Secondary Cancers After Management Of Testicular Cancer

Advancements in science and technology has made it fairly easy to detect and cure serious malignant disorders such as cancers. However, it is noteworthy that even after achieving complete remission, the survivors are left with numerous health concerns. Among many others, the greatest threat is reoccurrence of cancer. If same cancer reappears, it is termed as recurrence of cancer. However, some may develop a new type of cancer, unrelated to the previous malignancy. Such type of malignancy is referred to as secondary cancer. Unfortunately, regardless of type, it is always possible to develop new cancer. In fact, there are some cancers and cancer treatments that are known to increase the risk of secondary cancers.

Risk Of Second Cancers Associated With Testicular Cancer

• Rectal cancer
• Bladder cancer
• Pancreas cancer
• Second testicular cancer, different from previous one
• Acute myeloid cancer
• Kidney cancer
• Thyroid cancer

Secondary testicular cancer is the most common type observed in survivors of testicular cancer. In general, 2% to 5% men who had cancer in one testicle are at risk of developing malignant lesion in the other testicles. Patients who had surgical resection for the management of cancer are at greater risk for developing secondary testicular cancer. Whereas, chemotherapy reduces the risk significantly. In comparison to the general population, survivors of testicular cancer have twice as much greater chance of growing cancer outside testicles. The type of treatment and age at the time of treatment determines the likeliness of developing secondary cancers.

Other than testicular cancer, radiotherapy is also known to raise the risk for developing certain cancers. Organs that come under radiation field i.e. areas affected during radiation are more prone to develop cancer.

Risk Of Secondary Cancers Associated With Radiotherapy

Following are some type of cancers that may occur due to exposure of pelvic and abdominal region to radiations:

• Colon cancer

• Prostate cancer
• Rectal cancer
• Bladder cancer
• Kidney cancer
• Stomach cancer
• Pancreas cancer

Exposure of chest to radiation may cause:

• Thyroid cancer
• Lung cancer
• Esophagus cancer
• Cancer of outer lining of lungs (Mesothelioma)

Overall, radiotherapy can exacerbate risk of sarcoma i.e. cancer in connective tissues and melanoma skin cancer.

The risk of these cancers increases over 5 years and can double after 10 years in men who were exclusively treated with radiotherapy. Sadly, these risks remain high throughout the life and is much greater when both radiation and chemotherapy are combined or radiation alone is given in high doses. Due to high risk, treatment strategy for testicular cancer has been altered recently. Radiations are given in lower doses and the radiation therapy to chest for preventive measures has been stopped. However, to find out whether this treatment approach has reduced the risk or not, follow up studies on long term basis are required.

Risk Of Second Cancers Associated With Chemotherapy

Chemotherapies can also accelerate the risk of certain cancers however; risk factor is relatively lower than radiotherapy. Treatment of testicular cancer via chemotherapy is associated with increased risk of myelodysplastic syndrome (MDS) and leukemia. Cisplatin is a chemotherapeutic agent which can significantly aggravate the risk of developing leukemia and MDS. High dose of Etoposide can also increase the chances though, they are now used in lesser dose. Both MDS and leukemia are not much common type of cancers. Therefore, fewer patients develop these cancers from their treatment, although, the risk is greater than average.

Follow Up After Treatment

After treatment, people should still visit their doctor regularly. They may conduct test for several years to check upon the risk of cancer recurrence. Moreover, survivors should try to maintain good health by staying physically active and maintain healthy weight. Alcohol should be limited to not more than 2 drinks per day.

References

• Miller, K. D., Siegel, R. L., Lin, C. C., Mariotto, A. B., Kramer, J. L., Rowland, J. H., ... & Jemal, A. (2016). Cancer treatment and survivorship statistics, 2016. CA: a cancer journal for clinicians, 66(4), 271-289.
• Rusner, C., Streller, B., Stegmaier, C., Trocchi, P., Kuss, O., McGlynn, K. A., ... & Stang, A. (2014). Risk of second primary cancers after testicular cancer in East and West Germany: a focus on contralateral testicular cancers. Asian journal of andrology, 16(2), 285.