Second cancers  

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This section is not referring to whether the original tumour relapses but rather the well documented increased risk of developing a completely separate second cancer. Risks of these may have been discussed with you at the time of the initial treatment and varies enormously on the age, type, and amount of initial treatment. 

Chemotherapy has been found to somewhat increase the risks of leaukaemia and other tumours later in life. 

Likewise radiotherapy infers an increased risk, in the area irradiated. Fortunately, in most cases they are generally rare, with some notable exceptions. Women who received radiotherapy to the breast area before 25 years of age have almost twice the risk of breast cancer when they are older. Men with a type of testicular cancer, called seminoma often have had to receive a course of radiotherapy to their abdomen to prevent it spreading. In both these scenarios after 5 years, largely because the treatments are so successful the risks of secondary cancers are actually higher than the cancer returning. In other conditions which receive radiotherapy for example for breast, prostate, bladder, lung and rectal this risks are very small.

Nevertheless, environmental and lifestyle factors can considerably reduce these risks. Although the evidence is circumstantial it is glaringly obvious:

• Workers exposed to asbestos have a twice the risk of developing cancer of the lining of the lung (mesothelioma). 

• Smokers have a low (approximately 10%) increased of mesothelioma without asbestos exposure.

• Worker exposed to asbestos who also have a four fold increased risk of mesothelioma indicating that the underlying risk of cancer has been greatly magnified by the carcinogens in smoke.

This synergistic affect has also been identified in survivors of the Nagasaki and Hiroshima nuclear blasts. An eloquent observational study involved people who had significant but initially non-fatal radiation exposure. Two groups were identified based on their lifestyle. The group which exercised well, didn’t smoke and eat healthy quantified of fresh vegetables, fruit, soya, nuts and legumes had a significantly lower level of radiation induced cancers. This indirect evidence shows that lifestyle can influence an underlying acquired risk. It would be very interesting to investigate the influence of lifestyle on people who have a genetic risk of cancer such as those carrying the gene for breast cancer.

Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.