OncoLife Care Plan

Your Summary

Your personalized OncoLife Survivorship Care Plan gives you information about the health risks you may face as a result of cancer therapies. Your level of risk can vary based on the doses and duration of your treatment and the combination of treatments received.

You should discuss this plan with your oncology team to better understand your personal risks. These results can be concerning, but not every survivor experiences every side effect, and some survivors do not experience any long-term effects. Learning about these risks can help you develop a plan with your healthcare provider to monitor for or reduce your risk for these side effects through screening and a healthy lifestyle.

The information in your plan is broken down by:

  • Cancer therapies you received and related risks
  • Future screening recommendations
  • Healthy living tips
  • Psychosocial issues you may face

You may see a particular side effect in more than one section because more than one therapy can cause the same long-term effect.

The information in this plan is based on the available research and literature concerning cancer survivors. This area is continually growing, and as new information becomes available, it will be added to the program. You may want to redo your plan periodically.

You received the following treatments for Breast Cancer

  • Lumpectomy
  • Sentinel Node Biopsy
  • Cyclophosphamide (Cytoxan®, Neosar®)
  • Doxorubicin (Adriamycin®, Rubex®)
  • Tamoxifen (Nolvadex®)
  • Radiation treatment for breast cancer after lumpectomy

Information from your oncology office

Call in 6 months for follow up appointment.
Join us for breast cancer support group the first Tuesday of every month at 7pm in the community room.

Coordinating Your Care

As a survivor, it is important that you keep a journal or notebook of your care. Include your doctor's contact information, a list of past and current medications, therapies received, laboratory and radiology studies. (Visit the OncoPilot section on OncoLink for forms you can use to organize this material). While some survivors continue to see an oncologist, many return to a primary care provider or internist for routine care, many of whom are uncertain how to care for you. Developing the OncoLife Survivorship Care Plan can help you and your primary care provider understand what issues to look for, and how to handle them.

If you are being followed only by a primary care practitioner, it is a good idea to maintain a relationship with an oncologist or late effects clinic, should you need any guidance or referrals with regards to late effects. Call the cancer center where you were treated to ask if they have a survivor's clinic, or find one by searching OncoLink's Survivorship Clinic List (though this list is not exhaustive). A survivorship clinic will review the therapies you received, discuss your risks with you, and act as a consultant to your primary care team. Your OncoLife Survivorship Care Plan includes a "Healthcare Provider Summary" (found on the right side of your results), which is an abbreviated summary of recommendations that you can give to healthcare providers for reference.

