ABSTRACT
Improvements in cancer treatment in general and radiotherapy in particular, based on advances in medical radiation physics and radiation biology, have resulted in a substantial prolongation of survival times and significantly increased survival rates for a variety of malignancies over the past two decades. This has led to a transition from a perception of cancer patients to a recognition of and attention for cancer survivorship. Surviving cancer patients are, however, at an increased risk of developing secondary neoplasms. The most important reason for this is that patients cured of one cancer have a chance to grow older and hence underlies an increasing risk of ‘naturally’ occurring (then second) cancer with older age. Second, compared to the general population, they still retain more risk (e.g. molecular predisposition) to develop a (second) tumour than any other person of similar age, gender, lifestyle, etc., who had not previously experienced the disease. Third, the etiologic factors associated with the first tumour, for example, smoking for lung and head and neck tumours, or alcohol consumption for tumours of the head and neck or the oesophagus, or exposure to other carcinogens, in many cases do continue and hence promote the manifestation of a second malignancy.
