Cancer Risks after Transplant

Why are transplant patients at higher risk to get cancer?

 

Transplant patients take medicines life long to prevent rejection of their new organ.  These medicines work by suppressing the body’s normal immune system response of attacking foreign objects and abnormal cells, like cancer.  Being immune suppressed can also make your body vulnerable to viral infection.  Some viruses are known to stimulate certain types of cancer.  Also, many patients have a family history of cancer, a previous history of cancer before transplant, or ongoing disease that may put them at a higher risk for certain cancers.

 

What types of cancer are most common after transplant?

 

Skin cancer is the most common of all cancers seen after transplant.  Transplant patients have a twenty to sixty times higher risk of skin cancer than the general population.  Life long sun exposure, fair skin, history of burns, and heredity, as well as level of immune suppression, play a role in skin cancer development.  Skin cancers often occur five years or later after transplant.  To prevent skin cancer

 

• Reduce your exposure to sun as much as you can.
• Apply sunscreen with SPF 30 or higher daily, and re-apply as needed. 
• Wear protective clothing, wide brim hats, and sunglasses.
• Avoid mid-day sun when the sun’s rays are most intense. 
• Have a baseline full body exam by a doctor and see a dermatologist often.

 

Lymphoma is a type of cancer in the lymph glands and has 30 times higher incidence after transplant.  Lymphoma or Post Transplant Lymphoproliferative Disease (PTLD) has the highest incidence within the first year of transplant when immunosuppression medicines are at their highest.  However, PTLD can be seen even ten years after transplant.  PTLD is often but not always related to reactivation of Epstein Barr Virus.  Signs and symptoms of lymphoma can include unexplained fevers, night sweats, unintended weight loss, and enlarged lymph nodes in the absence of other infection.  Treatment varies greatly based on extent of disease, time frame after transplant, age of recipient, ethnicity, and amount of immunosuppression.  The transplant team works closely with hematology, oncology, and infectious disease team to provide ongoing care when lymphoma occurs after transplant.

 

Renal cell carcinoma of the native kidneys has a fifteen fold increase in incidence after kidney transplant, particularly if the patient has been on dialysis for a long period or has a history of acquired cystic kidney disease (ACKD).  Patients should be watched after transplant with a urinalysis for blood in the urine every three to six months.  It is important to discuss with your transplant doctor to decide if any other screening will be required.

 

Kaposi’s sarcoma has a twenty fold increase after transplant.  It is characterized by red, pink or purple lesions on the legs and lymphedema.  This is most often seen in patients of Mediterranean, Jewish, Arabic, Caribbean, or African descent and occurs within the first year of transplant.

 

Cervical, uterine, vaginal, penile, and other anal-genital cancers have a twenty fold increase after transplant.  Like other skin or epithelial carcinomas, these tend to occur five years or more after transplant.  It is important to do regular self skin exams, to have annual physical exams with your primary care doctors, and to see them sooner if you have unusual discharge or bleeding.  

 

There is also a small increase over the general population in the development of breast, lung, hepatobiliary, urologic, colorectal, ovarian, and prostate tumors.

 

What you can do to prevent cancer

 

It is important to know that there are many things you can do to prevent cancer. 

 

• Reduce your exposure to sun as much as you can.  Wear sunscreen with SPF 30 or higher routinely. 
• If you smoke, quit now. 
• Avoid second hand smoke.
• Eat a diet rich in fruits and vegetable and low in saturated fats.
• Exercise regularly.
• Attend yearly physical exams with local health care team.
• Let your doctors know of any new symptoms or complaints.

 

Early detection and treatment save lives.  The guidelines below are our recommendations for routine screening and prevention.

 

Cancer Type	Recommendations
Skin	Monthly self exam.  Annual skin exam by a doctor.  If suspicious lesions are noted see a dermatologist right away.
Cervical	Annual pap and pelvic exam for all women age 18 or older (even if you had a hysterectomy) and younger than 18 if sexually active.
Anal-genital	Yearly physical exam of anogenital area
Prostate	Annual screening with digital rectal exam and prostate specific antigen (PSA) blood test for men starting at age 50.  Consider sooner if there is a family history or  you are African American
Hepatocellular carcinoma (HCC)	For patients with chronic hepatitis B or C and cirrhosis: blood test for AFP and liver ultrasound or imaging every 6-12 months. For liver transplant patients with HCC at time of transplant: serum AFP and CT or MRI imaging every 3-6 months for first 24 months then yearly as ordered by your hepatologist
Breast	Monthly self exam and annual mammogram for all women starting at age 40.  Consider sooner if there is a family history.
Colorectal	Starting at age 50: colonoscopy every 5-10 years or more often if ordered by gastroenterologist.  Also recommended to do yearly fecal occult blood testing
Lung	Routine screening is not recommended.  Quit smoking and limit second hand smoke exposure
Renal Cell	Talk with your transplant doctor about recommended screening.

 

For More Information

 

www.transplantliving.org/afterthetransplant/cancer/

www.cancer.org

www.skincancer.org

www.lymphoma.org

www.healthytransplant.com

 

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 09/19/2008

Copyright © 09/19/2008 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. UWH #6780

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