What's In Your Care Plan

  • Your Summary
    • Follow Up Care After Cancer
      • Follow Up Care For Acute Lymphocytic Leukemia
        • Follow Up Care For Acute Myeloid Leukemia
          • Follow Up Care For Anal Cancer
            • Follow Up Care For Appendiceal Cancer
              • Follow Up Care For Bladder Cancer
                • Follow Up Care For Brain Cancer
                  • Follow Up Care For Breast Cancer
                    • Follow Up Care For Cervical Cancer
                      • Follow Up Care For Chronic Lymphocytic Leukemia (CLL)
                        • Follow Up Care For Chronic Myelogenous Leukemia (CML)
                          • Follow Up Care For Colon Cancer
                            • Follow Up Care For Endometrial (Uterine) Cancer
                              • Follow Up Care For Esophageal Cancer
                                • Follow Up Care For Fallopian Tube Cancer
                                  • Follow Up Care For Gall Bladder / Cholangiocarcinoma
                                    • Follow Up Care For Head & Neck Cancers: Tongue, Lip, Oropharynx, Nasopharynx
                                      • Follow Up Care For Hodgkin Lymphoma
                                        • Follow Up Care For Kidney Cancer
                                          • Follow Up Care For Liver Cancer
                                            • Follow Up Care For Lung Cancer
                                              • Follow Up Care For Melanoma
                                                • Follow Up Care For Mesothelioma
                                                  • Follow Up Care For Multiple Myeloma
                                                    • Follow Up Care For Myelodysplastic Syndrome (MDS)
                                                      • Follow Up Care For Non-Hodgkin Lymphoma
                                                        • Follow Up Care For Non-Melanoma Skin Cancers
                                                          • Follow Up Care For Ovarian Cancer / Primary Peritoneal Cancer
                                                            • Follow Up Care For Pancreatic Cancer
                                                              • Follow Up Care For Penile Cancer
                                                                • Follow Up Care For Prostate Cancer
                                                                  • Follow Up Care For Rectal Cancer
                                                                    • Follow Up Care For Sarcoma
                                                                      • Follow Up Care For Stomach Cancer
                                                                        • Follow Up Care for Testicular Cancer
                                                                          • Follow Up Care For Thymoma Or Thymic Carcinoma
                                                                            • Follow Up Care For Thyroid Cancer
                                                                              • Follow Up Care For Vaginal And Vulvar Cancers
                                                                              • Risks Related to Medications
                                                                                • Allogeneic Stem Cell or Bone Marrow Transplant
                                                                                  • Autologous Stem Cell or Bone Marrow Transplant
                                                                                    • Intravesicular Chemotherapy
                                                                                      • Intrathecal Chemotherapy
                                                                                        • Androgen Deprivation Therapy (ADT) for Prostate Cancer
                                                                                          • Immune Therapy
                                                                                            • New Skin Cancers
                                                                                              • Lung (Pulmonary) Complications
                                                                                                • Risk of Developing Cataracts
                                                                                                  • Risk of Bladder or Urinary Tract Toxicities
                                                                                                    • Risk of Developing Bladder Cancer
                                                                                                      • Risk for Cardiac (Heart) Problems Related to Anthracycline Chemotherapies
                                                                                                        • Peripheral Neuropathy
                                                                                                          • Development of Kidney Problems
                                                                                                            • Hearing Changes or Loss
                                                                                                              • Elevated Cholesterol Levels
                                                                                                                • Risk of Developing Osteoporosis
                                                                                                                  • Risk of Osteonecrosis (bone death)
                                                                                                                    • Raynaud's Phenomenon
                                                                                                                      • Risk of Pulmonary Toxicity
                                                                                                                        • Risk of Liver Toxicity
                                                                                                                          • Cardiac Risk with Targeted Therapies
                                                                                                                            • Skin Toxicities
                                                                                                                              • Long Term Immunosuppression
                                                                                                                                • Understanding Chemo-brain
                                                                                                                                  • Fertility Concerns for Female Survivors
                                                                                                                                    • Fertility and Sexuality Concerns for Male Survivors
                                                                                                                                      • Cardiac Risk
                                                                                                                                        • Epidermal Growth Factor Receptor (EGFR) Inhibitors
                                                                                                                                          • Risk of Cardiac (Heart) Problems Related to Cisplatin
                                                                                                                                            • Side Effects while taking Aromatase Inhibitors
                                                                                                                                              • Side Effects While taking Tamoxifen
                                                                                                                                                • Sexuality Concerns for Female Survivors
                                                                                                                                                  • Vision Changes
                                                                                                                                                    • Hypothyroidism
                                                                                                                                                      • Hepatitis B Infection/Reactivation
                                                                                                                                                        • Risk of Developing a Secondary Cancer
                                                                                                                                                          • What We Do Not Know
                                                                                                                                                          • Side Effects of Radiation
                                                                                                                                                            • Radiation to Chest wall for breast cancer (after mastectomy)
                                                                                                                                                              • Radiation for breast cancer (after lumpectomy)
                                                                                                                                                                • Radiation for Esophageal Cancer
                                                                                                                                                                  • Head & Neck Cancer Radiation
                                                                                                                                                                    • Radioiodine Therapy (I-131)
                                                                                                                                                                      • Brain
                                                                                                                                                                        • Spinal cord
                                                                                                                                                                          • Eyes
                                                                                                                                                                            • Ears
                                                                                                                                                                              • Salivary glands (Parotid)
                                                                                                                                                                                • Sinuses
                                                                                                                                                                                  • Throat / Upper Airway
                                                                                                                                                                                    • Thyroid
                                                                                                                                                                                      • Heart / Cardiovascular
                                                                                                                                                                                        • Breast as part of other field
                                                                                                                                                                                          • Lung
                                                                                                                                                                                            • Esophagus
                                                                                                                                                                                              • Bone
                                                                                                                                                                                                • Skin
                                                                                                                                                                                                  • Stomach
                                                                                                                                                                                                    • Spleen
                                                                                                                                                                                                      • Liver
                                                                                                                                                                                                        • Gall Bladder
                                                                                                                                                                                                          • Bowel
                                                                                                                                                                                                            • Nerve damage
                                                                                                                                                                                                              • Kidney
                                                                                                                                                                                                                • Bladder
                                                                                                                                                                                                                  • Male pelvis
                                                                                                                                                                                                                    • Testicles
                                                                                                                                                                                                                      • Female pelvis
                                                                                                                                                                                                                        • Total Body Irradiation
                                                                                                                                                                                                                          • Lymph nodes
                                                                                                                                                                                                                            • Partial Breast Irradiation with MammoSite or other radioactive implant
                                                                                                                                                                                                                            • Surgery Side Effects
                                                                                                                                                                                                                              • Sentinel Node Biopsy
                                                                                                                                                                                                                                • Permanent Colostomy or Ileostomy
                                                                                                                                                                                                                                  • Surgery for Ovarian, Primary Peritoneal, Fallopian Tube, Endometrial/Uterine and Cervical Cancers
                                                                                                                                                                                                                                    • Surgery for Vaginal and Vulvar Cancers
                                                                                                                                                                                                                                      • Isolated Limb Perfusion (ILP) / Isolated Limb Infusion (ILI)
                                                                                                                                                                                                                                        • Surgery for Appendiceal Cancer (Removal of appendix / Appendectomy)
                                                                                                                                                                                                                                          • Surgery for Gall Bladder Cancer (gall bladder removal / cholecystectomy)
                                                                                                                                                                                                                                            • Liver Resection
                                                                                                                                                                                                                                              • Surgery for Mesothelioma
                                                                                                                                                                                                                                                • Surgery for Thymoma or Thymic Carcinoma
                                                                                                                                                                                                                                                  • Surgery for Penile Cancer (Moh’s surgery/full or partial penectomy / Removal of the penis)
                                                                                                                                                                                                                                                    • Laryngectomy
                                                                                                                                                                                                                                                      • Head and Neck Surgeries
                                                                                                                                                                                                                                                        • Removal of the Thyroid (thyroidectomy)
                                                                                                                                                                                                                                                          • Lymph Node Removal (Dissection)
                                                                                                                                                                                                                                                            • Surgery to Remove Female Reproductive Organs (hysterectomy, oopherectomy)
                                                                                                                                                                                                                                                              • Splenectomy (Removal of Spleen)
                                                                                                                                                                                                                                                                • Amputation (Removal of a Limb)
                                                                                                                                                                                                                                                                  • Lung Resection
                                                                                                                                                                                                                                                                    • Removal of the Prostate (Prostatectomy)
                                                                                                                                                                                                                                                                      • Removal of the Testicle(s) (Orchiectomy)
                                                                                                                                                                                                                                                                        • Removal of a Section of the Bowel
                                                                                                                                                                                                                                                                          • Removal of the Bladder (cystectomy, bladder resection)
                                                                                                                                                                                                                                                                            • Removal of the Kidney (Full or Partial Nephrectomy)
                                                                                                                                                                                                                                                                              • Lumpectomy
                                                                                                                                                                                                                                                                                • Whipple Procedure (pancreatectomy)
                                                                                                                                                                                                                                                                                  • Surgery Involving the Brain or Spinal Cord
                                                                                                                                                                                                                                                                                    • Surgery to Remove the Stomach (Gastrectomy)
                                                                                                                                                                                                                                                                                      • Surgery for Rectal or Anal Cancer
                                                                                                                                                                                                                                                                                        • Other Surgeries Not Listed
                                                                                                                                                                                                                                                                                          • Removal of the Esophagus (Esophagectomy)
                                                                                                                                                                                                                                                                                            • Excision or Moh's Surgery
                                                                                                                                                                                                                                                                                              • Retroperitoneal Lymph Node Dissection (RPLND) for Testicular Cancer
                                                                                                                                                                                                                                                                                                • Mastectomy
                                                                                                                                                                                                                                                                                                • Healthy Living After Cancer
                                                                                                                                                                                                                                                                                                  • General Cancer Screening for Women after ALL
                                                                                                                                                                                                                                                                                                    • General Cancer Screening for Women after Acute Myeloid Leukemia
                                                                                                                                                                                                                                                                                                      • General Cancer Screening for Women after Anal Cancer
                                                                                                                                                                                                                                                                                                        • General Cancer Screening for Women after Appendiceal Cancer
                                                                                                                                                                                                                                                                                                          • General Cancer Screening for Women after Bladder Cancer
                                                                                                                                                                                                                                                                                                            • General Cancer Screening for Women after Brain Cancer
                                                                                                                                                                                                                                                                                                              • General Cancer Screening for Women after Breast Cancer
                                                                                                                                                                                                                                                                                                                • General Cancer Screening for Women after Cervical Cancer
                                                                                                                                                                                                                                                                                                                  • General Cancer Screening for Women after CLL
                                                                                                                                                                                                                                                                                                                    • General Cancer Screening for Women after CML
                                                                                                                                                                                                                                                                                                                      • General Cancer Screening for Women after Colon Cancer
                                                                                                                                                                                                                                                                                                                        • General Cancer Screening for Women after Endometrial Cancer
                                                                                                                                                                                                                                                                                                                          • General Cancer Screening for Women after Esophageal Cancer
                                                                                                                                                                                                                                                                                                                            • General Cancer Screening for Women after Gall Bladder / Cholangiocarcinoma
                                                                                                                                                                                                                                                                                                                              • General Cancer Screening for Women after Head & Neck Cancer: Tongue, Lip, Oropharynx, Nasopharynx
                                                                                                                                                                                                                                                                                                                                • General Cancer Screening for Women after Kidney Cancer
                                                                                                                                                                                                                                                                                                                                  • General Cancer Screening for Women after Liver Cancer
                                                                                                                                                                                                                                                                                                                                    • General Cancer Screening for Women after Lung Cancer
                                                                                                                                                                                                                                                                                                                                      • General Cancer Screening for Women after Lymphoma
                                                                                                                                                                                                                                                                                                                                        • General Cancer Screening for Women after Melanoma
                                                                                                                                                                                                                                                                                                                                          • General Cancer Screening for Women after Multiple Myeloma
                                                                                                                                                                                                                                                                                                                                            • General Cancer Screening for Women after Non-Melanoma Skin Cancers
                                                                                                                                                                                                                                                                                                                                              • General Cancer Screening for Women after Ovarian Cancer / Primary Peritoneal Cancer
                                                                                                                                                                                                                                                                                                                                                • General Cancer Screening for Women after Pancreatic Cancer
                                                                                                                                                                                                                                                                                                                                                  • General Cancer Screening for Women after Rectal Cancer
                                                                                                                                                                                                                                                                                                                                                    • General Cancer Screening for Women after Sarcoma
                                                                                                                                                                                                                                                                                                                                                      • General Cancer Screening for Women after Stomach Cancer
                                                                                                                                                                                                                                                                                                                                                        • General Cancer Screening for Women after Thymoma or Thymic Carcinoma
                                                                                                                                                                                                                                                                                                                                                          • General Cancer Screening for Women after Thyroid Cancer
                                                                                                                                                                                                                                                                                                                                                            • General Cancer Screening for Women after Cancer
                                                                                                                                                                                                                                                                                                                                                              • General Cancer Screening for Women after Hodgkin Lymphoma
                                                                                                                                                                                                                                                                                                                                                                • General Cancer Screening for Women after Mesothelioma
                                                                                                                                                                                                                                                                                                                                                                  • General Cancer Screening for Women after Uterine Cancer
                                                                                                                                                                                                                                                                                                                                                                    • General Cancer Screening for Women after Vaginal and Vulvar Cancers
                                                                                                                                                                                                                                                                                                                                                                      • General Cancer Screening for Women after Fallopian Tube Cancer
                                                                                                                                                                                                                                                                                                                                                                        • General Cancer Screening for Women after Myelodysplastic Syndrome
                                                                                                                                                                                                                                                                                                                                                                          • General Cancer Screening for Men after Acute Lymphocytic Leukemia (Male)
                                                                                                                                                                                                                                                                                                                                                                            • General Cancer Screening for Men after Acute Myeloid Leukemia
                                                                                                                                                                                                                                                                                                                                                                              • General Cancer Screening for Men after Anal Cancer
                                                                                                                                                                                                                                                                                                                                                                                • General Cancer Screening for Men after Appendiceal Cancer
                                                                                                                                                                                                                                                                                                                                                                                  • General Cancer Screening for Men after Bladder Cancer
                                                                                                                                                                                                                                                                                                                                                                                    • General Cancer Screening for Men after Brain Cancer
                                                                                                                                                                                                                                                                                                                                                                                      • General Cancer Screening for Men after Breast Cancer
                                                                                                                                                                                                                                                                                                                                                                                        • Genetic Risk
                                                                                                                                                                                                                                                                                                                                                                                          • General Cancer Screening for Men after CLL
                                                                                                                                                                                                                                                                                                                                                                                            • General Cancer Screening for Men after CML
                                                                                                                                                                                                                                                                                                                                                                                              • General Cancer Screening for Men after Colon Cancer
                                                                                                                                                                                                                                                                                                                                                                                                • General Cancer Screening for Men after Esophageal Cancer
                                                                                                                                                                                                                                                                                                                                                                                                  • General Cancer Screening for Men after Gall Bladder Cancer / Cholangiocarcinoma
                                                                                                                                                                                                                                                                                                                                                                                                    • General Cancer Screening for Men after Head & Neck Cancer: Tongue, Lip, Oropharynx, Nasopharynx
                                                                                                                                                                                                                                                                                                                                                                                                      • General Cancer Screening for Men after Kidney Cancer
                                                                                                                                                                                                                                                                                                                                                                                                        • General Cancer Screening for Men after Liver Cancer
                                                                                                                                                                                                                                                                                                                                                                                                          • General Cancer Screening for Men after Lung Cancer
                                                                                                                                                                                                                                                                                                                                                                                                            • General Cancer Screening for Men after Lymphoma
                                                                                                                                                                                                                                                                                                                                                                                                              • General Cancer Screening for Men after Melanoma
                                                                                                                                                                                                                                                                                                                                                                                                                • General Cancer Screening for Men after Multiple Myeloma
                                                                                                                                                                                                                                                                                                                                                                                                                  • General Cancer Screening for Men after Non-Melanoma Skin Cancers
                                                                                                                                                                                                                                                                                                                                                                                                                    • General Cancer Screening for Men after Pancreatic Cancer
                                                                                                                                                                                                                                                                                                                                                                                                                      • General Cancer Screening for Men after Penile Cancer
                                                                                                                                                                                                                                                                                                                                                                                                                        • General Cancer Screening for Men after Prostate Cancer
                                                                                                                                                                                                                                                                                                                                                                                                                          • General Cancer Screening for Men after Rectal Cancer
                                                                                                                                                                                                                                                                                                                                                                                                                            • General Cancer Screening for Men after Sarcoma
                                                                                                                                                                                                                                                                                                                                                                                                                              • General Cancer Screening for Men after Stomach Cancer
                                                                                                                                                                                                                                                                                                                                                                                                                                • General Cancer Screening for Men after Testicular Cancer
                                                                                                                                                                                                                                                                                                                                                                                                                                  • General Cancer Screening for Men after Thymoma or Thymic Carcinoma
                                                                                                                                                                                                                                                                                                                                                                                                                                    • General Cancer Screening for Men after Thyroid Cancer
                                                                                                                                                                                                                                                                                                                                                                                                                                      • General Cancer Screening for Men after a Cancer Diagnosis
                                                                                                                                                                                                                                                                                                                                                                                                                                        • General Cancer Screening for Men after Hodgkin Lymphoma
                                                                                                                                                                                                                                                                                                                                                                                                                                          • General Cancer Screening for Men after Mesothelioma
                                                                                                                                                                                                                                                                                                                                                                                                                                            • General Cancer Screening for Men after Myelodysplastic Syndrome (MDS)
                                                                                                                                                                                                                                                                                                                                                                                                                                              • Fatigue
                                                                                                                                                                                                                                                                                                                                                                                                                                              • Life After Cancer
                                                                                                                                                                                                                                                                                                                                                                                                                                                • Life After Cancer
                                                                                                                                                                                                                                                                                                                                                                                                                                                • Living with Metastatic Cancer
                                                                                                                                                                                                                                                                                                                                                                                                                                                  • Dealing with a Recurrence or Second Cancer
                                                                                                                                                                                                                                                                                                                                                                                                                                                  • Tobacco
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Tobacco Use and Quitting Smoking

