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Increased Risk for Gastrointestinal Cancer in Childhood Cancer Survivors FREE

[+] Article and Author Information

The full report is titled “Secondary Gastrointestinal Cancer in Childhood Cancer Survivors. A Cohort Study.” It is in the 19 June 2012 issue of Annals of Internal Medicine (volume 156, pages 757-766). The authors are T.O. Henderson, K.C. Oeffinger, J. Whitton, W. Leisenring, J. Neglia, A. Meadows, C. Crotty, D.T. Rubin, L. Diller, P. Inskip, S.A. Smith, M. Stovall, L.S. Constine, S. Hammond, G.T. Armstrong, L.L. Robison, and P.C. Nathan.


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Ann Intern Med. 2012;156(11):I-36. doi:10.7326/0003-4819-156-11-201206050-00001
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What is the problem and what is known about it so far?

Patients who survived cancer as a child, adolescent, or young adult have been noted to develop second cases of cancer at a rate higher than that of the general population. In particular, cancer of the gastrointestinal tract (such as colon cancer) occurs more often. However, whether specific factors related to the childhood cancer or its treatment are related to the increased incidence of second cancer is not well-defined.

Why did the researchers do this particular study?

To find out whether certain kinds of cancer or cancer treatments during childhood are associated with an increased risk for gastrointestinal cancer later in life.

Who was studied?

14,358 patients who had been treated for cancer diagnosed before age 21 years and who had survived for at least 5 years after the initial cancer diagnosis.

How was the study done?

The researchers contacted patients who had been treated for cancer as children at any of 26 treatment centers in the United States and Canada. They contacted the patient's family in cases where the patient was not available, was still a child, or had died. They collected information about when and what kind of cancer had been treated during childhood and whether new cases of cancer had developed. They also obtained permission to review medical records so that additional details about the cancer and its treatments could be obtained. They compared the rates of cancer among childhood cancer survivors with the rates reported in a large national cancer database.

What did the researchers find?

Childhood cancer survivors were at increased risk for cancer of the gastrointestinal tract, in particular, cancer of the colon and rectum. At particularly high risk were patients who had Hodgkin lymphoma or Wilms tumor (a cancer of the kidney) during childhood or who had radiation therapy to the abdomen or certain kinds of chemotherapy.

What were the limitations of the study?

Overall, the patients in the cohort were not yet at an age when cancer of the gastro-intestinal tract typically occurs in the general population, so additional cases and risk factors may be identified.

What are the implications of the study?

Patients who survived cancer as children, and in particular those who had Hodgkin lymphoma or Wilms tumor or who had received radiation to the abdomen or particular chemotherapy drugs, are at increased risk for new tumors. It may be appropriate to begin screening such patients for gastrointestinal cancer (for example, with colonoscopy) sooner than other patients.

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