Cancer Radiation Therapy Can Cause Second Cancers, Research Paper Example

Introduction

Radiation therapy that is used to treat cancer requires a significant amount of physical effort and focus from patients in order to achieve the intended outcomes in eliminating as many cancer cells as possible within a given area of the body. This requires an examination of the different advantages and disadvantages of radiation therapy in the treatment of cancer in order to effectively manage the needs of these patients facing a cancer diagnosis. It is important to identify some of the challenges that are present in radiation therapy as a form of cancer treatment and to be cognizant of the issues that are likely to occur with respect to these patients and their risks to long-term health. Therefore, it is important to identify the different aspects of the treatment plan that will be effective in supporting an understanding of these risks for patients. Therefore, the use of radiation therapy to treat cancer must be examined and evaluated closely in order to protect patients from unnecessary risk or harm, including an increased risk of secondary cancers in some cases. The following discussion will address these challenges in greater detail and will emphasize the importance of understanding the dynamics and need for radiation therapy as a cancer treatment alternative, in addition to the risks that it poses to the patient population who receives this type of treatment.

Body

Radiation therapy is often one of the first options available in the treatment of different types of cancer; however, it poses its own set of risks that may impact health in other ways: “Some of the treatments for cancer can damage normal cells and result in short-term and long-term side effects, including an increased risk of subsequent cancer years or decades later. The benefits of treatment of the first cancer are large compared to the risks of developing a second cancer” (American Cancer Society, 2009, p. 30). In addition, it is known that “The second cancers associated with radiation therapy include acute leukemia, chronic myelogenous leukemia, breast, lung, thyroid, and non-melanoma skin cancers” (American Cancer Society, 2009, p. 30). These risks are significant for patients and require clinicians to determine if the risks outweigh the benefits; therefore, each individual case must be examined because the level of risk may be different from one case to the next. It is important for these risks to be addressed and communicated to patients because the selection of radiation therapies may do more harm than good for some patients under specific circumstances. It is imperative to develop a strategy that will be effective in working towards a set of solutions to impact patients in a positive manner and to provide a framework for decision-making in order to prevent secondary cancers from developing in the future.

In spite of the risks of secondary cancer formation, it is also known that “Improvement in radiotherapy techniques over time has allowed the damage to normal tissue to be minimized while delivering an effective dose to the cancer” (American Cancer Society, 2009, p. 30). In this context, it is important to examine the different contexts of care and treatment and to determine what is required to enable patients to experience minimal side effects and other issues that may occur in patients who receive radiation therapy. When this treatment is required, it is necessary to consider dosing and other issues very carefully in order to minimize the risks for patients, as well as the side effects that may occur for this group. There must be a greater focus on whether or not specific patients are likely to face a greater risk of secondary cancers as a result of radiation therapy and to determine what steps are required to prevent these cancers and the formation of new cancer cells in other areas, including organs and tissues.

When patients receive these types of treatment, their risk of secondary cancers is likely to increase, based upon prior evidence; however, this is not necessarily the norm and requires each case to be examined individually to ensure that patients are protected from unnecessary side effects and further complications. To be specific, “developing a secondary cancer from cancer treatment is a relatively rare occurrence. Certain predispositions like genetic syndromes or hereditary do play a factor, but for the most part, the risk of developing a secondary cancer from treatments including chemotherapy and radiation is very small” (National Comprehensive Cancer Network, 2015). There must be a significant focus on radiation therapy and to fully examine its potential side effects, as these reflect a need to determine whether or not the risk of secondary cancers may occur, even if this risk is small (National Comprehensive Cancer Network, 2015). From a physician-based perspective, other conditions, such as genetic predispositions and other issues, may pose a more significant threat to patients than treatment using radiation therapy; as a result, this type of therapy should not be ruled out as the treatment of choice when patients are likely to benefit, and these benefits outweigh the risks related to this process (National Comprehensive Cancer Network, 2015). In essence, there must be a greater emphasis on understanding how secondary cancers form and the nature of cell development in this regard in order to have a better understanding of the most likely risks that may contribute to secondary cancer development (National Comprehensive Cancer Network, 2015).

