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Secondary Primary Malignancy-

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“Second Primary Malignancy (SPM) is not a phenomenon of cancer recurrence or metastasis, but it is suffering from another cancer (different from first primary malignancy)”

I was diagnosed with a blood cancer called multiple myeloma in January of 1994. I spent the next four years undergoing aggressive therapies including surgery, chemotherapy, radiation and an autologous stem cell transplant.

The highest priority of all newly diagnosed cancer patients is to cure or at least reach complete remission aka cancer-free status. Unfortunately, newly diagnosed cancer patients like me, don’t know that the more toxicity they undergo, the greater their risk of a second primary malignancy.

Chemotherapy and radiation can cause second primary cancers.

My guess is that newly diagnosed cancer patients approve aggressive therapies such as an autologous stem cell transplantation thinking that aggressive therapies give them their greatest chance for cure or a long remission. This is what I thought when I was told about a relatively new procedure called ASCT.

The reality of aggressive therapy is more nuanced and must be understood my newly diagnosed cancer patients.

Chemotherapy and radiation therapy are two of the most common treatments for cancer. While they can be highly effective in killing cancer cells, they also have the potential to cause damage to normal cells in the process. This can lead to a range of side effects, including the potential development of a second primary malignancy.

  1. Chemotherapy and Second Primary Malignancy:
    • DNA Damage: Chemotherapy drugs work by targeting rapidly dividing cells, which includes both cancer cells and some healthy cells. This can lead to DNA damage in healthy cells, potentially increasing the risk of mutations and the development of a second primary malignancy.
    • Weakened Immune System: Some chemotherapy drugs can suppress the immune system, making it harder for the body to defend against new cancer cells that may form.
  2. Radiation Therapy and Second Primary Malignancy:
    • DNA Damage: Radiation therapy uses high-energy rays to target and kill cancer cells. However, it can also affect nearby healthy cells, potentially causing DNA damage and increasing the risk of a second primary malignancy.
    • Scattered Radiation: Although radiation therapy is highly targeted, some scatter of radiation to nearby tissues can occur, potentially affecting healthy cells and increasing the risk of a second cancer.
  3. Combined Effect:
    • In some cases, patients receive both chemotherapy and radiation therapy. This combination can have a cumulative effect on the risk of developing a second primary malignancy.
  4. Specific Cancer Types:
    • The risk of developing a second primary malignancy can vary depending on the type of cancer being treated and the specific chemotherapy and radiation regimen used. Some types of cancer and specific treatments may carry a higher risk.
  5. Monitoring and Surveillance:
    • Because of the potential for developing a second primary malignancy, individuals who have undergone chemotherapy and/or radiation therapy are often monitored closely for any signs of new cancers. This includes regular follow-up appointments, imaging studies, and other tests.
  6. Risk Management:
    • Oncologists carefully consider the benefits and risks of chemotherapy and radiation therapy for each individual patient. The potential for developing a second primary malignancy is one of the factors taken into account when deciding on a treatment plan.

The fact is evidence-based non-conventional therapies such as curcumin, omega-3 fatty acids, etc. can reduce the risk of  a second primary malignancy.

Are you a cancer survivor who has undergone aggressive toxicity? To learn more about an anti-cancer lifestyle contact me at David.PeopleBeatingCancer@gmail.com.

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Second primary malignancies among cancer patients

“We conducted a retrospective study identifying patients over the age of 18 who were diagnosed with SPM from the 16 most common cancer sites between 2000 and 2013 from Surveillance, Epidemiology, and End Results data. Cox proportional hazards regression was used to analyze the relationship between different factors associated to the prognosis of SPM. Standard incidence rate of multiple primary (MP-SIR) was also calculated…

Conclusions- With the advancement of medical standards, the survival time of cancer patients is prolonged, but the occurrence of SPM is also increasing, and the prognosis is not optimistic. More attention needs to be invested in the prevention and treatment of SPM…

High-Dose Chemo and HSCT Linked to Second Primary Malignancy in Lymphoma Survivors

“Lymphoma patients who receive high-dose chemotherapy followed by autologous hematopoietic stem cell transplant (HSCT) have an increased risk of second primary malignancy…

In this population-based study, researchers examined data from 803 patients with aggressive lymphoma who received high-dose chemotherapy and autologous HSCT during 2001-2017. These patients were compared to 4015 matched control individuals from the general population…

Over a median follow-up of 7.76 years, the incidence of second primary malignancies was significantly higher in the lymphoma patients than in the matched control individuals — 16% and 11%, respectively…

Yang et al.reported that SPMs are common in cancer patients with an overall cumulative incidence of 14% at 25 years of follow-up ()…

  • The 5-year cumulative risk of second primary malignancies was 12% among lymphoma patients and 7% in the control group.
  • The 10-year cumulative risk was 20% and 14%, respectively.
  • The 15-year cumulative risk was 24% and 21%, respectively.

Second primary malignancy (SPM) is not a phenomenon of cancer recurrence or metastasis, but it is suffering from another cancer [different from first primary malignancy (FPM)] (,)…

These findings have “implications for clinical practice and patient counseling, emphasizing the need for careful consideration of the potential risks and benefits of this treatment in patients with lymphoma with the availability of other chemotherapy-free therapies,” the researchers wrote.”

Host genetics helps explain childhood cancer survivors’ mortality risk from second cancers

Newswise — (MEMPHIS, Tenn. – October 02, 2023) The population of childhood cancer survivors in the U.S. is increasing, with an overall childhood cancer survival rate greater than 85% five years after diagnosis. However, survivors can still be at increased risk of various health conditions, including second cancers. Using data from the Childhood Cancer Survivor Study (CCSS) and the St. Jude Lifetime Cohort Study (St. Jude Life), scientists at St. Jude Children’s Research Hospital have identified a genetic explanation for why a small proportion of survivors are more likely to develop second cancers and why they may be more severe or deadly…

The St. Jude group showed that survivors with pathogenic (damaging) genetic variants in specific genes, called cancer-predisposing variants, are at an increased risk of developing second, or subsequent, cancers as adults, and those cancers are more likely to be severe and deadly…

Cancer prevention in adult childhood cancer survivors 

The total number of childhood cancer survivors who develop second or subsequent cancers is small (<10% based on current studies), and the percentage of survivors who carry cancer-predisposing variants is low (~6%). Together, these factors have made it extremely challenging to study and understand the genetic risks for second cancers and their outcome in this population. To reach statistically meaningful results, Wang and his collaborators combined whole genome/exome sequencing and clinical data from over twelve thousand survivors of childhood cancer. The study combined data from North America’s two largest survivorship studies, the CCSS and St. Jude LIFE cohorts.

These variants are part of the inherited, or germline, DNA that people are born with. This means they can be detected in children when they are first diagnosed with childhood cancers, arming survivors with the knowledge they need to lower their risk later in life. 



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