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care After Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care. This includes physical examinations, radiology studies, blood tests, and reporting concerning symptoms to their healthcare provider. The oncology team should provide a specific follow up plan.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Acute Lymphocytic Leukemia

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for ALL, it is important for survivors to adhere to their oncology team’s plan for follow-up care. This includes physical examinations, bone marrow biopsies, radiology studies, blood tests, and reporting concerning symptoms to their physician. General recommendations for ALL follow-up care state that survivors should be monitored with:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Periodic complete blood count (CBC) and bone marrow biopsy / aspirate if these results are abnormal.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Other tests as needed, including liver function tests, cerebrospinal fluid testing and cardiac testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Physical exam, every 1-2 months for the first year after completing chemotherapy, every 3 months for the second year and every 6 months thereafter.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Acute Myeloid Leukemia

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for AML, it is important for survivors to adhere to their oncology team’s plan for follow-up care. This includes physical examinations, radiology studies, blood tests, and reporting concerning symptoms to their physician. General recommendations for ALL follow-up care state that survivors should be monitored with:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have a complete blood count (CBC) checked every 1-3 months for 2 years, then every 3-6 months for up to 5 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • A bone marrow biopsy / aspirate is only necessary if these results are abnormal.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Anal Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for anal cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care. This includes physical examinations, radiology studies, blood tests, and reporting concerning symptoms to their physician. General recommendations for anal cancer follow-up care include: 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Be seen and examined by their physician as often as every 3 months for at least 2 years. This visit should include digital rectal exam, anoscopy (visual exam of the anus), and evaluation of the lymph nodes in the groin area. 
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Blood tests and imaging tests such as CT scans may be used to monitor for recurrence in higher risk disease.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Appendiceal Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for cancer of the appendix, it is important for survivors to adhere to their oncology team’s plan for follow-up care. This includes physical examinations, radiology studies, blood tests, and reporting concerning symptoms to their physician.  There are no formal guidelines for follow up care; therefore, your physician will determine your monitoring plan. Typical monitoring includes:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Abdominal CT scan every 6 months for 3-5 years, then at the discretion of the oncology team.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Tumor markers may be evaluated every 3-6 months if they were initially elevated at the time of diagnosis (these can include CEA, CA-125 and CA 19-9).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Bladder Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow up care for bladder cancer varies widely, depending on the stage and grade of the tumor, and the treatments received. It is important for survivors to adhere to their oncology team’s plan for follow-up care. This includes physical examinations, radiology studies, blood tests, and reporting concerning symptoms to their physician. The recommended follow-up care for patients with bladder cancer according to the stage and grade of the cancer are as follows:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Non invasive, low grade tumors (Ta, low grade):
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Cystoscopy every 3 months initially, with increasing time intervals between cystoscopies as deemed appropriate.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Early stage tumors (Ta - high grade, T1 – low and high grade).
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Cystoscopy with urine cytology every 3-6 months for 2 years, then increasing intervals as appropriate. Your physician may choose to check urinary tumor markers as well.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Radiology tests (CT, MRI) every 1-2 years may be considered in the case of high-grade tumors.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Muscle invasive tumors treated with the intent to cure:
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Laboratory testing (urine, liver function, electrolytes, and creatinine) and chest x-ray every 6-12 months.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Radiologic imaging (CT, intravenous pyelogram [IVP], ultrasound, etc.) of the upper urinary tracts, abdomen and pelvis every 3-6 months for 2 years, then as indicated.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • If bladder-sparing surgery has been performed: cystoscopy with cytology every 3-6 months for 2 years, then at increasing intervals as deemed appropriate.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Follow up after cystectomy (removal of the bladder):
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Laboratory work (urine cytology, creatinine and electrolytes) every 3-6 months for 2 years, then as indicated.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Imaging (CT, MRI) of the chest, abdomen and pelvis every 3 to 12 months for 2 years (based on the risk of recurrence), then as indicated.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Urethral washings cytology every 6-12 months.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • If the surgery was a partial cystectomy, follow up should also include cystoscopy every 3-6 months for 2 years, then at increasing intervals to monitor for relapse in the bladder.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • All survivors: any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Brain Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    There are a number of different types of brain tumors, each with its own treatment and follow up recommendations. It is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology studies, blood tests, and reporting concerning symptoms to their physician. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The following are general recommendations to discuss with your oncology team:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Physical exam and brain MRI every 2-6 months (depending on tumor type) for 2-3 years, then every 6-12 months (also determined by tumor type).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Be sure to promptly let your team know if you experience any concerning symptoms, such as depression, vision changes, headaches, dizziness, difficulty remembering things or concentrating, feeling unbalanced or difficulty walking, any numbness or tingling.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Discuss the possibility of seizures and whether you need anti-seizure medication. If seizures are a concern, discuss safety implications, including your ability to operate a vehicle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Breast Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for breast cancer, it is important for survivors to adhere to their provider’s plan for follow up care. General recommendations for follow up care include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors who have had breast conserving therapy (lumpectomy) or single mastectomy should have a mammogram annually. In addition, breast MRI may be considered for survivors at high risk for cancer in the other breast. Those who have had double mastectomy generally do not need mammograms, but should examine the chest wall for swelling or rash, and report any changes to their oncologist. Some oncologists will recommend mammograms for women who have reconstructed breast(s).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors should be seen by their oncologist every 3 to 6 months for the first 3 years and then every 6-12 months for the next 2 years, and annually after 5 years. Women who are taking tamoxifen and still have an intact uterus should be seen annually by a gynecologist and be sure to report any vaginal bleeding to their physician immediately, as this can be a sign of uterine cancer. Women taking an aromatase inhibitor, which results in a decrease in estrogen levels and can lead to loss of bone strength, should have their bone health evaluated by a Dexa scan at baseline and then periodically thereafter.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Routine CT scans or bone scans to look for cancer spread (otherwise known as metastases) are not recommended. Research has shown that if a woman does develop metastatic disease, the type of treatment, response to treatment, and overall survival are equivalent, regardless of if it is found before symptoms develop. In other words, outcomes are similar for those who are treated for metastases found on routine scans (with no symptoms present) and women who are not treated until those metastases cause symptoms. Therefore, providers do not routinely screen patients for metastatic disease unless they have developed symptoms.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Finally, research has demonstrated that leading an active lifestyle and maintaining a healthy weight, with a body mass index (BMI) of 20-25, may result in better breast cancer outcomes. Weight bearing exercise, such as walking, yoga and dancing, can also help maintain bone strength. Talk with your healthcare team about resources to get started (or back to) a healthy lifestyle!

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Recommendations for patients with breast cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Mammogram annually for those who have had a single mastectomy (the first mammogram should be six months after therapy for survivors who underwent lumpectomy and radiation therapy).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Perform monthly self-breast exams and / or examination of the chest wall and scar line. Report any changes, lumps, swelling or skin rashes to your physician.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women with an intact uterus on tamoxifen should see a gynecologist annually and notify their physician of any vaginal bleeding.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women taking aromatase inhibitors whose menstrual cycles have stopped should have a Dexa scan as a baseline, then periodically.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consider referral to genetic counseling if family or personal history includes early age at diagnosis of breast cancer (<50), triple negative disease, multiple primary cancers, or a family history of breast or ovarian cancer.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Evidence has shown that leading an active lifestyle and maintaining a healthy weight (body mass index of 20-25), may lead to improved breast cancer outcomes.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Cervical Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After treatment for cervical cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care. It is important to communicate with your healthcare team and to attend all of your follow up appointments. If you are having symptoms in between appointments, call your healthcare team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    If you received radiation therapy, you will need to use a vaginal dilator regularly to prevent the vaginal tissue from losing elasticity and forming scar tissue, which can make intercourse or vaginal exams painful. This is important both for improving quality of life, and for allowing your provider to perform effective pelvic exams.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The Society for Gynecologic Oncology recommends the following follow up care:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Physical and pelvic exams by oncologist every 3-6 months for 2 years, then every 6 months to 1 year in years 2-5, and then annually.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual Pap testing of cervical/vaginal tissue.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report any new or unusual symptoms to your provider, including vaginal bleeding, vaginal discharge, weight loss, abdominal or pelvic pain and fatigue.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • After radiation, survivors should use of vaginal dilators regularly for the rest of their lives to prevent losing vaginal elasticity and the formation of scar tissue.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Chronic Lymphocytic Leukemia (CLL)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for CLL, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their provider. The recommendations for CLL follow up care depend on what therapies you have received and where you are in treatment. Some patients are observed over time, some have received chemotherapy and others have received a bone marrow transplant. These patients would all be monitored differently. Speak with your oncology team about their recommendations. General recommendations include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Physical exams will be scheduled per your provider’s recommendation. These visits may be frequent at first and become less frequent as time goes on. At these appointments you may be instructed to have blood or imaging tests completed.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                     

