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Solid tumors
Source: Hodgkin Lymphoma Treatment (PDQ®)–Health Professional Version, National Cancer Institute.
Source updated: February 12, 2025 · Captured 2026-09-09.
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An increase in second solid tumors has also been observed, especially mesothelioma and cancers of the lung, breast, thyroid, bone/soft tissue, stomach, esophagus, colon and rectum, uterine cervix, and head and neck.[27-34] These tumors occur primarily after radiation therapy or with combined-modality treatment (especially when involving mechlorethamine or procarbazine), and approximately 75% occur within radiation ports. The risk of developing a second solid tumor (cumulative incidence of a second cancer) increases with time after treatment.
At 15-years of follow-up, the risk is approximately 13%.[30]
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At 20-years of follow-up, the risk is approximately 17%.[35]
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At 40-years of follow-up, the risk is approximately 48%.[37]
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In a cohort of 18,862 5-year survivors from 13 population-based registries, the younger patients had elevated risks for breast, colon, and rectal cancers for 10 to 25 years before the ages when routine screening is recommended in the general population.[29] Even with involved-field doses of 15 Gy to 25 Gy, sarcomas, breast cancers, and thyroid cancers occurred with similar incidence in young patients, compared with those receiving higher-dose radiation.[35]
Lung cancer and breast cancer are among the most-common second solid tumors that develop after therapy for HL.
Lung cancer. Lung cancer is seen with increased frequency, even after chemotherapy alone, and the risk of this cancer increases with cigarette smoking.[38-41] In a retrospective Surveillance, Epidemiology, and End Results (SEER) Program analysis, stage-specific survival was decreased by 30% to 60% in HL survivors, compared with patients with de novo non-small cell lung cancer.[42]
Breast cancer. Breast cancer is seen with increased frequency after radiation therapy or combined-modality therapy.[27,28,43-45] The risk appears greatest for females treated with radiation before age 30 years, especially for girls close to menarche.[46] The incidence of breast cancer increases substantially after 15 years of posttherapy follow-up.[27,47,48] In a cohort of 1,964 female 5-year HL survivors treated between 1975 and 2008, doxorubicin also increased breast cancer risk independent of age at first treatment or prior chest radiation therapy.[49] Survivors who received more than 200 mg/m2 of doxorubicin had a 1.5-fold increased risk (95% CI, 1.08–2.10) versus survivors who did not receive doxorubicin. In two case-control studies of 479 patients who developed breast cancer after therapy for HL, cumulative absolute risks for developing breast cancer were calculated as a function of radiation therapy dose and the use of chemotherapy.[50,51] With a 30-year to 40-year follow-up, cumulative absolute risks of breast cancer with exposure to radiation range from 8.5% to 39.6%, depending on age at diagnosis. These cohort studies show a continued increase in cumulative excess risk of breast cancer beyond 20 years of follow-up.[50,51]In a nested case-control study and subsequent cohort study, patients who received both chemotherapy and radiation therapy had a statistically significant lower risk of developing breast cancer than did those treated with radiation therapy alone.[43,52] Reaching early menopause with fewer than 10 years of intact ovarian function appeared to account for the reduction in risk among patients who received combined-modality therapy.[52] Reduction of radiation volume also decreased the risk of breast cancer after HL.[52]
Late effects of autologous stem cell transplant for failure of induction chemotherapy include second malignancies, hypothyroidism, hypogonadism, herpes zoster, depression, and cardiac disease.[53]
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Preserved source evidence · Not medical advice