The risk of developing which of the following cancers is most increased in patients with Hodgkin’s disease?

A 45-year-old woman was treated with chemo-radiotherapy for Hodgkin’s lymphoma at the age of 18. She has heard about an increased risk of secondary malignancy in patients treated with radiotherapy for Hodgkin’s lymphoma and wants your advice. The risk of developing which of the following cancers is most increased in patients with Hodgkin’s disease?
The risk of breast cancer and lung cancer is significantly increased in patients who have received traditional mantle radiotherapy for Hodgkin’s lymphoma. A proportionately greater risk of secondary cancer is seen in patients treated at a younger age for Hodgkin’s lymphoma. The absolute excess risk (AER) for lung cancer is 14.0 per 10 000 patient years, and for breast cancer, it is 5.1 per 10 000 patient years.
Colon cancer is increased in patients who have received treatment for Hodgkin’s lymphoma, although the AER is less at 2.5. This may be because the burden of radiotherapy is greater to tissues in the thorax.
Melanoma risk is only slightly increased in patients post-radiotherapy, with an AER of 1.3. This is in contrast to a much greater increased risk of non-melanoma skin cancer (5.1).

  • Breast cancer
  • Colon cancer
  • Melanoma
  • Stomach cancer
  • Thyroid cancer

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Explanation

Breast cancerA
Stomach cancer carries an AER of 1.5 where patients have received chemotherapy and radiotherapy for Hodgkin’s lymphoma.
Thyroid cancer has a lower incidence vs other cancers such as breast and lung cancer. The AER for thyroid cancer post-radiotherapy for Hodgkin’s lymphoma is smaller at 0.7 than that for other cancers.
Stomach cancer