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Chronic Myelogenous Leukemia (CML)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for CML, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting any concerning symptoms to their physician. The recommendations for CML follow up care depend on what therapies you have received and where you are in treatment. General recommendations include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Patients who are taking a tyrosine kinase inhibitors may be monitored for a complete cytogenetic response at 3, 6, 12 and 18 months. Once a response is detected, BCR-ABL levels are typically measured every 3-6 months. 
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Patients who have undergone allogeneic transplant are typically monitored every 3 months for 2 years, then every 6 months for 3 years. 
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Colon Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for colon cancer, it is important for survivors to adhere to their oncology team's plan for follow-up care, including physical examinations, radiology and blood tests and reporting concerning symptoms to their physician. The guidelines for follow up care vary based on stage:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Early stage:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Survivors should undergo colonoscopy one year after surgery.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • If advanced adenoma is present, repeat in 1 year.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • If no advanced adenoma, repeat in 3 years, then every 5 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Advanced Stage:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Be seen and examined by their physician every 3-6 months for two years, then every 6 months for a total of 5 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • The tumor marker CEA should be checked at these visits.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Survivors should undergo colonoscopy one year after surgery (this should be done in 3-6 months if no colonoscopy was performed before surgery).
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • If advanced adenoma is present, repeat in 1 year.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • If no advanced adenoma, repeat in 3 years, then every 5 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual CT scan for up to 5 years after diagnosis for survivors at high risk for recurrence. Stage IV survivors will have more frequent CT scans; every 3-6 months for 2 years, then every 6-12 months for up to 3 more years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Endometrial (Uterine) Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for uterine (endometrial) cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care. It is important to communicate with your healthcare team and to attend all of your follow up appointments. If you are having symptoms in between appointments, call your healthcare team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    If you received radiation therapy, you will need to use a vaginal dilator regularly to prevent the vaginal tissue from losing elasticity and forming scar tissue, which can make intercourse or vaginal exams painful. This is important both for improving quality of life, and for allowing your provider to perform effective pelvic exams.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The Society for Gynecologic Oncology recommends the following follow up care:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have a physical and pelvic exam by oncologist every 3-6 months for the first year.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In subsequent years, physical examination should occur every 6 months until 5 years post treatment.  In patients with low risk, stage IA/grade 1 or 2 disease, this exam can occur annually in years 2-5.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • After radiation, survivors should use vaginal dilators regularly for the rest of their lives to prevent losing vaginal elasticity and the formation of scar tissue.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Your provider will assess for symptoms of cancer returning, including vaginal bleeding, abdominal/pelvic pain, weight loss and fatigue.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Lab tests or radiology testing may be performed for concerning symptoms.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consider genetic testing if you are under the age of 50, or have a significant family history of cancers associated with Lynch Syndrome (HNPCC), including colorectal, endometrial or small bowel cancer, and transitional cell carcinoma of the ureter and renal pelvis.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.   

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Esophageal Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for esophageal cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their physician. The recommendations for follow up testing after esophageal cancer vary based on the stage at diagnosis and the treatment received. In general, follow up will include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Physical exam every 3-6 months for 1-2 years, then every 6-12 months for years 3-5, then annually thereafter.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Blood work when new symptoms arise or there are problems maintaining adequate nutrition.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Endoscopy and imaging studies should be obtained as recommended by your oncologist, as these are based on stage, risk, and the cancer treatment received. 
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Fallopian Tube Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for fallopian tube cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests and reporting concerning symptoms to their physician. General recommendations for follow up care include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Oncology visits every 2-4 months for 2 years, then every 3-6 months for 3 years, then annually after 5 years. Each visit should include:
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Physical exam with pelvic exam.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Ca-125 level (or other tumor marker level, if these were elevated at initial diagnosis). Other blood work if your oncologist feels it is needed.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Radiology testing (X-ray, MRI, CT or PET scan) may be done if there are concerning symptoms.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Gall Bladder / Cholangiocarcinoma

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for gallbladder cancer, it is important for survivors to adhere to their oncology team's plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their physician. The recommendations for gallbladder cancer follow up state that:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • The healthcare provider may consider imaging (CT scan, MRI) every 6 months for 2 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Head & Neck Cancers: Tongue, Lip, Oropharynx, Nasopharynx

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for head and neck cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology tests, dental care and reporting concerning symptoms to their provider. There are several types of cancer that fall into the category of “head and neck cancer,” so it is important to talk with your care team about your specific follow up care needs. The following are general recommendations to discuss with your oncology team:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Physical exam every 1-3 months for year 1, then every 2-6 months for year 2, then every 4-8 months for years 3-5, then annually thereafter.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Post-treatment baseline scan within 6 months of completing treatment. Further imaging should be conducted when your provider feels there is a concerning symptom, but is not needed routinely.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • If your neck was in the radiation treatment field, thyroid stimulating hormone (TSH) levels should be checked every 6-12 months, as radiation can impair thyroid function.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • If you continue to smoke or use alcohol, you should be referred to a cessation or counseling program to help you quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Former smokers may be recommended to have lung cancer screening.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • If your mouth was in the treatment field, you should have routine dental evaluations and perform regular oral care, including fluoride, frequent tooth brushing, avoiding sugary and acidic foods to help prevent and identify any long-term damage early.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Follow recommendations to combat dry mouth (xerostomia) to aide in dental health and quality of life.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Referral for speech, hearing and swallowing rehabilitation and/or nutritional counseling if needed.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Hodgkin Lymphoma

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for Hodgkin Lymphoma, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting any concerning symptoms to their physician.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivorship research in Hodgkin’s disease has been going on for a number of years and, in turn, there are a number of recommendations based on what we know about life after treatment for this disease. Follow up recommendations are broken down by time since completing treatment and can vary based on age, stage at diagnosis, treatment, and risk.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow up after treatment, up to 5 years:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Physical exam every 3-6 months for 1-2yrs, then every 6-12 months until year 3, then annually.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual flu vaccine.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual thyroid stimulating hormone (TSH) level if you received radiation to the neck.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Some survivors may have a CT scan within the first year after treatment. Otherwise, bloodwork and radiology studies are performed as needed, based on symptoms.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow up after 5 years:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    As you have read in your care plan, cancer therapies put you at risk for health concerns many years after treatment. There has been a considerable amount of research done in Hodgkin’s lymphoma survivors and, as a result, guidelines for monitoring for late effects in these survivors have been developed. The American Cancer Society recommendations include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Physical exam annually. Continued follow up is important to monitor for late effects.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Check blood pressure annually. Heart disease can develop at a young age, so risk factors for heart disease should be managed aggressively, including hypertension, elevated cholesterol and triglycerides.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual flu vaccine.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Patients who had a splenectomy or radiation to the spleen should be re-vaccinated with pneumococcal, meningococcal and Haemophilus influenza type b (Hib) vaccines and follow precautions for a non-functioning spleen.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Due to the risk of heart disease, your provider may consider a stress test / echocardiogram every 10 years. If you received radiation that included the neck, you may have an ultrasound of the neck veins every 10 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Laboratory studies, including complete blood count and chemistry profile annually. Annual thyroid stimulating hormone (TSH) level for survivors who received radiation therapy that included the neck. Lipid (cholesterol) levels should be checked twice a year.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual chest x-ray or chest CT for patients who are at increased risk for developing lung cancer due to prior therapy, including alkylating agent chemotherapy (typically Cytoxan [cyclophosphamide]), radiation to the chest, or heavy smoking.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Breast cancer screening is recommended for women who received radiation to the chest or axilla (armpit). This includes:
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Annual breast exam by a healthcare professional, and monthly self-breast exam.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Begin annual mammograms 8-10 years post therapy, or at age 40, whichever is earlier.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Breast MRI, in addition to the annual mammogram, for women who had chest irradiation between the ages of 10 and 30 years.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Kidney Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for kidney cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their physician. The recommendations for kidney cancer patients state that follow-up should include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • A physical exam and blood work (comprehensive metabolic panel) every 3-6 months for 2 years, then annually for 5 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Radiologic testing may include: chest and abdominal CT scan, MRI, abdominal/renal ultrasound, and chest x-ray. The test and frequency are dependent on the treatment you received and the stage of the cancer.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Liver Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for liver cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their healthcare provider. Patients who have undergone a liver transplant will require different monitoring, which will be directed by your transplant team and oncologist. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Radiologic imaging every 3-6 months for 2 years, then every 6-12 months.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Alpha fetal protein (AFP) level (if initially elevated) every 3-6 months for 2 years, then every 6-12 months.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Lung Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for lung cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their physician. The general recommendations for patients with no signs of cancer remaining include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • For Non-small cell lung cancer:
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Physical exam and chest CT every 6-12 months for 2 years, then annually.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • For Small cell lung cancer:
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Physical exam and chest CT about every 3 months for the first couple of years, then every 6 months for the next several years, then annually thereafter.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • If you are a smoker, you should be offered smoking cessation advice, medications to help you quit, and recommendations for a cessation program.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual flu vaccine and vaccination for herpes zoster (shingles) and pneumococcal pneumonia.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Melanoma

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for melanoma, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting any concerning symptoms to their physician. The general recommendations for follow up of melanoma include, by stage:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • All survivors should have annual skin exam by a healthcare provider for life. Regular skin and lymph node self-exams, reporting any changes to your provider.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • You should receive education regarding sun safety, skin protection and performing skin self-exams

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Stages IIB-IV:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • History and physical exam by your healthcare provider every 3-6 months for 2 years, then every 3-12 months for 3 years, then annually.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In the first 3-5 years, the physician may choose to perform chest x-ray, CT or PET scan and brain MRI to screen for metastatic disease in patients with high-risk disease. Radiologic screening is not recommended after 3-5 years.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Stages IA-IIA:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • History and physical exam by your healthcare provider every 3-12 months for 5 years, then annually.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Radiologic testing (CT scan, US) may be performed if concerning symptoms arise.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Mesothelioma

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for mesothelioma, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their healthcare provider. There are no formal recommendations for follow up care; therefore, your healthcare team will determine your monitoring plan. Typical monitoring includes:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Physical exam and chest CT scan every 3 months for 2-3 years, then every 6 months until year 5, then annually thereafter.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Multiple Myeloma

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for multiple myeloma, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting any concerning symptoms as they arise. The general recommendations for follow up of multiple myeloma recommend:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Periodic physical exam; monthly during initial treatment, then every 2-3 months during maintenance and observation
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Laboratory testing:
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Quantitative immunoglobulins & quantitation of M protein at least every 3 months.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Complete blood count with differential, and a complete metabolic panel to follow BUN and creatinine (to follow your kidney function), and calcium.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Bone marrow biopsy and a serum free light chain assay are only needed if symptoms arise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Radiologic testing:
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Annual bone survey, or more often if symptoms present.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Other radiology tests (MRI, PET) if symptoms arise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Myelodysplastic Syndrome (MDS)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for MDS, it is important for survivors to adhere to their oncology team’s plan for follow-up care. This includes physical examinations, bone marrow biopsies, radiology studies, blood tests, and reporting concerning symptoms to their physician. There are no formal guidelines for follow up care; however, your team may monitor you with:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Periodic complete blood count (CBC) and bone marrow biopsy / aspirate if these results are abnormal.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Non-Hodgkin Lymphoma

