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Life After Cancer A Roadmap for Cancer Survivors

The Occurrence of a Second Cancer or a New Cancer in Cancer Survivors
Ernest H. Rosenbaum, MD

A Second Cancer or a New Cancer
Warning Signs and Symptoms of a Potential New or Secondary Cancer

A Second Cancer or a New Cancer
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With more than 10 million people in the United States surviving cancer or living with cancer, as time goes by there is an increased risk for the occurrence of a new cancer or a cancer recurrence. Researchers predict that there will be an increase in the incidence of multiple malignancies as the cancer incidence continues to rise as longevity increases.

Studies of survivors with a late recurrence or a new cancer have shown incidence rates up to 14% for new primary cancers when compared to the general population. Another study (National SEER data following 796,467 survivors since 1970) found that 8% of all survivors had already developed more than one primary cancer, which is why 20-plus years of follow-up monitoring are needed. By developing a relationship with a primary care provider or medical internist who knows your cancer treatment history, the risks of late complications and your recommended screening schedule, you will improve your chances of catching a recurrent or a new cancer at an earlier, more treatable stage.

Unfortunately, the risk of cancer increases for everyone as they age. A survivor's risk of developing a new or a secondary cancer is related to specific factors that can contribute to the risk:
- Diagnosis - type of cancer and aggressiveness
- The person's age at diagnosis
- Their specific treatments (surgery, chemotherapy, and/or radiation therapy)
- Their genetic risk analysis and family history
- The drugs used in their treatment (second cancer risk is related to certain chemotherapy drugs and the radiotherapy field and dose)
- Other exposures such as tobacco and alcohol use or hormone replacement therapy

By practicing better health maintenance behaviors, you become sensitive to changes in your body and increase the likelihood that problems will be detected at earlier stages. These and any new or persistent symptoms should be reported to your healthcare provider promptly.

For those with inherited gene mutations:
- A family history of cancer in some patients who have inherited gene changes (mutations) increases the chances of getting a new primary cancer or a secondary cancer (usually earlier in life). But overall, these inherited changes are relatively uncommon and account for less than 6-8 percent of patients with cancer.
- Your family medical history will help tell whether genetic counseling or testing is needed. Your doctor will advise you if you need genetic counseling, but it is a good policy to ask your doctor if genetic counseling or testing is needed.

Warning Signs and Symptoms of a Potential New or Secondary Cancer
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Examples of warning signs and symptoms include:
Pulmonary Persistent cough or hoarseness
Shortness of breath
Coughing up bloody sputum
Oral, Head, Neck Discolored areas or sores in the mouth that do not heal
Breast Lump or breast mass
Neurological/Brain Persistent headaches
Vision changes
Persistent early morning vomiting
Hematological/Blood Easy bruising or bleeding
Paleness of the skin; excessive fatigue (anemia)
Bone New or persistent bone pain
Skin Changes in moles or sores that do not heal
New lumps or skin changes
Gastrointestinal Difficulty swallowing or changes in stomach or gastrointestinal symptoms such as nausea, vomiting, constipation or diarrhea
Changes in bowel habits
Persistent abdominal pain
Blood in the stools
Genital/Urinary Blood in the urine
Painful urination or defecation (constipation)
Mass (lump) in testes
Ovary Persistent abdominal bloating
Abdominal or pelvic pain
Difficulty eating or a feeling of fullness
Frequent urination or change in bowel habits

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First appeared December 10, 2007; updated August 2, 2008