corticosteroids

Dexamethasone

   Decadron

Prednisone

 

 

 

 

Enzymes

Asparaginase

 

 

 

 

Plant alkaloids

Vincristine

Vinblastine

 

 

 

 

Epipodophyllotoxins

Etoposide

   VP16

Teniposide

   VM26

 

 

X

 

 

Radiation

Secondary benign or malignant neoplasm occurring in or near radiation field

Dysplastic nevi

Skin Cancer

Basal Cell Carcinoma

Squamous Cell Carcinoma

Melanoma

Bone malignancies

Brain Tumor

Thyroid Cancer

Breast Cancer

Colorectal Cancer

Bladder Malignancy

All Radiation

X

X

 

 

 

 

 

 

 

TBI

X

X

 

X

X

X

X

 

Head/Brain

X

X

X

X

X

 

 

 

Neck

X

X

X

 

X

 

 

 

Thorax

X

X

X

 

X

X

 

 

Abdomen

X

X

X

 

 

 

X

X

Pelvis

X

X

X

 

 

 

X

X

Extremity

 

X

X

X

 

 

 

 

 

Hematopoeitic

Stem Cell Transplant

Acute Myeloid Leukemia

Myelodisplasia

Solid Tumors

Lymphoma

Oral Cancer

Squamous Cell Carcinoma of the skin

Hematopoeitic Stem Cell Transplant

X

Autologous only

X

Autologous only 

X

X

 

 

Hematopoeitic Stem Cell Transplant with ANY history of chronic Graft vs. Host Disease (GVHD)

 

 

 

 

X

X

For recommendations on how to screen for all potential late effects, please refer to The

Children's Oncology Group Long-term Follow-up Guidelines.

 

Health Links – Teaching Handouts from The Children’s Oncology Group

Reducing the Risk of Second Cancers

Breast Cancer

Colorectal Cancer

Skin Health

 

  Visit http://www.survivorshipguidelines.org/ to find many of the Health Links translated into other languages.

Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers, and related Health Links Version 4.0. October, 2013. www.survivorshipguidelines.org.

Mertens, A., Liu, Q., Neglia, J., Wasilewski, K., et al. Cause-specific late mortality among 5-year survivors of childhood cancer: The Childhood Cancer Survivor Study. Journal of the National Cancer Institute 2008. 100: 1368-1379.

Source: Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta
Last Updated: 2/10/2015 8:54:11 PM
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