Surviving childhood cancer: the hidden threat of second malignancies

Despite improved cancer mortality rates, pediatric cancer survivors face significant challenges in the long term due to therapy-related complications. A critical complication is the development of second malignant neoplasms (SMNs), which account for nearly half of non-relapse deaths among long-term survivors. This imaging review touches upon various risk factors for SMN development such as chemotherapeutic drugs, radiation, hereditary syndromes, and hematopoietic stem cell transplantation. Common SMNs include leukemia, thyroid cancer, sarcoma, and breast carcinoma. Early detection through imaging and structured surveillance is critical for improving outcomes. Strategies to mitigate risks include dose modification, advanced radiation techniques, and comprehensive survivorship care. As the field of pediatric oncology progresses, a dual focus on optimizing primary cancer treatment and minimizing late effects like SMNs is paramount. Lifelong surveillance, tailored therapies, and interdisciplinary care models are essential for enhancing survivors' quality of life.