The diagnosis of cancer can be frightening and devastating. According to the American Cancer Society website, advances in radiation therapy and chemotherapy have increased the chances of surviving cancer. People with cancer are now living longer.

Now the not so good news…

Cancer Treatments Can Cause Many Complications…Including Second Cancers

Radiation therapy and chemotherapy have both been linked to the development of second cancers.

Radiation therapy is linked to several types of leukemia, for up to five to nine years after treatment. Radiation also increases the risk of developing other cancers which are mostly solid tumors. These can take over 15 years to develop. Higher doses of radiation tend to raise the risk of developing solid tumors. The area treated is also important because cancers tend to develop in or near areas treated with radiation.

Other factors affecting the risk of developing a second cancer after radiation include:

Age: exposure to radiation at a young age increases the risk of developing breast cancer. Early menopause can lower this risk.

Smokers: a smoker has an increased risk of developing lung cancer after radiation.

Chemotherapy is also linked to the development of certain types of leukemia. Patients have a higher risk of developing leukemia after chemotherapy than after radiation therapy. Different types of chemotherapy can lead to different types of cancer. Treatment with alkylating agents can lead to leukemia within about two years after treatment. The risk decreases about 10 years after the chemotherapy. The risk increases with higher doses, longer treatment times, or higher doses of chemotherapy over a short period of time.

There is a well-known causal relationship between Cytoxan (cyclophosphamide) administration and the development of bladder cancer. The first case linking cyclophosphamide to the development of bladder cancer was before 1975.

Cytoxan is one of the “old warhorses” of chemotherapy. It has been around since the 1950s. The authors of the article “Bladder and kidney cancer following cyclophosphamide therapy for non-Hodgkin’s lymphoma”, Journal of the National Cancer Institute, 1995 April 5; 87(7):524-30: http://www3.cancer.gov/intra/dce-old/pdfs/bkcf.pdf reported that cyclophosphamide was an established carcinogen. The authors of this article concluded that the development of bladder cancer was dose dependent. The authors stated, “The strong dose-dependent relationship and high absolute risk of bladder cancer underscore the importance of limiting the cumulative dose of cyclophosphamide to what is required to achieve therapeutic endpoints.”

According to the “Cyclophosphamide (Cytoxan) American College of Rheumatology Patient Fact Sheet (updated 2012): http://www.rheumatology.org/practice/clinical/patients/medications/cyclophosphamide.asp

“Bladder cancer is the most common cancer related to cyclophosphamide.”

Because of the risk of developing a second cancer after treatment for cancer, physicians need to be diligent about closely monitoring their patients treated for cancer. Most cancers are far more treatable when they are detected early. A delay in identifying and treating the development of second cancer can be the difference between life and death.

If you are working on a case involving a patient who suffered the consequences of a delay in diagnosis and treatment of a devastating illness, call us to help you develop your case. We can organize and summarize the records, develop a chronology and analysis, and locate experts. We can also testify as fact witnesses to explain the medical records.

Jane Heron MBA RN LNCC is a legal nurse consultant employed by Med League.

Med League provides medical expert witnesses to trial lawyers. Please call us at (908)788-8227 or contact us today to discuss your next case.