Cancer Surveillance

Cancers are a risk

Your transplant medications keep your organ safe, but also increase the risk of developing cancers. A transplant recipient is approximately twice as likely to have cancer. This risk varies between the types of transplanted organs and cancer types. Regular screening helps in early detection and treatment of new cancers.

This section covers the basics of some common cancers including symptoms to watch for, and practical steps recipients can take to avoid them.

Studies have shown that Non-Hodgkin lymphoma has the highest incidence in lung recipients, intermediate in liver and heart recipients, and lowest in kidney recipients. Lung cancer risk is highest in lung recipients, with smoking-related disease often the reason for the transplant. While the risk of liver cancer was elevated only among liver recipients, the risk of kidney cancer is increased for all recipients.

Cancer Screening – it is your responsibility. Do not delay!

The most common places to get new cancers are skin, kidneys, cervix, lungs and in the blood. The risks are higher if recipients have had cancer before or were transplanted at a young age (under 20). By taking care of your body and through regular screening, the risks can be managed.

 

Skin Cancer

Skin cancer is one of the most common cancers that recipients can develop. The risk is higher if you are a fair-skinned or on long-term immunosuppresent therapy.

Too much exposure to ultraviolet (UV) radiation from the sun or from artificial tanning damages the skin and makes you susceptible to skin cancer.

Here are some preventative steps:

  • As a part of your normal morning routine apply a broad-spectrum sunscreen (SPF 30+ or higher). Don’t miss exposed parts of your body like the face, ears, lips, neck and backs of your hands. If you have thinning hair, ensure you apply it on your scalp
  • If outdoors, reapply sunscreen every two hours
  • Seek the shade, especially between between 10:00 am and 4:00 pm
  • Wear sunglasses with UV protection and a broad-brimmed hat
  • Protective clothing like long-sleeved shirts and pants is a great way to stay sunsafe
  • Sunscreen can wear off easily. Remember to reapply after excessive sweating, toweling or swimming
  • Carry out a self-examination of your skin once a month. It doesn’t take long. Look out for new or changing growths, pink patches or spots and changing moles. Report the changes to your dermatologist, transplant doctor or nurse

For more on skin cancer click on the resource Skin Cancer Risks in Transplant Recipients: Know the Facts.

Skin cancer facts risks

Tony Harding, liver transplant, 1988: “Regular checks paid off when, fifteen years ago, I had a regular skin check and a small skin cancer was detected on my face. It was so small that the biopsy was able to completely excise the basal cell carcinoma. There is now no scar or anything that would indicate that I once had a skin cancer removed.”

Post-Transplant Lymphoma

One of the cancers recipients will be most susceptible to is lymphoma related to the Epstein Barr Virus (EBV).

If you’ve had EPV as a child, there is a chance of the virus reactivating after transplantation. The greatest risk of reactivation is during the first six months post-transplant when your immunity is at its lowest. The virus can also be passed on from the donor or exposure to the environment.

Symptoms include:

  • Fever
  • Night sweats
  • Fatigue
  • Enlarged tonsils
  • Enlarged glands, particularly in the neck

Contact your transplant doctor if you have any of these symptoms. Unusual symptoms should be reported ASAP.

Breast Cancer

mammographBreast cancer forms in the area of the breast where the cells replicate in an uncontrolled way.  Women who’ve had a transplant are at a higher risk of developing it due to their suppressed immune system.

Monthly self breast-examination is important to check for lumps or bumps, and should be done about one week after you have a period. Things to look out for include:

  • A new lump or lumpiness in your breasts, especially if it’s only in one breast
  • Change in the size and shape of your breast
  • Change to the nipple such as crusting, an ulcer, redness or the nipple pulled in
  • Change in the skin of your breast such as redness, dimpling or puckered skin
  • Pain that does not go away

Schedule mammograms as part of your routine screening. Changes in the look and feel of your breast can sometimes be unrelated to cancers, but it’s good to get them checked without delay even if your screening mammogram was normal.

Symptoms of breast cancer depend on where the tumour is in the breast, the size of the tumour and how quickly it’s growing. 