                                                                                                                                                                                                                                                                                                                                                                                                                                                    There are a number of different types of non-Hodgkin’s lymphoma, each with its own treatment and follow up plan recommendations. It is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, blood tests, radiology scans and reporting concerning symptoms to their physician. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your oncology team about your plan for follow up care, including what testing you should have, at what intervals, and who is responsible for ordering these tests and reviewing the results. Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Non-Melanoma Skin Cancers

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for non-melanoma skin cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to your physician. The general recommendations for follow up of non-melanoma skin cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Basal cell cancers:
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Skin examination every 6-12 months for life.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • You should receive education regarding sun safety, skin protection and performing skin self-exams.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Squamous cell cancers:
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Local, resected tumor: physical exam every 3-12 months for 2 years, then every 6-12 months for 3 years, than annually.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Tumor with spread to lymph node: physical exam every 1-3 months for year 1, every 2-4 months for year 2, every 4-6 months for 3 years, then every 6-12 months for life.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • You should receive education regarding sun safety, skin protection and performing skin self-exams.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Ovarian Cancer / Primary Peritoneal Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After treatment for ovarian cancer, your oncology team will monitor you closely for an extended period of time. It is important to communicate regularly with your healthcare team and to attend all of your follow up appointments.  If you are having symptoms in between appointments, call your healthcare team. The Society for Gynecologic Oncology recommends the following follow up care after treatment:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Oncology visit every 2-4 months for 2 years, then every 3-6 months for 3 years, then annually after 5 years. Each visit should include:
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Physical exam with pelvic exam.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Ca-125 level (or other tumor marker level, if these were elevated at initial diagnosis). Other blood work if your oncologist feels it is needed.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Radiology testing (X-ray, MRI, CT or PET scan) may be done if there are concerning symptoms.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Your physician may consider referral to genetic counseling if your family or personal history includes early age at diagnosis (<50) of breast or ovarian cancer, triple negative breast cancer, multiple primary cancers, or a family history of breast or ovarian cancer.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Pancreatic Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for pancreatic cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their healthcare provider. The guidelines for pancreatic cancer follow up recommend:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Physical examination every 3-6 months for 2 years, then annually.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Based on your oncologist’s recommendations, a CA19-9 blood test (tumor marker test) and CT scan may also be done every 3-6 months for 2 years and then annually. 
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Penile Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for penile cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care. This includes physical examinations, radiology studies, blood tests, and reporting concerning symptoms to their healthcare provider. The recommendations for penile cancer follow-up care depend on the stage at diagnosis and the treatment received. In general survivors will have:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Exams every 3-6 months for the first 2 years, then every 6-12 months thereafter. These should include a thorough examination of the penis and groin area.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • You should examine your penis and groin area routinely and report any changes to your provider.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In general, CT scans and chest x-rays are done periodically in men who had lymph node involvement, or if symptoms arise in any survivor.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Prostate Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for prostate cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their healthcare provider. The recommendations for prostate cancer follow up care are as follows:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Men who have not yet received treatment (also called "active surveillance," "observation," or "watchful waiting") should have:
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • PSA (prostate specific antigen) every 6 months.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Digital rectal exam (DRE) every 12 months, which should be performed after the PSA blood test, as DRE can affect the PSA result.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • May have periodic repeat biopsies to evaluate whether the tumor’s aggressiveness is changing. For men on active surveillance, this is usually performed one year after the initial prostate needle biopsy, and then annually.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • For men who have been treated with surgery and/or radiation therapy, post-treatment surveillance includes:
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • PSA every 6-12 months for the first 5 years, then annually.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Digital rectal exam (DRE) every year, which should be taken after the PSA blood specimen, as DRE can affect the PSA result.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Survivors who have locally advanced or metastatic disease should have a physical exam and PSA every 3-6 months. 
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Rectal Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for rectal cancer, it is important for survivors to adhere to their physician’s plan for follow up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their healthcare provider. The general recommendations for follow up care for rectal cancer survivors include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Be seen and examined by their physician every 3-6 months for two years, then every 6 months for a total of 5 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • The tumor marker CEA should be checked at these visits for patients who had tumors that were at least Stage T2 at diagnosis.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Survivors should undergo colonoscopy one year after surgery. If no colonoscopy was performed before surgery, this should be done in 3-6 months.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • If advanced adenoma is present, repeat in 1 year.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • If no advanced adenoma, repeat in 3 years, then every 5 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Survivors at high risk of recurrence may be followed with an annual CT scan for up to 5 years after diagnosis.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.   
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • If the woman has received pelvic radiation therapy, she should use a vaginal dilator regularly to prevent the vaginal tissue from losing elasticity and forming scar tissue, which can make intercourse or vaginal exams painful. This is important both for improving quality of life, and for improving the ability to follow your cancer after treatment for evidence of recurrence.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report any concerns regarding chronic diarrhea, urinary incontinence, urgency or frequency, or sexual concerns. Your team can refer you to specialists to help manage these concerns.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Sarcoma

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for a sarcoma, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their healthcare provider. The recommendations for sarcoma follow up care vary slightly from one type to the next and by the grade of the lesion, but in general include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Frequent physical exams for 2-5 years (exact timing dependent on the sarcoma type, stage and location) and annually thereafter. Talk to your oncology team about the schedule for your follow up care plan.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Some survivors will require chest imaging (CT scan or chest x-ray) at varying intervals or imaging of the primary tumor site.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Other blood work and imaging tests are ordered based on the type of sarcoma or new symptoms.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Assessment of function and referral for rehabilitative therapy when needed.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Stomach Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for stomach cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their healthcare provider. The general recommendations for stomach cancer follow up care include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Physical exam every 3-6 months for 1-2 years, then every 6-12 months for 3-5 years, then annually.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Radiology and laboratory tests and endoscopy are done if concerning symptoms develop.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Patients who have had surgical removal of the stomach need to be monitored and treated for vitamin B12 and iron deficiency.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care for Testicular Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for testicular cancer, it is important that survivors adhere to their physician’s plan for follow up care. Recommendations for follow up care are available on the Testicular Cancer Resource Center website (TCRC). Follow up care varies based on the type of testicular cancer (seminoma versus non-seminoma), the stage of the disease, and the treatment received.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow up care includes an examination by the physician, tumor markers, abdominal CT scan and/or chest x-ray. The frequency of these tests, and how many years after treatment they are performed, depends upon the tumor type and stage. Survivors should discuss their specific follow up plan and TCRC guidelines with their healthcare team. Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Thymoma Or Thymic Carcinoma

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for thymoma or thymic cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their healthcare provider. Survivors of thymoma or thymic cancer should:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have periodic physical exams, which should continue for at least 10 years due to the risk of late recurrence of these cancers.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have a chest CT scan every 6 months for 2 years, then annually for 5 years for thymic carcinoma and annually for 10 years for thymoma.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Thyroid Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for thyroid cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their healthcare provider. The recommendations for thyroid cancer follow up care vary slightly depending on the tumor type, stage and treatment received, but in general include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • A physical exam (including neck examination) and TSH, thyroglobulin and antithyroglobulin antibody levels at 6 and 12 months, then annually if disease free.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Periodic neck ultrasound.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Some survivors will require imaging (radioiodine or non-radioiodine), depending on their initial staging and previous imaging results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Follow Up Care For Vaginal And Vulvar Cancers

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After receiving treatment for vaginal or vulvar cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their healthcare provider. There are no formal recommendations for follow up care; however, your team may monitor you with:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Frequent exams for the first 5 years, then every 6-12 months thereafter. These should include a pelvic exam and Pap smear.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT scans and chest x-rays may be done periodically, or if symptoms arise. 
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Risks Related to Medications

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Allogeneic Stem Cell or Bone Marrow Transplant

