FaCD Online Syndrome Fact Sheet

Last updated: 1 Jun 2003

Name: Non-Hodgkin Lymphoma, Multiple Primary Malignancies in Patients with

Tumor features

Hodgkin disease (Hodgkin's lymphoma)
melanoma, cutaneous
non-Hodgkin lymphoma
urinary bladder cancer

Tumor features (possible)

glioma of the brain
lip, squamous cell cancer of the
lung/bronchial cancer
renal cell cancer
soft tissue sarcoma
thyroid cancer
tongue cancer

Comment

A range of second primary cancers has been reported in patients with non-Hodgkin lymphoma (NHL). Brennan et al.[1] analyzed the occurrence of second primary neoplasms following NHL in 12,452 patients from the New South Wales Central Cancer Registry. They observed excesses of cutaneous melanoma (SIR = 2.38, 95% CI 1.92-2.91), lip cancer (2.74, 1.59-4.38), tongue cancer (2.53, 1.09-4.99), bladder cancer (1.64, 1.19-2.21), soft tissue sarcomas (3.61, 1.80-6.45) and thyroid cancer (3.42, 1.56-6.49).
Travis et al.[2] studied the risk of second cancer in 6171 NHL patients from 4 different international tumor registries. Approximately 1000 of these patients lived 15 or more years after diagnosis. Significant excess was seen for acute nonlymphocytic leukemia (AML) (Observed/Expected = 4.83), melanoma (2.38), Hodgkin's disease (12.0), and cancers of the lung (1.36), brain (2.33), kidney (2.07), and bladder (1.77). The authors concluded that NHL patients continue to be at significantly elevated risk of second primary cancer for up to two decades following diagnosis.
Levi et al.[3] observed an excess of NHL following squamous cell skin cancer (SIR 2.6, 95% CI 1.6-3.8) or basal cell skin cancer (1.9, 1.4-2.6) in approximately 15,000 Swiss non-melanoma skin cancer patients.

General aspects to consider with respect to multiple primary tumors:
- Shared genetic (immune response, metabolic/hormonal/DNA-repair pathways) or non-genetic (chemical carcinogens, radiation, viruses, life-style) risk factors
- Therapy (radiation, chemotherapy, hormonal) related effects
- Possible bias because of increased surveillance and autopsy findings.

References

[1] Brennan P, Coates M, Armstrong B, Colin D, Boffetta P. Second primary neoplasms following non-Hodgkin's lymphoma in New South Wales, Australia. Br J Cancer 2000; 82(7):1344-1347.
[2] Travis LB, Curtis RE, Glimelius B, Holowaty E, van Leeuwen FE, Lynch CF, Adami J, Gospodarowicz M, Wacholder S, Inskip P, . Second cancers among long-term survivors of non-Hodgkin's lymphoma. J Natl Cancer Inst 1993; 85(23):1932-1937.
[3] Levi F, Randimbison L, Te VC, La Vecchia C. Non-Hodgkin's lymphomas, chronic lymphocytic leukaemias and skin cancers. Br J Cancer 74[11], 1847-1850. 1996.