Use of anti-rejection medications increases the risk of developing certain types of cancers. The most common types of cancer seen are:
- Lymphoma (a cancer of the blood cells) called Post Transplant Lymphoproliferative Disease or PTLD
- Cancer of the cervix for women
- Digestive tract cancer
- Skin cancer
PTLD most often occurs in the first few months after transplantation, but may occur years after. PTLD is a serious complication and the treatment involves reduction or discontinuation of anti-rejection medications and chemotherapy or radiation in some cases.
Cancer of the cervix in female recipients can be detected on Pap smear; therefore, it is recommended at least once a year. This test helps detect abnormal cells so that they can be treated quickly. Early detection usually makes this type of cancer curable.
Digestive tract cancer is often difficult to detect just based on signs and symptoms. Report significant changes in bowel habits (e.g. alternating diarrhea and constipation, or the presence of blood in the stool) to family doctor or transplant team. Early detection and treatment is important. Individuals over age 50 need regular screening by colonoscopy. Ask your family doctor to refer you to a specialist.
Transplant recipients may develop other cancers at similar rates to people who do not have a transplant. Women should have annual breast examinations done through their family doctor and report any abnormalities immediately. Routine mammograms are usually started once a woman reaches age 50, or earlier in some cases. Men should do monthly testicular checks for any abnormal lumps, and should report these immediately. Men over the age of 40 should also discuss the need for prostate checks, including the PSA blood test and a physical examination with their family doctor.
Skin cancer is very common among transplant recipients. It is easily treated if detected early. Your transplant team or family doctor should screen you for skin cancer and can refer you to a dermatologist if necessary.
What you can do to minimize your risk of skin cancer:
- Use sunscreen with sun protection factor (SPF) 30 or higher (remember commonly missed areas such as lips, behind the ears, along hairline, backs of the hands and tops of the feet). Reapply sunscreen after swimming or sweating heavily.
- Use sunscreen even in winter if you are outside for a prolonged period especially at higher elevations (e.g. skiing) and if it is sunny outside.
- Wear a hat, long sleeve shirts and pants when you are out in the sun. Remember though that regular clothing does not prevent UV rays from reaching you skin. Only specialized sun-protective (SPF) clothing reliably provides such protection.
- Avoid the sun especially in the summer between 11:00 a.m. and 3:00 p.m. Even on cool, cloudy or overcast days, 70-80% of the sun’s ultraviolet (UV) rays still get through. Sitting in the shade or swimming underwater does not fully protect you.
- Examination of your skin and monthly checks for moles are a wise precaution. Look for any scaliness, changes in the color or shape of moles, or any persistent itching or oozing.
- Apply sunscreen 10 minutes before going outside and reapply every two hours. Refer to the following information to ensure that you receive the required protection.
- Apply 1 teaspoon to face, head, and neck;
- 2 teaspoons to front and back of torso;
- 1 teaspoon for each of arms and forearms;
- 2 teaspoons for each thighs, legs, and feet.