Cancer Fighters Thrive is a quarterly print and online magazine bringing readers practical, innovative and inspirational information about cancer treatment and survivorship.
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SUMMER 20 15 | C A NCER FIGH T ER S T HR I V E 33 C A NCERFIGHTER S THRI V E .COM CANCER JOURNEY REDUCING RISK Though secondary cancers remain an important consideration for survivors, perhaps the most signifcant message about risk is that advances in treatment are allowing doctors to limit this threat. The emphasis, says Dr. Patel, is on treating the current cancer while limiting long-term side effects. Dr. Patel admits, however, that safety cannot be entirely guaranteed when it comes to the affect of cancer treatment. For example, "There is no safe dose of radiation," he says, "but we're aware of the risk and try to limit exposure." Newer technology that limits radiation exposure includes proton radiation therapy. This approach uses streams of protons (tiny particles with a positive charge) to kill tumor cells. Because radiation is targeted at cancer cells, exposure to surrounding healthy tissues is reduced. The goal is a lower risk of long-term complications, including secondary cancers. Long-term risks related to chemotherapy have also been reduced as research related to treatment has advanced. "Selection of chemotherapy agents to eliminate or minimize exposure to alkylating agents [shown to increase the risk of secondary cancers] will decrease the risk of long-term second malignancies, such as certain types of leukemia, lymphoma or blood disorders," Dr. Crilley explains. As a patient, says Dr. Crilley, you can play a role in making informed decisions about your treatment and the potential long-term risk of a secondary cancer. She encourages patients to ask questions and become well informed. "In-depth discussions with your oncology providers, including your radiation and medical oncologists, will provide insight to help you understand any potential risks, short or long term," she says. The considerations you and your doctor will take into account include personal factors and treatment options, says Dr. Crilley. "Your age at the time of the initial treatment of the primary cancer may infuence selection of which treatment would be least likely to cause long-term adverse effects," she explains. SCREENING AND PREVENTION Once you have made an informed decision to move forward with a treatment that carries a risk of secondary cancer, you can take important steps to reduce your risk or detect a secondary cancer early, if one develops. "Effective screening is available for patients at risk for a secondary cancer," says Dr. Crilley. "For example," she explains, "in women at risk for breast cancer after treatment with radiation for Hodgkin's lymphoma, a yearly breast MRI [magnetic resonance imaging scan] may detect an early secondary cancer." She adds that, similarly, patients at risk for lung cancer after radiation can be screened with a CT [computed tomography] scan. In any case, secondary cancers that are found early can be treated early, which can improve outcomes. You can also take proactive steps of your own to reduce your risk. "Lifestyle can make a difference," says Dr. Patel. He recommends avoiding smoking (which can make treatment less effective and increase the risk of side effects, including secondary cancers), avoiding alcohol in excess or altogether, engaging in regular physical activity and eating a healthy diet. REMAIN VIGILANT Awareness and close follow-up re- main important measures for reduc- ing your risk of secondary cancers. Though the risk of secondary cancers with current treatment is not great, in some cases it remains a long-term, or ongoing, complication. "As a survivor, you'll want to continue close follow- up with your oncology care team," says Dr. Patel. Ultimately, survivors should be encouraged by the fact that advances in treatment to limit long-term com- plications mean the risk of a second- ary cancer is likely very low. And remember, your oncologist's goal is to choose treatment that effectively treats current cancer with minimal long-term risks. References 1. Cancer Facts & Figures 2014. American Cancer Society. Retrieved March 22, 2015, from http:// www.cancer.org/acs/groups/content/@research/ documents/webcontent/acspc-042151.pdf 2. Rheingol, S. R., Neugut, A. I., & Meadows, A. T. (2003). Secondary cancers: Incidence, risk factors, and management. In D. W. Kufe, R. E. Pollock, R. R. Weichselbaum, R. C. Bast Jr., & T. S. Gansler (Eds.). Holland-Frei cancer medicine (6th ed.). Hamilton, ON: BC Decker. Two big culprits in secondary cancers are radiation and chemotherapy, and they carry diferent risks. MIA JAMES is a staff writer and social media manager at OMNI Health Media, where she develops patient education content and oversees online support and information networks.