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Allogeneic transplant utilizes the blood stem cells of a donor to “rescue” the patient from bone marrow-ablating chemotherapy doses, as well as induce a useful immune response from the donor’s cells, known as the graft versus tumor effect. These two goals lead to different, but equally important, long-term effects.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The use of high doses of chemotherapy during transplant can increase the risk for certain side effects. As you review the information related to each late effect in your plan, keep in mind those medications that were given during transplant (and therefore in high doses), as this will be specified when it is relevant to the late effect. In addition, if total body irradiation was used for transplant preparation, its effects will be discussed in the radiation section of your plan. Chronic graft versus host disease (GVHD) can result in unique effects. These are discussed here, but you should talk with your transplant team about any other risks related to your specific case. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Risk of infection is highest for most survivors in the first 3 months after transplant but remains high even 1-2 years after transplant, and immune recovery can become a long-term issue for some. Talk with your transplant team about your immunity and any necessary precautions. Your transplant team will likely follow you closely during this period. You should not visit other healthcare providers during the time you are immunocompromised without first discussing this with your transplant team. In particular, you should not see a dentist without specific recommendations from your team and women should not have gynecologic exams while immunocompromised.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Immunocompromised survivors may be given antibiotic prophylaxis against certain bacteria (encapsulated organisms), Herpes Simplex Virus, Pneumocystis carinii pneumonia (PCP) and fungal organisms, and require antibiotic prophylaxis prior to dental work as well. It is important to receive immunizations (typically Pneumovax, H. Influenza, diphtheria, tetanus, flu and later on MMR and possibly other vaccines) on schedule as determined by your transplant provider. Most patients should receive a yearly flu shot. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Studies evaluating the health of long term survivors of allogeneic transplant have found this group is more likely to develop cardiovascular disease, and at an earlier age, than expected in the general population. This can put them at risk for vascular problems, such as stroke, myocardial infarction (heart attack), blood clots and peripheral artery disease. Survivors are at risk for developing hypertension (high blood pressure), hypercholesterolemia (high cholesterol) and diabetes. These risks are higher in those survivors with chronic graft versus host disease (GVHD) and/or who are taking long-term immunosuppressive medication. A healthy lifestyle is an important part of risk reduction. Smoking, sedentary lifestyle and a high fat diet can increase cardiac risk and should be avoided. In addition, your healthcare provider will check your blood pressure regularly and may check cholesterol and triglyceride levels periodically.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Pulmonary (lung) late effects are not uncommon in transplant survivors and can include bronchiolitis obliterans syndrome (BOS), fibrosis (scarring), pneumonia and infections. Any signs or symptoms of lung compromise, such as shortness of breath and cough, should be reported. Evaluation of lung function is often done using pulmonary function tests (PFTs) and/or chest x-ray. Smoking greatly increases the risk of these effects and must be avoided (this includes second hand smoke). After total body irradiation, some survivors may develop pneumonitis, a chronic inflammation of the lungs. This is usually treated with low-dose steroids that need to be tapered slowly, over a period of months.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Oral and dental health is a major concern for those who received total body irradiation and/or have developed chronic GVHD. All transplant survivors should have good oral hygiene, including frequent tooth brushing, daily flossing and regular use of a mouth rinse. Survivors should have routine dental examinations, teeth cleaning and assessment for oral cancers. Your dentist needs to be aware of your health history and take into account your immune status. The need for preventative antibiotics before dental work should be discussed with the transplant physician. Survivors experiencing chronic dry mouth may benefit from artificial saliva products or sucking on sour candies. Chronic dry mouth can lead to increased risk of dental problems, so be sure to discuss this symptom with your dentist if you develop it. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endocrine late effects are those that effect specific hormone levels, including thyroid and sex hormones (which can affect sexuality, fertility and bone health). Thyroid function tests should be performed annually in transplant recipients. Infertility occurs in almost all men and women after transplant. (However, occasional pregnancies have occurred after transplant and therefore effective birth control is essential). Beyond that, low levels of sex hormones more often cause concerns for women, including inducing menopause, decreased libido, decreased vaginal lubrication (can be worse with GVHD) and an increased risk of osteoporosis. Hormonal function in women should be assessed annually by proper exams and by measuring blood levels of certain hormones (estradiol, LH, FSH). Hormonal function in men should be measured (testosterone) and low levels can lead to decreased libido, erectile dysfunction and osteoporosis. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Late effects to the eyes are most common in those with chronic GVHD or TBI recipients. These effects can include cataracts, Sjögren’s Syndrome (Sicca Syndrome) and damage to the retina. All survivors should have an eye exam 1 year after transplant and further exams based on symptoms or concerns. Any visual changes should be reported to the healthcare team and followed with an eye exam. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Osteoporosis, or bone loss, is a concern for both men and women who have received long-term therapy with corticosteroids, tacrolimus and/or cyclosporine, and TBI. Having received high dose chemotherapy, induction of early menopause and effects on hormone levels also affect bone health. Survivors should be screened with dexa scan annually for 4 years post transplant (longer if on chronic steroids). Please see the bone loss information in the chemotherapy section of your plan for information on prevention, including calcium and vitamin D needs. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Components of transplant care, including TBI, some chemotherapies and immunosuppressive therapies, may cause long-term damage to the kidneys. This can result in renal insufficiency (decreased kidney function) and hypertension (high blood pressure). This risk is increased in people with diabetes. For all patients, yearly history and physical by a healthcare provider should evaluate blood pressure. Kidney function should be checked periodically through blood tests, and survivors should have annual testing of renal function and urinalysis. Survivors should also have strict control of blood pressure with medications, if necessary, and any survivor with diabetes should have strict control of blood sugar levels.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • During the time that you are immunocompromised, you should not see other healthcare providers, such as dentists and gynecologists, without first discussing this with your transplant team.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Avoid things that increase your risk of cardiac and lung disease, such as smoking, sedentary lifestyle and high fat diet.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual flu shot. Additional vaccination schedule as determined by your transplant team.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual blood work to include:
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Thyroid function (TSH)
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Hormone levels (Testosterone in men, Estradiol, LH and FSH in females)
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Consider triglyceride and lipid panel
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual pulmonary function tests (PFTs) for those experiencing pulmonary symptoms.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual eye exam, particularly for those who had TBI.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Evaluation of bone health
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Osteoporosis prevention: take calcium citrate 1500mg/day and vitamin D 800 IU/day.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Dexa scan annually for 4 years after transplant, longer if taking chronic steroids.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Assess for avascular necrosis (bone death caused by poor blood supply). Symptoms include: pain in affected joint, pain occurs even at rest, poor range of motion in affected joint.  May need x-rays or MRI to evaluate symptoms.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual dental examination once recovered from the acute effects of transplant. Dental cleanings usually require antibiotic prophylaxis.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Autologous Stem Cell or Bone Marrow Transplant

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The premise behind autologous transplant is the ability to use very high doses of chemotherapy to treat the cancer, while trying to protect a patient’s own bone marrow. This means that survivors have received high doses of any of the chemotherapy agents used during the transplant. When reviewing the information related to each late effect, keep in mind those medications that were given during transplant (and therefore in high doses), as this will be specified when dose is relevant to the effect.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    While risk for certain complications are lower for autologous transplant than with allogeneic transplant, survivors should still have them on their radar screen. These include: pulmonary (lung) complications (pneumonia, fibrosis/ scarring, and bronchiolitis obliterans syndrome), dental and oral health complications, changes in hormonal function and a decrease in kidney function.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors are at risk for premature vascular disease, which can put them at risk for vascular problems, such as stroke, myocardial infarction (heart attack), blood clots and peripheral artery disease. Survivors are at risk for developing hypertension (high blood pressure), hypercholesterolemia (high cholesterol) and diabetes. A healthy lifestyle is an important part of risk reduction. Smoking, sedentary lifestyle and a high fat diet can increase cardiac risk and should be avoided.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Intravesicular Chemotherapy

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Giving chemotherapy directly into the bladder (intravesicular) results in very little absorption into the rest of the body (systemic absorption).  As a result, most side effects will be “local”, or affecting the bladder only, though some medications may cause systemic effects such as fatigue and fever.  There has not been any research into the long term effects of this type of chemotherapy, though it is unlikely to cause the same problems as giving the same medication into a vein (systemically).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Intrathecal Chemotherapy

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Intrathecal chemotherapy involves injecting chemotherapy into the spinal fluid. This can be accomplished by a lumbar puncture or instilling the chemotherapy into a port placed in the head (called an Omaya reservoir). While researchers have looked at the effects of this therapy on children, information in adults is lacking. Children who receive intrathecal therapy are at risk for neurocognitive deficits, including memory and attention problems, learning disabilities and behavioral changes. But, their brain and spinal cord are still in development, which likely leads to these problems, making it difficult to apply this research to adult survivors. Unfortunately, this lack of knowledge leaves adult survivors with little information about their risks from intrathecal therapies. It is likely that radiation to the brain and/or spinal cord along with intrathecal chemotherapy would increase the risk of any late effects.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Androgen Deprivation Therapy (ADT) for Prostate Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    One treatment for prostate cancer is to decrease the body’s production of testosterone, or block it from working, using medications.  While interfering with testosterone can slow or stop the growth of prostate cancer, it can have some unpleasant side effects, including sexual dysfunction, hot flashes, and fatigue, which can last for many months after stopping treatment.  In addition, there is a risk of loss of muscle mass, osteoporosis (thinning of the bones), weight gain (particularly in the belly), and an increased risk of diabetes, high cholesterol and cardiovascular problems, such as stroke and heart attack. These risks may improve over time, though this is an area of ongoing research. The following are tips and resources for managing these side effects and reducing risk.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sexual Dysfunction & Body Image Concerns

                                                                                                                                                                                                                                                                                                                                                                                                                                                    ADT causes a loss of libido (sexual desire) in a majority of men, which tends to occur within the first few months of therapy, followed by erectile dysfunction (decreased ability to obtain or maintain an erection; also called ED or impotence). Libido typically returns a few months after androgen deprivation therapy has been completed. Depending on other cancer treatments and other medical problems, erectile function also recovers for many men.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Keep the communication lines open between you, your partner and your healthcare providers. Don’t let fear or embarrassment ruin your relationship. Educate yourself about ED, seek help from your urologist, who is trained in the treatment of ED and consider seeing a sex therapist, which can be very helpful for couples facing these side effects.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition to ED, ADT can also cause a temporary increase in breast tissue (called gynecomastia), a decrease in the size of the penis and/or testicles, and a thinning of body hair. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Osteoporosis

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Osteoporosis is a decrease in bone density (thinning of the bones) that can lead to fractures (broken bones).  There are things you can do to lower your risk of a fracture and strengthen your bones.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get 1000-1200mg a day of calcium.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • It is best to get calcium in a balanced diet, including 4-8 servings of calcium rich foods a day.  Examples of calcium rich foods are low fat milk, yogurt, cheese, green leafy vegetables, nuts, seeds, beans, legumes and calcium fortified foods and juices.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • A dietician can provide more guidance in choosing calcium rich foods. A good resource is www.myplate.gov
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • If you cannot take in the recommended amount of calcium in foods, take calcium citrate petite supplements (250mg of calcium per tablet).  Your body does not absorb calcium supplements well, so spread the dose out by taking 1 tablet multiple times a day.  If you take synthroid (thyroid hormone), separate it from calcium doses by at least 4 hours.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Take 1000 IU of vitamin D-3 daily.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Your healthcare provider may check blood levels of vitamin D with the 25-OH Vitamin D blood test.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Do not take more than 2000 IU of vitamin D3 a day unless directed by your healthcare provider.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Weight bearing exercise and strength training can improve your bone strength.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Before you start an exercise program, check first with your oncologist or primary care physician to determine if it is safe. 
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Start with what is comfortable for you and work up to the following recommendations:
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Get 30-40 minutes of weight bearing exercise 3 times a week. Weight bearing exercises are those in which your feet or legs bear your body’s weight while the bones and muscles work against gravity. Examples include: walking, jogging, Tai Chi, yoga and dancing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Strength training should be done 2-3 times per week with a day of rest in between each session. Complete 8-12 repetitions of the exercises below, and repeat them two times (2 sets). Choose a weight where the tenth repetition is hard for you to complete and you can’t complete an 11th time.  Now remove 1-5 pounds from that "maximum weight," and use that as your training weight.  When you can easily do 12 repetitions, try to increase the weight by 3-5lbs. 
                                                                                                                                                                                                                                                                                                                                                                                                                                                        • Exercises include: leg extensions, calf raises, leg curls, chest press, latissimus pulldown, overhead press, row machine and curl ups.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Your provider can refer you to a physical therapist or a physical medicine and rehabilitation physician for more guidance regarding bone-strengthening exercises.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Decrease or stop caffeine intake, as these can weaken bones.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Quit smoking. Learn more about how to get started on OncoLink.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Your provider may order a DEXA scan, which is a test used to measure the thickness (density) of your bones.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Heart Health, Muscle Loss & Weight Gain