The selection of radiation therapy to treat a primary form of cancer is a viable option for some patients; however, this option requires an examination of the short and long-term impacts, some of which may occur over a period of years (American Cancer Society, 2014). Under these conditions, it is likely that secondary cancers will not be a primary consideration over the short term, but it should be considered over the long term as a potential side effect of this form of treatment (American Cancer Society, 2014). In many cases, the benefits of radiation therapy to treat primary cancers are more critical than the risks that are likely to occur, particularly when the secondary cancer risk is very small (American Cancer Society, 2014). It is imperative to develop and understand the reasons why radiation therapy is chosen as the optimal form of treatment for primary cancer and to be cognizant of the issues that may occur that could impact patients and their potential risk of side effects, as well as future secondary cancers that may form under some circumstances.

The factors that influence patients must be closely examined and must provide a means of recognizing the need to determine how radiation therapy impacts patient health beyond the treatment of primary cancer. Therefore, it is necessary to develop risk assessments for this group of patients that will support the determination of whether or not patients may experience second cancers under specific conditions that are a direct result of radiation therapy (Newhauser & Durante, 2011). This process also requires an examination of the issues that will influence the health and wellbeing of these patients on a long-term basis and to determine if a risk assessment will have a positive and lasting impact on these patients and their risk of secondary cancers (Newhauser & Durante, 2011). The dosing of radiation must be carefully managed and cancer targeting must be closely monitored in an effort to make a difference in treating the primary cancer without facilitating any additional complications or side effects in this regard (Newhauser & Durante, 2011).

A number of additional factors that go beyond radiation therapy must be considered in order to determine the overall risk of developing secondary cancer in patients, including the following: 1) whether or not a patient has developed cancer during his or her childhood years, including those who are diagnosed with cancer before the age of 15; 2) patients who are older and may face an independent risk of developing cancer due to their age; 3) patients with a family history of different cancers that impact their risk of developing a secondary form of cancer; 4) a “field effect” which may influence surrounding tissues and may contribute to the formation of a second type of cancer in the future; 5) prior forms of cancer treatment, including but not limited to radiation therapy; and 6) different lifestyle factors such as alcohol use, diet, and exercise, which may reduce quality of life and increase the propensity for additional cancers in the future (National Comprehensive Cancer Network, 2015). These specific characteristics represent a means of understanding the potential risk factors that individual patients face, particularly those who have already experienced a cancer diagnosis and are vulnerable to developing a secondary type of cancer (National Comprehensive Cancer Network, 2015).

One of the most intriguing and disturbing trends in cancer development is related to children who have been diagnosed with cancer, including the side effects of treatment that may linger into adulthood and beyond (American Cancer Society, 2009). Under these conditions, a set of guidelines known as the “Long Term Follow-up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers” provides a means of identifying the long-term influences of cancer and the creation of risk factors that could contribute to the formation of cancers in future years; most importantly, this requires clinicians to examine these risk factors during the childhood years and to move forward with a strategy that includes counseling, continuous evaluations on a regular basis, and health screenings as appropriate (American Cancer Society, 2009). In this context, children must be evaluated closely and provided with the tools and resources that are necessary to meet expectations and to make the most of the circumstances that will impact health moving forward.

The nature of radiation therapy is to have a significant impact on the destruction of cancer cells in patients; however, this may create other challenges on a long-term basis in the risk of formation of secondary cancers. It is known that “Secondary cancers are caused by injury to the DNA of irradiated cells in such a way that genetic programming is altered to favor abnormal cellular growth and proliferation. In general it takes many years for secondary cancers to develop” (Dr. Loiselle, 2011). Therefore, it is possible that some patients will experience long-term effects of radiation therapy that genetically alter the DNA of some surrounding cells to the extent that cancer cells could potentially form in some cases (Dr. Loiselle, 2011). As a result, the concept of radiation carcinogenesis must be addressed because there is always a risk with this treatment that a secondary cancer could perform, even if the risk is minimal (Dr. Loiselle, 2011). It is imperative that the treatment strategy must also consider long-term impacts and side effects, as this will reflect a need to further advance the principles of assessment and evaluation in supporting future outcomes for these patients over time.

