Second malignancies in children: the usual suspects?

The aim of this article is to provide an up to date review of second malign ant neoplasms (SMN's) following treatment for childhood cancer, referring t o their incidence, the role of genetic factors, and how the primary maligna ncy and treatment received influence the type, site and prognosis of SMN's. The role of genetic factors will be discussed as far as they impact upon a predisposition to later development of SMN's. The primary malignancies tha t have important associations with SMN's will then be discussed, in particu lar Hodgkin's disease, retinoblastoma and acute lymphoblastic leukaemia. Th e important second malignancies will be highlighted, including tumours of t he CNS and thyroid, osteosarcoma, secondary acute myeloid leukaemia and mel anoma. Emphasis will be put upon identifying which patients are most likely to suffer from these tumours. An important part of the article are case hi stories. These are provided in combination with illustrations as a useful a djunct to the text, with a particular emphasis on radiological features, di agnosis and screening. Finally, the important but different roles of causal agents, in particular chemotherapy and radiotherapy are highlighted. (C) 2 001 Elsevier Science Ireland Ltd. All rights reserved.