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight through diet and exercise. You can use online calculators to determine your body mass index (BMI), a measure of body fat.  Aim for a BMI of 18.5-24.9. A BMI above 25 is considered overweight and a BMI above 30 is obese.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Tips for a heart healthy diet:
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Have a diet high in fruits and vegetables. Eat unrefined whole grains, fat-free or low-fat dairy and lean meats and fish.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Avoid processed foods, foods high in trans-fats, cholesterol and sodium, red meats, sugary drinks, soda and alcohol.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Good resources for dietary information include: American Institute for Cancer Research and www.myplate.gov
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Engage in regular weight bearing and muscle strengthening exercises as described above.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Engage in regular aerobic exercise 3 times a week for 30 minutes.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Always start with a 5-minute warm up.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The goal of aerobic exercise is to increase your heart rate and break a sweat. To determine how high you should get your heart rate, first calculate your maximum heart rate (220-your age).  In general, getting your heart rate to 50-65% of the maximum will cause you to sweat.  If your rate is below 50% of the maximum, you should work harder.  If it is above 65% of the maximum, you may want to slow down.  If you are just starting to exercise, you should start at a low intensity such as 40-50% of your maximum heart rate. Learn more about aerobic exercise on OncoLink.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Examples of good aerobic exercises include: walking, using a treadmill, cycling, elliptical trainer, and swimming.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Your provider can refer you to a physical therapist or a physical medicine and rehabilitation physician for more guidance
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Quit smoking. Learn more about how to get started on OncoLink.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • See your primary care provider at least once a year to monitor blood pressure, blood sugar (glucose and Hemoglobin A1C), and cholesterol.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Go to the nearest emergency room if you experience chest pain, shortness of breath or lightheadedness.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Hot Flashes

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Decrease or eliminate caffeine, hot beverages or foods, alcohol (particularly red wine), and spicy foods and reduce stress.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep your bedroom cool.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Dress in layers and wear cotton or lightweight, breathable fabrics.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Immune Therapy

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You received a medication that works by stimulating your immune system. As a result of being stimulated, your immune system can attack normal organs and tissues in your body, leading to serious or life threatening complications. Most of these side effects will resolve in the months after treatment is stopped. However, these medications are relatively new and we do not know a lot about the long-term effects of having received them. It is important to notify your healthcare provider if you develop any new, unusual or persistent symptoms.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Notify your healthcare provider if you develop any new, unusual or persistent symptoms.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    New Skin Cancers

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In clinical trials of cobimetinib and elotuzumab, patients developed new skin cancers and pre-cancerous skin lesions. It is not clear for how long after therapy this risk continues. You should inspect your skin regularly to become familiar with existing skin lesions and notify your care provider if you notice any changes or new lesions. Talk with your oncology care team about the need for ongoing dermatology visits for skin examination.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Inspect your skin regularly for any changes or new lesions.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consider dermatology visits for skin exams.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung (Pulmonary) Complications

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Pulmonary fibrosis (PF) is a thickening and scarring of the lung tissue affecting lung function. Risk for PF is increased with radiation therapy given in combination with certain chemotherapies, including bleomycin, busulfan (doses > 500mg/m2), BCNU (doses > 600mg/m2) and CCNU [lomustine]) 1. Survivors who had part of the lung surgically removed (lobectomy) are at higher risk with these therapies. Survivors who have had radiation therapy to the lung are strongly encouraged not to smoke, as this can greatly increase the risk of pulmonary problems. Annual history and physical by a healthcare provider should include a pulmonary exam and review of possible symptoms related to PF (cough, shortness of breath, wheezing). Survivors should receive annual flu vaccines and the pneumococcal vaccine (a pneumonia vaccine). Physicians may consider periodic chest x-rays or pulmonary function tests for those at highest risk or with a change in pulmonary status. Of note, the Children's Oncology Group recommends survivors at risk should not scuba dive without medical clearance from a diving medicine specialist.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    1. Individual doses of chemotherapy are often given by m2, or meter-squared. A patient's height and weight are combined to come up his/her m2.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not smoke
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual health maintenance 
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Pulmonary exam (may include chest x-rays or pulmonary function tests)
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Flu vaccine annually
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Pneumococcal (pneumonia) vaccine
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Tell your doctor if experience any of the following symptoms 
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Cough
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Shortness of breath
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Wheezing
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consider obtaining medical clearance prior to scuba diving

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Risk of Developing Cataracts

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The risk of developing cataracts is linked to busulfan, corticosteroids (dexamethasone, prednisone), tamoxifen, anastrozole and radiation therapy involving the eye (including total body irradiation). Survivors should report any symptoms of cataracts and have an eye exam performed by an ophthalmologist every few years. Symptoms of cataracts include: blurry vision, light sensitivity, poor night vision, double vision in one eye, seeing halos around objects, needing brighter light to read or fading or yellowing of colors.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have an eye exam by an ophthalmologist every 1-2 years
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • See your doctor if you experience any cataract symptoms 
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Blurry vision
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Light sensitivity
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Poor night vision
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Double vision in one eye
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Seeing halos around objects
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Needing brighter light to read
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Fading or yellowing of colors

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Risk of Bladder or Urinary Tract Toxicities

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The risk for bladder and urinary track toxicities is highest for survivors who received cyclophosphamide (doses > 3g/m2), ifosfamide and/or radiation to the abdomen. Late effects to the urinary tract can include hemorrhagic cystitis, a condition characterized by bleeding from the bladder lining and bladder scarring leading to a decrease in the bladder capacity. Symptoms of hemorrhagic cystitis include urinary frequency and urgency, blood in the urine and pain. Bladder scarring can present as difficulty urinating, frequency or urgency. Survivors at risk should report these symptoms to their healthcare provider right away. Survivors should understand that alcohol use and smoking can contribute to bladder dysfunction, so these should be avoided.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Avoid alcohol
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Avoid smoking
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report the following symptoms to your healthcare provider 
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Pain when urinating
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Urinary hesitancy (difficulty starting the stream)
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Urinating frequently 
                                                                                                                                                                                                                                                                                                                                                                                                                                                        • Urinating more than 5 times per day
                                                                                                                                                                                                                                                                                                                                                                                                                                                        • Getting up in the middle of the night to urinate
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Blood in your urine

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Risk of Developing Bladder Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In rare cases, cyclophosphamide, ifosfamide and streptozocin can contribute to the development of bladder cancer. This risk is increased for those who also received radiation therapy to the abdomen. Symptoms of bladder cancer include blood in the urine, urinary frequency and urgency, urinating at night and incontinence and should be reported to the healthcare provider. Survivors should be counseled that alcohol use and smoking can contribute to bladder cancer, so these should be avoided.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Avoid alcohol
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Avoid smoking
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report the following symptoms to your healthcare provider 
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Pain when urinating
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Urinary hesitancy – starting and stopping while urinating
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Urinating frequently 
                                                                                                                                                                                                                                                                                                                                                                                                                                                        • Urinating more than 5 times per day
                                                                                                                                                                                                                                                                                                                                                                                                                                                        • Getting up in the middle of the night to urinate
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Blood in your urine

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Risk for Cardiac (Heart) Problems Related to Anthracycline Chemotherapies

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The group of chemotherapy agents called anthracyclines are known to cause specific cardiac toxicities, including cardiomyopathy (weakening of the heart muscle), arrhythmias (rhythm abnormalities) and left ventricle dysfunction (causing heart failure). The risk of developing one of these problems is tied to the cumulative (lifetime) dose a person has received, but even low doses can lead to abnormalities. Toxicity can develop anywhere from shortly after completing chemotherapy to decades later (called delayed). For example, it is known that cumulative doses of doxorubicin greater than 550mg/m2 can lead to an increased risk of cardiac toxicity, but doses as low as 250mg/m2 can result in subclinical cardiac changes. Subclinical changes can be detected on tests such as ECG, echocardiogram and/or MUGA scan, and often, these changes do not cause symptoms for the survivor. The doses of the various anthracycline agents are not equivalent, so you should discuss the dose you received and your risk with your provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    This risk is higher for those who also receive other cancer therapies with cardiac side effects or radiation therapy that includes the heart. In addition, pre-existing cardiac problems, such as high blood pressure or CVD (cardiovascular disease) increases the risk of cardiac side effects. Survivors should maintain healthy lifestyles as smoking, drug use, obesity, sedentary lifestyle and poor dietary choices can increase the risk of cardiac disease. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cardiac toxicities can cause symptoms such as shortness of breath (with or without exertion), orthopnea (difficulty breathing when lying down), chest pain, palpitations, exercise intolerance, dizziness/lightheadedness or edema (swelling of the extremities). In younger survivors (under age 25), cardiac symptoms may present as abdominal symptoms such as nausea and vomiting.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Annual history and physical by a healthcare provider should include a cardiac exam and review of possible symptoms. Survivors who received anthracyclines (any dose) should have had their left ventricular function evaluated at baseline with an echocardiogram, as studies have found many people with abnormalities did not exhibit symptoms. Experts suggest repeat evaluation of ventricular function between 6 and 12 months after the conclusion of anthracycline therapy for those survivors considered at high risk for cardiac problems. New or worsening symptoms should be reported to your care provider and may prompt further investigation with cardiac blood work and/or echocardiogram.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain healthy lifestyle: 
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Avoid smoking.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Avoid drug use.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Maintain a healthy weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Exercise regularly eat a well-balanced diet.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have an annual physical exam that includes a cardiac exam 
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts suggest echocardiogram between 6 and 12 months after therapy for those survivors considered at high risk for cardiac problems.  
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • New or worsening symptoms should prompt further investigation with cardiac blood work and/or echocardiogram.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Monitor and manage blood pressure and cholesterol levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report the following symptoms to your healthcare provider: 
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Shortness of breath (with or without exertion).
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Difficulty breathing when lying down.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Chest pain / heartburn.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Palpitations.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Dizziness/lightheadedness.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Swelling of the arms or legs.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • If you received chemotherapy under age 25, report symptoms of nausea and vomiting.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Peripheral Neuropathy