A research study conducted by de Gonzalez et.al (2011) addresses the significance of long-term risks or complications related to radiation therapy that may include the formation of secondary cancers in some patients. The study adopted a prospective cohort model using the U.S. Surveillance, Epidemiology and End Results cancer-based registry to evaluate areas of the body where radiation therapy is most commonly used, and out of 647,672 patients evaluated seven years after the initial cancer diagnosis, and of these patients, 60,271, or nine percent of patients, experienced a second form of cancer; however, these statistics are relatively low in the context of their impact on patients who have received radiation therapy to treat the initial form of cancer (Gonzalez et.al, 2011). It is important for researchers and clinicians to continue to examine this focus area and to recognize the potential risk of secondary cancer formation as it relates to patient outcomes for this group, along with other factors that will have a lasting impact on patients with a primary form of cancer who are at risk of developing a second form, such as genetics and overall lifestyle factors (Gonzalez et.al, 2011).

It is believed that specific types of cancer diagnoses may carry a higher level of risk in some patients, including breast cancer. For example, research was conducted by Johansen, Danielsen, & Olsen (2008) using dose volume statistics to determine if secondary malignancies are likely to form relative to an initial breast cancer diagnosis, and it was determined that additional underlying factors must also be considered, as these may provide insight regarding the formation of secondary malignancies in the breast. Furthermore, there are significant complexities related to the secondary formation of malignancies in the breast that may be a result of radiation therapy, but that do not necessarily tell the entire story of this process and its overall impact on patient outcomes and relative risk of secondary cancer formation in these patients (Johansen et.al, 2008).

A study conducted at the University of Michigan Comprehensive Cancer Center (2014) addresses the significance of radiation therapy in the treatment of prostate cancer, and it was determined that there is a greater risk of developing rectal and/or bladder cancer in this patient population that could be related to this type of therapy. In this study, of the 441,504 males that were evaluated from the Surveillance, Epidemiology and End Results (SEER) program, there was a 70 percent higher risk of developing a secondary form of rectal cancer and a 40 percent greater likelihood of developing a secondary form of testicular cancer within this patient population (University of Michigan Comprehensive Cancer Center, 2014). Therefore, although this risk does not represent a means of discouraging radiation therapy, which is a common form of treatment for prostate cancer patients, it may pose questions regarding the overall development of assessment and screening tools that are likely to have an influence on any future growth of secondary cancers within this patient population (University of Michigan Comprehensive Cancer Center, 2014).

It is necessary for clinicians to recognize the factors related to secondary cancer formation and to consider radiation therapy as part of this equation, as it may reflect a need to further develop new ideas and approaches that will have a lasting impact on outcomes and the long-term health of these patients. In the context of prostate cancer, a study by Murray et.al (2013) notes the following: “One of the most serious long term effects following radiotherapy is development of a radiation induced second primary cancer (RISPC). Newer radiotherapy techniques such as IMRT have facilitated dose escalation, but differences in dose distribution and scatter have raised theoretical concerns about an increased risk of RISPC. The potential risk of RISPC is particularly relevant in PCa: patients are now diagnosed at an earlier stage than in the past and so may receive treatment earlier, and patients are surviving for longer. As such, patients have a longer period in which RISPC may develop.” Based upon this knowledge, it is imperative to recognize the need for additional insight regarding prostate cancers and the long-term prognosis of these patients, as it may be affected by early treatments using radiation therapy (Murray et.al, 2013). In addition, it is important to determine how this long-term recovery period from prostate cancer may be disrupted by the potential formation of a secondary cancer, as this reflects a need to better understand how radiation therapy may influence the surrounding cells and their DNA and may have a direct influence on the formation of new cancer cells in other organs and tissues (Murray et.al, 2013). The development of an assessment strategy to counteract these issues is essential in the development of new strategies for the future to guide patients who have overcome prostate cancer and to be proactive in working towards solutions that will positively impact this group of patients over the long term with the expectation that future cancer diagnoses will be prevented or will be minimized with respect to their long-term impacts (Murray et.al, 2013).

Finally, it is important to identify the specific types of radiation therapy and whether or not different forms may impact the risk of patients differently, and a study by Chung et.al (2012) adopted a retrospective cohort model to evaluate 558 patients who had received proton radiation, using the Surveillance, Epidemiology and End Results program. The study indicated that based upon follow-up measurements, 5.2 percent, or 29 patients receiving proton therapy, were diagnosed with secondary malignancies, while 40 photon patients, or 7.5 percent of cases, were diagnosed with a secondary form of cancer; however, these statistics are not necessarily indicative of a difference in the type of radiation therapy (photon or proton) that will continue to be considered in the future as the different types of radiation therapies are considered (Chung et.al, 2012). This is an important step in the discovery and evaluation of radiation therapies and their long-term impact on the formation of secondary cancers, which must be evaluated as a means of understanding the needs of patients who require this form of treatment for primary cancers. It is imperative that physicians must examine these issues and to determine the best possible treatment strategies that will influence health over the long term, including the potential formation of secondary cancers in some patients, even for those who have been cancer-free over a period of many years.

