Lymphoma Prevention: Secondary Cancer & Survivorship

This is part of the ongoing series on lymphoma prevention. It bears repeating that in reality it is impossible to prevent something if you don't know how it was caused. This does not however rule out preventive measures.

In the case of the topic at hand—the risk of developing a second cancer long after having been treated for the original cancer—prevention is perhaps the wrong term. Vigilance might be a better term, since there may be no preventing the development of a second primary cancer after treatment for an initial cancer, but by establishing a survivorship care program, you can go a long way in catching any problems early enough to have your best shot at overcoming them.

Secondary Cancers

Naturally one of the last things the person who has survived one bout with cancer wants to think about is enduring an altogether new cancer diagnosis. However, this is an important thing to pay attention to, as the statistics—and there are a lot of them—bear it out.

According to the National Cancer Institute publication "New Malignancies Among Cancer Survivors: Chapter16: HL, NHL and Myeloma", lymphoma patients are particularly vulnerable to specific second cancers later in life, meaning they are vulnerable to a new primary cancer as they get older. The cumulative incidence for all second cancers 25 years after diagnosis of the initial lymphoma is 14.1 percent for men and 18.9 percent for women.

Among women, the most commonly diagnosed second cancer is breast cancer. While it's just speculative, many believe this is likely due to radiotherapy directed to the chest. For this same reason, another commonly diagnosed second cancer among both men and women is lung cancer. However it should be noted that second cancers found in the lung and bronchus are not uncommon even among patients who did not receive radiotherapy. One large study dating from 2002 determined a dose-dependent association with an increased risk of secondary lung cancer in Hodgkin's patients who received an alkylating agent as part of their combination chemotherapy regimen.

The most commonly prescribed combination chemotherapy regimen for Hodgkin's patients—the ABVD regimen—features one such alkylating agent: the dacarbazine. Because this has been found to be dose-dependent, study groups such as the German Hodgkin's Study Group have been actively trying to find new ways to approach Hodgkin's treatment that limits the doses patients receive so as to mitigate their risk of developing secondary cancers later in life.

This risk of a second cancer tends to be much higher in patients with Hodgkin's lymphoma, not just because it more commonly uses radiotherapy or because of the dacarbazine, but because Hodgkin's patients tend to be so much younger than non-Hodgkin's patients.

Finally, it's worth noting that one of the reasons noted for the increased risk of lung cancer among these patients is the health problems associated with smoking. Keep in mind that these statistics cover the years between 1973 and 2000, and thanks to extraordinary public health policies, there are fewer smokers today than there had been in the 1970s.

Survivorship

The American Cancer Society estimates that there are almost 14 million cancer survivors living in the United States right now. Surviving cancer doesn't always mean being considered 'cured'. Sometimes it means living with the disease as a chronic ailment requiring intermittent treatment. Nonetheless, this population has become an increasingly important area of research since cancer survivors have medical needs that are beyond the norm, and many primary care physicians do not understand what the long-term adverse effects of the likes of radiotherapy or chemotherapy are. For that reason, creating and sticking to a cancer survivorship plan falls on the shoulders of the patient.

What cancer survivors must do is initiate the discussion of post-cancer care with their oncologist, then develop an individualized and long-term follow-up care plan that they can then take back to their primary care physician.

Official, published guidelines relating to short-term survivorship care exist, but to date there are few long-term guidelines for patients and doctors to follow. What few there are have not been proven to be effective in extending the lives of former cancer patients. This doesn't mean they won't work, it merely means that research has not been carried out to demonstrate their efficacy.

Follow-Up Care for Survivors of Non-Hodgkin's Lymphomas

As outlined by the MD Anderson Cancer Center's Survivorship Care page, long-term follow-up care for non-Hodgkin's lymphoma survivors includes the following recommendations for annual exams or tests:

• Medical history/physical exam
• Chest X-ray
• Urinalysis
• Mammogram at 40, then annually (start at 30 if you've had radiation to the chest area)
• Thyroid function tests (if radiation to upper body)
• Adult vaccines as recommended by the Centers for Disease Control and Prevention, especially if the spleen was removed

Follow-Up Care for Survivors of Hodgkin's Lymphomas

Curiously, no guidelines have been published for the long-term care of Hodgkin's patients, according to MD Anderson. In this case, it is recommended that Hodgkin's survivors discuss the issue with their oncologist and work out an individualized plan.

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For more information on the topic of Lymphoma Prevention, please click on the links to see previous entries:
-- Environmental exposures
-- Diet and Nutrition
-- Exercise and physical activity
-- Viral and Bacterial Sources