Secondary Cancers in Hodgkin Lymphoma Survivors

“Secondary Cancer” refers to a cancer that is unrelated to the original diagnosis of Hodgkin Lymphoma. Unlike a recurrence of Hodgkin’s, which would be considered a “relapse” of the disease, secondary cancers result from the treatment- namely radiation and chemotherapy treatments. People who have been treated for Hodgkin’s are almost twice as likely to develop a secondary cancer than the normal population.

Radiation therapy, particularly when given in large doses, is now known to cause an increase risk for solid tumors in areas of the body that received this treatment.

For Hodgkin’s survivors, this is most likely to be in the area of the neck, chest, and abdominal regions. Radiation to the chest or “mantle” area puts survivors at greater risk for breast cancer and lung cancer. Radiation to the neck presents an increased risk for thyroid cancer and cancer of the esophagus. Abdominal radiation increases the risk for cancers of the gastrointestinal (GI) tract, including stomach cancer, colon cancer, and pancreatic cancer. In addition, any area of the body that was irradiated is also at risk for developing skin cancers, including melanomas. Some chemotherapy drugs, especially those that are “alkylating agents” can also have serious, toxic effects on the body, including risk of secondary cancer.

The following chemotherapy regimens contained alkylating agents: -CHOP, BEACOPP. DA-EPOCH -ABVD -MOPP -rituximab -BEAM -ICE and IVAC -ChlVPP and MCP

These chemotherapy agents put survivors at greater risk for blood cancers like leukemia, but can also cause solid tumors, including lung tumors. Secondary cancers may take months, years, and even decades to develop and therefore may go undetected for some time. For this reason, it is very important that Hodgkin’s survivors remain vigilant about their follow up care. You may need more frequent follow up visits, mammograms, MRI’s, etc. than others who don’t share your Hodgkin’s history.

Breast Cancer:

Women who were treated for Hodgkin’s and had radiation and/or certain chemotherapy treatments are at a significant risk for developing breast cancer. Estimates put this risk as similar to a woman who carries the BRAC1 gene mutation. Women who were treated at a younger age, especially in their teens, have a greater chance of developing breast cancer years later than do women who were diagnosed later in life. There are other factors that influence the risk of having breast cancer after Hodgkin’s, including the area of the chest that was radiated and the specific chemotherapy drugs that were given. As with most cancers, family history and lifestyle also come into play. It is important to note that if a woman who is a Hodgkin’s survivor develops breast cancer years after their initial (Hodgkin’s) diagnosis, they may not have the same choices for treatment than another person without that history might have.

For example, they may be restricted in receiving further radiation. Hodgkin’s survivors who are faced with a secondary diagnosis of breast cancer or who are evaluating their personal risk need to be able to discuss ALL of the possible options for treatment as well as prevention. This may include more frequent mammograms, breast exams, and possibly the addition of MRI’s in their regular evaluations. It may also include the option of choosing prophylactic mastectomies.

Other Secondary Cancers that Hodgkin’s survivors risk:

Lung Cancer

Thyroid Cancer

Leukemia (particularly acute myeloid leukemia, AMA)

Non-Hodgkin Lymphoma

Skin Cancer

Gastrointestinal Cancers

As we have said earlier, a survivor’s risk of developing a secondary cancer after earlier treatments depends on several different factors, including:

Type of treatment (Radiation, Chemotherapy for example)

Area Treated (Chest, neck, abdomen, etc.)

Amount of treatment given (Radiation “GY’s” for example)

Age treated (Younger age at increased risk for certain cancers)

Family History (Family history of breast cancer, lung cancer for example)

Lifestyle (Weight, Exercise habits, etc.) For additional information about Secondary Cancers in Hodgkin’s survivors and research articles on this subject, please refer to our

Resources Page on this website.