Conclusion

The potential development of secondary cancers with the treatment of radiation therapy for a primary cancer must be considered as an important step towards the discovery of new ideas and approaches that will have a lasting impact on outcomes and the relative risk of secondary cancers within this population group. The adoption of radiation therapy as a primary form of cancer treatment must always be considered based upon prior research evidence regarding its effectiveness in some situations; however, it also represents a means of developing new strategies in order to be successful in treating primary cancers and in the prevention of secondary cancers in patients. This process will demonstrate a greater need to understand the dynamics of radiation therapy and its benefits in eradicating cancer cells, while also considering how it influences individual patients, including those who have fought cancer and won and are identified as in remission, even for a period of many years. These considerations must be made when electing to use radiation therapy and must be considered in the context of treatment selections for cancer patients, while also considering genetics and other factors that may influence outcomes in different ways and create additional challenges for some patients over time.

For patients who have been diagnosed with a primary form of cancer, it is imperative to consider the treatment methods that have been successful in managing the potential risk factors and side effects that may occur with some of these patients. It is important to recognize the value of radiation therapy and in supporting the continued treatment of some forms of cancer. However, this requires an element of caution in some cases and demonstrates a greater need to understand the dynamics of radiation treatment and how it impacts individual patients. However, additional issues must also be considered and may be part of the discussion regarding the value of continuous monitoring and evaluation on a consistent basis in the formation of secondary cancers. It is important for physicians to also consider other factors, such as lifestyle considerations and genetics, in determining the risk associated with secondary cancers that could also contribute to future diagnoses in this regard. Therefore, a number of characteristics related to radiation therapy must be identified in order to determine whether or not patients with a primary form of cancer may develop a secondary cancer as a direct result of radiation therapy in some cases.

References

American Cancer Society (2009). Cancer facts and figures. Retrieved from http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-038825.pdf

American Cancer Society (2014). Does radiation therapy cause second cancers? Retrieved from http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/radiation/radiationtherapyprinciples/radiation-therapy-principles-second-cancers

American Cancer Society (2014). Second cancers in adults. Retrieved from http://www.cancer.org/acs/groups/cid/documents/webcontent/002043-pdf.pdf

Chung, C.S., Yock, T.I., Nelson, K., Xu, Y., Keating, N.L., & Tarbell, N.J. (2013). Incidence of second malignancies among patients treated with proton versus photon radiation. International Journal of Radiation Oncology, 87(1), 46-52.

de Gonzalez, A. B., Curtis, R. E., Kry, S. F., Gilbert, E., Lamart, S., Berg, C. D., … & Ron, E. (2011). Proportion of second cancers attributable to radiotherapy treatment in adults: a cohort study in the US SEER cancer registries. The lancet oncology, 12(4), 353-360.

Dr. Loiselle (2011). Secondary malignancies after radiation therapy. Retrieved from http://cancergrace.org/radiation/2011/05/09/secondary-malignancies/

Johansen, S., Danielsen, T., and Olsen, D.R. (2008). Estimated risk for secondary cancer in the contra-lateral breast following radiation therapy of breast cancer. Acta Oncologica, 47(3), 391-396.

Murray, L., Henry, A., Hoskin, P., Siebert, F.A., & Venselaar, J. (2013). Second primary cancers after radiation for prostate cancer: a review of data from planning studies. Radiation Oncology, retrieved from http://www.ro-journal.com/content/8/1/172

National Comprehensive Cancer Network (2015). Understanding your risk of developing Secondary cancers. Retrieved from http://www.nccn.org/patients/resources/life_after_cancer/understanding.aspx

Newhauser, W. D., & Durante, M. (2011). Assessing the risk of second malignancies after modern radiotherapy. Nature Reviews Cancer, 11(6), 438-448.

University of Michigan Comprehensive Cancer Center (2014). Radiation for prostate cancer linked to secondary cancers, study finds. Retrieved from http://www.mcancer.org/news/archive/radiation-prostate-cancer-linked-secondary-cancers-study-finds