Secondary Cancers

Childhood cancer survivors have an increased risk of developing a second cancer later in life.

Certain factors related to treatment increase the risk of second cancers. These include the following:

  • Radiation therapy may cause solid tumors and leukemia.
  • Risk of second cancers after radiation therapy is increased if alkylating agents were also used and if the patient is female, was younger at the time of diagnosis, or had Hodgkin lymphoma or soft tissue cancer.
  • Certain anticancer drugs, such as alkylating agents or platinum drugs, may cause leukemia and myelodysplastic syndrome.
  • Survivors of childhood Hodgkin lymphoma have the highest risk of developing second cancers, especially breast or thyroid cancer. Young age at diagnosis and treatment for relapsed disease increase the risk.
  • Bone marrow transplants increase the risk of tumors later in life.

Childhood cancer survivors with certain genetic syndromes have an increased risk of developing a second cancer.

Some childhood cancer survivors have an increased risk of developing a second cancer because they have certain genetic syndromes that also placed them at risk of developing the primary cancer. These include the following:

  • Neurofibromatosis.
  • Li-Fraumeni syndrome.
  • Familial polyposis.
  • The genetic form of retinoblastoma.

Frequent and careful follow-up exams are very important for these childhood cancer survivors.



Improvements in cancer treatment have decreased the number of deaths from primary cancer. The number of late effects in childhood cancer survivors may increase with age, however, and survivors may not live as long as people who did not have cancer. The most common causes of death in childhood cancer survivors include the following:

  • Relapse of the primary cancer.
  • Second cancer.
  • Heart damage.

Studies of the causes of late effects have led to changes in treatment. This has improved the quality of life for cancer survivors and helped to prevent deaths from late effects.

The Web site of the National Cancer Institute (

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