Cervical cancer

The cervix is the lower part of the uterus that opens into the upper part of the vagina. The cells of the cervix undergo changes (pre-cancers) before they develop into cancers. Detectable by pap tests, these pre-cancers can become cancerous if left untreated.

If you were sexually active before surgery, it’s recommended you undergo a pap test every year to detect these early changes.

Symptoms include:

  • Unusual menstrual bleeding patterns (vaginal bleeding between periods/menstrual bleeding that is unusually long or heavy)
  • Pain during intercourse/bleeding
  • Unusual vaginal discharge
  • Vaginal bleeding after menopause
  • Excessive tiredness
  • Leg pain or swelling
  • Lower back pain

If any of these symptoms arise it’s best to speak with your GP.

Liver recipient Annie Gilberthrope“I consider regular testing very important to maintaining good health and am still working full-time as a teacher. Liver transplants are too precious to waste. So, don’t put off that 10-minute procedure. Have tests regularly.”

Bowel Cancer

Tony Harding: “While I received a liver transplant in 1988, I want to keep this going as long as possible. To do this, I undergo regular skin checks and I am regularly screened for bowel cancer.”

Cancer that develops in the inner lining of the bowel is called colorectal cancer or bowel cancer.

The risk of bowel cancer can be reduced by maintaining a healthy lifestyle, a diet that includes plenty of fresh fruit and vegetables, regular physical activity and refraining from smoking.

Initial symptoms of bowel cancer can be subtle. Things you should look out for include:

  • Change in bowel habits with diarrhea, constipation or the feeling of incomplete emptying
  • Thin bowel movements
  • Blood in the stools
  • Abdominal bloating or cramping
  • Weight-loss
  • Fatigue
  • Unexplained anaemia

Growths (polyps) in the stomach lining are precursors to the disease. Left undetected, they can become cancerous. Regular screening will help in early detection, prevention and disease management.

A free and easy-to-use screening test kit offered by the National Bowel and Cancer Screening Program will help you carry out a simple test at home. All eligible people between the ages of 50 and 75 are invited to participate.

If you’re not eligible to be invited through the program you can speak with your doctor or pharmacist about how to obtain a screening kit.

Renal Cancer

Transplant recipients are at risk of renal cancers because of their low immunity. Forming in the tubules of the kidney, renal cancers do not have symptoms that are easily detectable. Doctors don’t know what causes it, but high blood pressure, advanced kidney disease and exposure to certain materials like lead or asbestos makes a person susceptible to this disease.

If there are symptoms, these may include:

  • Blood in the urine
  • Painful spasms in the ureters or bladder
  • Lump in the area of the kidney
  • Dull pain in the side
  • Persistent high temperature, night-sweats, tiredness and weight-loss

Tip: If you have any of these symptoms you should have them checked by your doctor – but remember, most people with these symptoms won’t have renal cancer. Other more common conditions, such as an infection or stones in the bladder or kidneys, are often the cause.

Kidney recipients Matty Hempstalk and Linda Petrovski. Matty: “So far, symptoms like these have been due to infections. Over the years I’ve learnt not to worry or stress until all tests are done and I’ve spoken to the doctor.

Prostate Cancer

Another cancer recipients must be aware of is prostate cancer. Prostate cancers commonly affect older men with a family history of the disease. A high percentage of diagnoses in this cancer category occurs in men over 65.

Symptoms to look out for include:

  • Difficulty passing urine
  • Slow, interrupted flow of urine
  • Frequent passing of urine, including at night
  • Blood in urine
  • Pain during urination
  • Lower back or pelvic pain

Sometimes you might experience these symptoms due to an enlargement of the prostate that may be non-cancerous. If you experience these symptoms, visit your doctor.

PSA blood test and an internal prostate examination will help with early detection. An internal exam to find out if your prostate is normal in size and shape is quick and easy. You may experience slight discomfort and an urge to urinate if your prostrate is inflamed or enlarged, but it will be momentary.

These are some of the most common cancers that transplant recipients may be prone to, but is not an exhaustive list.

For more information, please visit Cancer Australia. For more information about cancer screening in Australia, click here.

Acknowledgement

Transplant Australia gratefully acknowledges the contribution of A/Prof Germaine Wong, Transplant Nephrologist, Westmead Hospital in reviewing this material.