Second Cancers After Hodgkin Lymphoma

Cancer survivors can be affected by a number of health problems, but often a major concern is facing cancer again. If the same kind of cancer comes back after treatment it's called a recurrence. But some cancer survivors might develop another type of cancer later (usually more than 10 years after treatment). This is called a second cancer.

People who have had Hodgkin lymphoma (HL) can get any type of second cancer, but research has found they have an increased risk of certain cancers. These tend to be linked to the treatments used for HL. Chemo is linked to blood cancers, and radiation therapy is linked to cancers in the organs in the area that was treated. The cancers include:

• Leukemia
• Myelodysplastic syndrome (MDS)
• Non-Hodgkin lymphoma
• Breast cancer (in women)
• Lung cancer
• Thyroid cancer
• Cancer of the lip and tongue
• Salivary gland cancer
• Stomach cancer
• Colon cancer
• Liver cancer
• Pancreas cancer
• Bone cancer
• Soft tissue cancer
• Anal cancer
• Cancer of the uterus
• Cancer of the ureter (the tube that connects the kidney and the bladder)
• Melanoma of the skin
• Kaposi sarcoma

The increased risk of many of these cancers are linked to treatment with radiation. For example:

• Women who have had chest radiation (especially before age 30) have been found to have a higher risk of breast cancer.
• Radiation to the neck has been linked to a higher risk of thyroid cancer.
• Radiation to the chest has been linked to a higher risk of lung cancer.

But over time, the use of radiation to treat HL has changed a lot. Radiation is now given in lower doses, and often only to the areas directly affected by the lymphoma. The risks with modern radiation treatment are likely to be lower, still long-term studies are needed to be sure.

Chemotherapy (chemo), especially with drugs called alkylating agents (such as dacarbazine and cyclophosphamide) has been linked with a higher risk of several types of cancer, including leukemias. Today, alkylating agents are used less often and at much lower doses, so these risks are probably not as high as they were in the past, but, again, long-term follow-up studies are needed to be sure. 

Follow-up care after Hodgkin lymphoma treatment

After completing treatment for HL, you should still see your doctor regularly and may have tests to look for signs that the cancer has come back. Let them know about any new symptoms or problems, because they could be caused by the lymphoma coming back, by a new disease, or by second cancer.  

Women who were treated with radiation therapy to the chest (such as mantle field radiation therapy ) before age 30 have an increased risk of breast cancer. The American Cancer Society recommends yearly breast cancer screening with breast MRIs along with mammograms and clinical breast exams beginning at age 30 for these women. Some experts recommend that screening start 8 to 10 years after treatment or at age 40 (whichever is earlier).

The Children’s Oncology Group has guidelines for the follow-up of patients treated for cancer as a child, teen, or young adult, including screening for second cancers. These can be found at www.survivorshipguidelines.org.

Survivors of HL should also follow the American Cancer Society guidelines for the early detection of cancer, such as those for colorectal and lung cancer. Most experts don’t recommend any other testing to look for second cancers unless you have symptoms.

Can I lower my risk of getting a second cancer?

There are steps you can take to help lower your risk and stay as healthy as possible. For example, it’s important to stay away from tobacco products. Smoking increases the risk of many cancers, including some of the second cancers seen in people who have had Hodgkin lymphoma.

To help maintain good health, HL survivors should also:

• Get to and stay at a healthy weight
• Keep physically active and limit the time you spend sitting or lying down 
• Follow a healthy eating pattern that includes plenty of fruits, vegetables, and whole grains, and limits or avoids red and processed meats, sugary drinks, and highly processed foods
• Not drink alcohol. If you do drink, have no more than 1 drink per day for women or 2 per day for men

These steps may also lower the risk of other health problems, including heart disease.

See Second Cancers in Adults for more information.