Second Cancers After Testicular Cancer

Cancer survivors can be affected by a number of health problems, but often their greatest concern is facing cancer again. If a cancer comes back after treatment it's called a recurrence. But some cancer survivors may develop a new, unrelated cancer later. This is called a second cancer.

Unfortunately, being treated for cancer doesn’t mean you can’t get cancer again. People who have had cancer can still get the same types of cancers that other people get. In fact, certain types of cancer and cancer treatments are linked to a higher risk of certain second cancers.

Common second cancers after testicular cancer

Survivors of testicular cancer can get any second cancer, but they have an increased risk of:

• A second testicular cancer (this is different than the first cancer coming back)
• Rectal cancer
• Pancreas cancer
• Bladder cancer
• Kidney cancer
• Thyroid cancer
• Acute myeloid leukemia (AML)

The most common cancer seen in testicular cancer survivors is a second testicular cancer.

Compared with most men in the general population, testicular cancer survivors are up to twice as likely to develop a new cancer outside the testicle. The chance of a second cancer changes over time and depends on which treatments were used and how old the patient was when he was treated.

If you had radiation therapy

Treatment with radiation is linked to some second cancers after testicular cancer. The risk is highest for cancers in organs in or near the area that was treated (the radiation field) -- the abdomen (belly) and pelvis, and include:

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

If the radiation field includes the chest, there's an increased risk of:

• Lung cancer
• Esophagus cancer
• Mesothelioma (cancer of the outer lining of the lung)
• Thyroid cancer

Radiation treatments also increase the risk of melanoma skin cancer and connective tissue cancer (sarcoma).

The risks of these cancers starts going up within 5 years and doubles after 10 years in those men who were treated with radiation alone. This risk remains high and doesn’t seem to go down with time. This is why long-term follow-up is so important. The risks are generally greater with higher radiation doses or if the patient got both chemotherapy and radiation.

In recent years, radiation therapy for testicular cancer has changed. Lower doses of radiation are used, and preventive radiation treatment to the chest has been stopped. Long-term follow-up studies are needed to see if these changes have lowered second cancer risks.

If you had chemotherapy

Chemotherapy is also linked to an increased risk of second cancers, but it's slightly less than what's seen after radiation. Treatment with chemo has been linked to increased risk for these cancers:

• Kidney
• Thyroid
• Soft tissue

There's also an increased risk of leukemia and myelodysplastic syndrome (MDS) after chemotherapy for testicular cancer. Use of the chemo drug cisplatin is linked most often to leukemia and MDS, though high doses of etoposide (VP-16, Etopophos, or Vepesid) are sometimes also a factor. (The doses were higher in the past than those normally used today.) Radiation given with chemotherapy seems to increase risk even more. Leukemia and MDS are both uncommon cancers normally, so even though the risk of these cancers is higher than average, very few patients develop them from their treatment.

Follow-up after treatment

After completing treatment for testicular cancer, you should still see your doctor regularly. You may have tests for a number of years to look for signs the cancer has come back or spread. Experts don’t recommend any other testing to look for second cancers in people without symptoms. But let your doctor know about any new symptoms or problems, because they could be caused by the cancer coming back or by a new disease or second cancer.

Survivors can do regular testicular self-exams to look for cancer in the remaining testicle.

All patients should follow the American Cancer Society guidelines for the early detection of cancer, such as those for colorectal cancer.

The Children’s Oncology Group has guidelines for the follow-up of patients treated for cancer as a child, teen, or young adult, including screening for second cancers. These can be found at www.survivorshipguidelines.org.

All survivors of testicular cancer should not use tobacco and avoid tobacco smoke. Smoking increases the risk of many cancers.

To help maintain good health, survivors should also:

• Get to and stay at a healthy weight
• Keep physically active and limit the time you spend sitting or lying down
• Follow a healthy eating pattern that includes plenty of fruits, vegetables, and whole grains, and limits or avoids red and processed meats, sugary drinks, and highly processed foods
• Not drink alcohol. If you do drink, have no more than 1 drink per day for women or 2 per day for men

These steps may help lower the risk of some other health problems, too.

See Second Cancers in Adults for more information about causes of second cancers.