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

Autologous only

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

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: 5/6/2019 7:18:18 PM

Tweets by Survivor_Link

SurvivorLink™ has been designed to increase awareness and knowledge about the life-long healthcare needs of pediatric cancer survivors, and increase communication about the specific healthcare needs of individual survivors between survivor and family, cancer survivor team, primary care provider, and healthcare subspecialists.