What the Heck is “Second Cancer”?

When I first heard the term “second cancer” about a year ago, it sounded like a bad joke. Unfortunately, it's something very real.

Second cancer is different from recurrence

Second cancer, I learned, is not the same as a cancer recurrence. Instead, second cancer is when a cancer survivor gets a separate cancer diagnosis unrelated to the first. Surprisingly, about 1 in 6 people diagnosed with cancer have had a different type of cancer at some point in the past – meaning second cancer is actually common.

But why exactly does this happen? I reached out to Dr. Walter Stadler, an oncologist at the University of Chicago Health and an expert on prostate, kidney, and bladder cancers, to get a better understanding of this phenomenon (and to assuage my anxiety).

Environmental factors

“The biggest issues that cause second cancer are environmental factors that put you at risk for more than one cancer,” Stadler said in a phone interview. With bladder cancer specifically, smoking is the most obvious risk. “Patients with bladder cancer are particularly at risk for other smoking-related cancers, specifically in the lung, head, and neck.”

Treatment-related second cancers

Second cancers can also be therapy-related, Stadler said. In other words, the treatment used to cure cancer can actually put patients at risk for an additional malignancy later on. “We see this more in patients who are treated for cancers with very high doses of chemotherapy at a younger age,” he says. “The lag time is more like 10-20 years between exposure to a medical toxin and the development of a cancer, so it's not as relevant with bladder cancer because patients are generally older when they're diagnosed and we don't use that much chemotherapy [to treat bladder cancer].”

Other times, bladder cancer itself can be the second malignancy: “Patients who get radiation for prostate cancers successfully in their fifties might be at risk for bladder cancer in their sixties and seventies,” Stadler says. Patients who have an upper-tract urothelial cancer in the ureter or renal pelvis also have an increased risk of developing bladder cancer later.

Reducing your risk

Fortunately, some of this is preventable. Because the most common situation with bladder cancer and second malignancies is lung cancer, patients with bladder cancer should take care to reduce smoking or quit altogether. Maintaining a healthy weight, eating more plants, and consuming less alcohol can also help reduce your risk, according to the American Cancer Society.

Any kind of cancer can be scary, and the prospect of it coming back or developing an unrelated cancer is always in the back of my mind and many others who have experienced this journey. But knowing that it's not a foregone conclusion and that I can actually take steps to prevent it definitely helps me sleep better at night.