Some treatment for Hodgkin Lymphoma and related cancers, particularly radiation therapy, may increase the risk for developing other cancers like lung, thyroid, breast, and other cancers. The risk for developing other cancers is increased among those who have been treated with radiation, especially to the head and neck areas. There are strategies to detect and prevent secondary cancers early. Please see your primary care provider annually to ensure that you are up to date with age-related screenings for common adult cancers or to consider other cancer screenings that might be appropriate for you depending on how and when you were treated (as detailed below).
Overview of Risks for Secondary Cancer with Dr. Andrea Ng
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Breast Health Exposing healthy breast tissue to radiation during the treatment of Hodgkin Lymphoma can increase the risk of developing a second breast cancer in the future. This risk is higher for those exposed to radiation while breast tissue is still developing, as in adolescents and young adults. Breast cancer risk as an adult, when treated with chest radiation for Hodgkin Lymphoma as an adolescent or young adult, begins to increase as early as 10 years after Hodgkin Lymphoma treatment. During this time, you should talk to your doctor, such as a gynecologist, breast surgeon, or medical oncologist, about the risk for second breast cancer and breast screening 8 to 10 years after completing radiation treatment. Screenings include regular mammograms and breast magnetic resonance imaging (MRI). Those treated with chest radiation should also monitor signs and symptoms of breast cancer including a hard lump in breast or armpit, visible change in the size or shape of your breast, skin thickness or redness, or nipple changes such as bleeding or discharge or the nipple being inverted.
Breast cancer risk can be lowered through healthy lifestyle behaviors such as regular exercise, maintaining a healthy body weight, not smoking, and minimizing alcohol intake. Medications are also used to lower the risk of developing breast cancer, such as hormonal therapies (i.e., tamoxifen) that may reduce breast cancer risk in Hodgkin Lymphoma survivors who received chest radiation. Some women may choose to undergo prophylactic mastectomy to reduce breast cancer risk. Please speak with your doctor about your breast cancer risk and timely screening and preventive options.
Risk for Breast Cancer in Women: Understanding Screening Options with Dr. Andrea Ng
Lung Health The risk for second lung cancer is also increased by Hodgkin Lymphoma survivors treated with chest radiation. Specifically, male and/or older patients who had Hodgkin Lymphoma as an adolescent or young adult are more likely to develop lung cancer as an adult, with this risk compounded by smoking behavior. Additionally, chest radiation can also cause lung damage initially. Patients who have received radiation to the chest to treat Hodgkin Lymphoma as an adolescent or young adult should focus on not smoking, exercising regularly, and eating healthily. These patients should talk to their doctor about screening options for the early detection of lung cancer, especially important among higher risk groups.
Risk of Lung Cancer: The Importance of Avoiding Tobacco with Dr. Andrea Ng
Thyroid Health Thyroid nodules, hypothyroidism, or thyroid cancer can occur after cancer treatment with radiation. Being female, having a history of an enlarged thyroid, having a family history of thyroid disease or cancer, and certain genetic conditions may increase your risk of developing thyroid cancer after Hodgkin Lymphoma treatment has ended. Being aware of thyroid cancer signs and symptoms (i.e., swelling or lump in the neck, trouble swallowing or breathing, hoarseness) is helpful.
You should be screened by getting an annual TSH (thyroid stimulating hormone) and thyroid exam. Women treated at age 20 or younger should have a thyroid ultrasound 10 years after neck radiation therapy. If you have a nodule (bump) in your thyroid, your doctor should have you get a thyroid ultrasound or refer you to an endocrinologist or other doctor who specializes in thyroid care.
Gastrointestinal Health Patients in long-term survivorship treated with abdominal and/or pelvic radiation may also be at increased risk for second gastrointestinal cancer. Eating healthily, exercising regularly, not smoking, and limiting your alcohol intake may reduce this risk. Among Hodgkin Lymphoma survivors, colonoscopy is important in removing precancerous lesions or polyps to detect and treat cancer early.
Risk for Gastrointestinal Cancer in Long-Term Survivors with Dr. Andrea Ng
Skin Health Patients who have been treated with radiation to treat Hodgkin Lymphoma may also be at increased risk for skin cancer in the areas that were irradiated. Specifically, those treated with radiation are more likely to experience basal cell cancers. For this reason, prevention and early detection is important through regular dermatological exams. Practicing sun safety, like wearing appropriate sunscreen while spending time outside, is imperative for reducing the risk of these cancers.
Risk for Skin Cancer: The Importance of Sun Safety with Dr. Andrea Ng