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Late Effects

Second Malignant Neoplasm



All survivors of childhood cancer are recommended to have a comprehensive yearly health check up.

Survivors should be aware that any new symptoms of concern should be immediately reported to their family doctor or health care provider such as:

  • A new swelling or lump (either painful or non-painful) anywhere
  • New pain in any area - such as bone.
  • Symptoms of a blood disorder:
    • Easy bruising
    • New tendency to bleed easily (such as frequent nose bleeds)
    • Pale skin
    • Lack of energy
  • Night sweats and fevers
  • Changes in any moles, such as:
    • Increase in size
    • Itchyness
    • Increase or decrease in pigmentation
    • New "raised" area or ulcer
  • Bowel problems:
    • Change in bowel habit (such as constipation)
    • Rectal bleeding
  • Blood in the urine
  • CNS problems:
    • New headaches (especially associated with nausea)
    • New visual changes
  • Respiratory symptoms:
    • Cough
    • Shortness of breath


To reduce the risk of second cancers, survivors should avoid exposure to toxic agents associated with cancer:

1. Tobacco (smoked, chewed etc) leads to cancer.  Exposure to second hand smoke should also be avoided.

2. Marijuana:  In June 2002, a panel of experts brought together by the International Agency for Research on Cancer (an agency of the World Health Organization) determined that second-hand smoke causes cancer. Marijuana and cigarette smoke contain as many as 50 of the same cancer causing substances. For these reasons, experts believe that exposure to second-hand marijuana smoke is at least as harmful as second-hand tobacco smoke.

A healthy diet - low in fat, high in fibre and plenty of green vegetables.


Reducing the risk of second cancers at the Children's Oncology Group Survivorship Guidelines


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