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Peripheral neuropathy is caused by irritation or damage to nerves, resulting in feelings of numbness, "pins and needles", tingling, burning, or a generalized weakness/heaviness of the limbs. This toxicity can cause difficulties with fine motor skills such as buttoning a shirt, sensation of hot or cold (causing a safety hazard) or difficulty walking. In many patients, this toxicity resolves within weeks to months after completing therapy or stopping the drug that caused the problem. Unfortunately, for others, the problem becomes a chronic one, requiring physical, occupational and medical therapy as well as adaptive changes to ensure safety.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Pain management is best achieved with medications that are not typically thought of as pain medications. These include tricyclic antidepressants, gabapentin and pregabalin. If the pain is not well managed, referral to a pain specialist may be helpful.  This is a side effect that develops during or shortly after treatment which can become chronic. It does not develop as a late effect and if a survivor does develop symptoms suggestive of neuropathy after therapy, other causes should be investigated.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Peripheral neuropathy can be a long-lasting side effect that can require physical therapy, changes in your daily life for safety and managing pain with medication.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Development of Kidney Problems

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cisplatin, carboplatin and ifosfamide (Ifex) can cause damage to kidney function. This is more common in childhood cancer survivors treated under the age of 5 and the risk in adult survivors is not well understood. Risk is increased if the kidneys were in the field of radiation therapy. Kidney damage may present with elevated blood pressure or abnormalities in electrolytes (blood test). Survivors who develop high blood pressure or electrolyte abnormalities should be referred to a nephrologist for consultation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have blood pressure checked annually during physical exam
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have electrolytes (blood chemistries) checked annually during physical exam.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Hearing Changes or Loss

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Ototoxicity can present as hearing loss, tinnitus (ringing in the ears) or vertigo (sensation of spinning or loss of balance). This is most commonly seen in young children treated with cisplatin or carboplatin (in high doses) and those who received these medications in combination with radiation therapy to the head/neck area. Hearing loss may be seen in as many as 26% of adult survivors of testicular cancer treated with cisplatin. This finding may translate to survivors of other cancers treated with cisplatin.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some hearing loss may go unnoticed because it affects frequencies higher than speech. Survivors should report any hearing difficulties or other signs of ototoxicity. Audiogram or consult with an audiologist should be initiated with any sign of toxicity.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Report the following symptoms to your healthcare provider, and request an audiogram and consult with audiologist:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Hearing loss 
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Trouble hearing the TV, or need for increased TV volume
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Trouble hearing others in meetings or at large gatherings
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Ringing in your ears
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Dizziness/spinning and/or loss of balanc

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Elevated Cholesterol Levels

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors who received cisplatin and/or carboplatin may develop elevated cholesterol at earlier than expected ages. Baseline fasting lipids should be checked after completion of therapy and annually thereafter.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have cholesterol checked after completing therapy and annually thereafter.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Risk of Developing Osteoporosis

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Osteoporosis and osteopenia (the precursor to osteoporosis) are decreases in bone density, which increases the risk of fracture of the affected bones. Long term use of corticosteroids (dexamethasone or prednisone, > 5mg per day for more than 2 months), receiving chemotherapy medications or radiation to weight bearing bones (spine, hips, legs) all increase the risk of developing osteoporosis.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Women who develop premature menopause, have their ovaries removed before menopause or those who take aromatase inhibitors (anastrozole, letrozole and exemestane) are at increased risk for osteoporosis. Men who receive hormone therapy for prostate cancer or undergo orchiectomy are at greater risk. In addition, patients who have undergone gastrectomy (removal of the stomach) are at increased risk to develop osteoporosis.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    As for lifestyle risks, smokers, people who consume excessive alcohol and those who do not participate in weight bearing exercise have an increased risk of developing osteoporosis. Therefore, it is very important that survivors not drink alcohol or smoke. In addition, survivors should engage in weight-bearing exercise such as walking, weight lifting, riding a stationary bicycle, jogging, dancing, and any exercise where the legs are supporting the body's weight. These efforts, combined with increasing calcium and vitamin D in your diet and taking calcium and vitamin D supplements, will greatly help to reduce your risk of developing osteoporosis.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors at risk should have adequate intake of calcium (1200-1500mg total per day, taken in divided doses) and vitamin D (400-800 international units per day if under age 50, and 800-1000 international units per day if over age 50).  Calcium supplements are an easy way to get the recommended daily amount and come in 2 forms: calcium carbonate and calcium citrate. The body does have some trouble absorbing large amounts of calcium, so supplements should be split into 2 or more doses per day. Calcium carbonate requires stomach acid to be absorbed by the body, therefore people that take acid reducers (such as Zantac, Tagamet) and/or proton pump inhibitors (such as Prilosec, Prevacid, etc) should use calcium citrate. If you have trouble tolerating your calcium supplement, talk to your doctor or nurse; there may be another formulation you can tolerate more easily. It is important to take Vitamin D with the calcium supplements because it helps your body to absorb calcium better. Survivors should talk to their healthcare provider about screening with DEXA scan (a test used to assess bone density) and options for treatment, if necessary.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Avoid smoking and excessive alcohol intake.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Perform weight bearing exercise 2-3 times per week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Calcium intake of 1200-1500mg per day plus Vitamin D 400-800iu or 800-1000iu per day (either in dietary intake or supplements).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consider screening with DEXA scan.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Risk of Osteonecrosis (bone death)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Osteonecrosis is the death of bone due to a lack of blood supply, resulting in pain and ultimate collapse of the affected bone. It is most common in large joints, such as the hip and shoulder. This can be caused by long term use of corticosteroids (dexamethasone, prednisone) and/or radiation therapy to the bone. Treatments can include devices to support weight on the joint and physical therapy, but the majority of cases ultimately require surgery. Surgical options include bone grafts, replacement of the affected joint or repositioning of the joint to give improved weight support.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report any joint or bone pain to your healthcare provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Raynaud's Phenomenon

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Raynaud's phenomenon is a condition that causes blood vessels in certain areas of the body to constrict or spasm, causing numbness and cold feeling in that area. This may happen when the area is exposed to cold, or can be triggered by stress. Most people experience the symptoms in their hands/fingers or feet/toes, but it can involve the nose, earlobes, lips or cheeks as well. Spasm and constriction of the blood vessels leads to decreased blood flow to that area, resulting in a lack of oxygen, causing tissues to appear pale or blue in color. Once the attack subsides, the tissues may appear red from the rush of blood back into them.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors who have received vinca alkaloid chemotherapies (vincristine, vinblastine or vinorelbine) are at highest risk for developing this phenomenon. Raynaud's has been seen in testicular cancer survivors and is thought to be related to the use of bleomycin, cisplatin or vinblastine in those people. Symptoms may begin during, or months after treatments are completed and while some survivors have a gradual resolution of symptoms, others do not. In some cases, Raynaud's is seen in conjunction with hypertension or erectile dysfunction because of their similar pathology.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    People with this condition should attempt to prevent attacks by avoiding exposing the affected area to cold. Nicotine can also constrict blood vessels, so smoking should be avoided. In addition, some medications can cause constriction of the blood vessels, including pseudoephedrine, birth control pills and certain heart and blood pressure medications. Talk to your healthcare provider if you are taking any of these medications and are experiencing Raynaud's phenomenon. Medications that dilate blood vessels may be used to control symptoms in severe cases, although these are not without side effects. Survivors should also have their blood pressure evaluated annually.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Avoid smoking and medications that constrict blood vessels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Protect affected areas from cold exposure.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Evaluate blood pressure annually.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Risk of Pulmonary Toxicity

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Pulmonary toxicity has been associated with long term use of methotrexate, but this would typically occur while the patient was taking the medication. Long term therapy is commonly used in the treatment of rheumatoid arthritis and psoriasis. Pulmonary toxicity with this long term use includes lung infiltrates (abnormal accumulation in the lung), pleural effusion or pulmonary fibrosis (scarring). Mitomycin-C can cause pulmonary complications in patients receiving the drug, but this too, usually happens acutely. This appears to be related to doses exceeding 60mg/m2. Although the initial injury occurs while on therapy, it can lead to chronic lung disease in a survivor.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not smoke.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Pulmonary exam (may include chest x-rays or pulmonary function tests)
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flu vaccine annually
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Pneumococcal (pneumonia) vaccine
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Tell your healthcare provider if experience any of the following symptoms: cough, shortness of breath, wheezing

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Risk of Liver Toxicity

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Hepatic dysfunction is abnormal functioning of the liver. This can range from having abnormal results on a blood test with no symptoms to cirrhosis or liver failure. The majority of complications tend to occur during or soon after therapy and patients who receive methotrexate, mercaptopurine, thioguanine, BCNU (carmustine), plicamycin and tamoxifen are at highest risk of developing liver problems. Toxicities may resolve over time, but in some cases, can result in chronic liver problems.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Avoid alcohol.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Obtain blood work annually to check liver function while on therapy.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cardiac Risk with Targeted Therapies

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some targeted therapy medications can cause heart failure, a decrease in left ventricular function, and/or cardiomyopathy in patients receiving these medications. This risk is higher for those receiving other chemotherapies with cardiac side effects in conjunction with these medications. While we know that this can happen while receiving therapy, we do not have a good understanding of the long-term risk of having received these medications at this point. Survivors should report any symptoms of cardiac problems to their healthcare provider, including chest pain, shortness of breath, swelling (fluid retention), and exercise intolerance. Survivors and their healthcare providers should be aware of this risk and include cardiac screening in their annual physical exam. Due to the increased risk of heart disease with smoking, sedentary lifestyle and obesity, survivors should be counseled to live a healthy lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain healthy lifestyle:
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Avoid smoking
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Maintain a healthy weight
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Exercise regularly
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat a well-balanced diet
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have an annual physical exam that includes a cardiac exam.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Survivors who develop symptoms should consider being seen in a survivorship clinic or by a cardio-oncology specialist.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report the following symptoms to your healthcare provider:
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Shortness of breath (with or without exertion)
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Difficulty breathing when lying down
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Chest pain
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Palpitations
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Swelling of the arms or legs

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin Toxicities

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some chemotherapy agents will cause the skin to darken or lighten in spots or cause the nails to change color or fall off. While this typically happens while on therapy, these effects can become chronic. Good hygiene and skin care, including washing with a mild soap and water, hydrating lotions for dry or scaly skin, and protecting any open skin wounds can all aid in recovery from these toxicities.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Practice good hygiene and skin care using mild soaps and hydrating lotions.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Protect open skin wounds and report any signs of infection (redness, tenderness, drainage) to your healthcare team. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Long Term Immunosuppression

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cladribine (2- CDA) can cause suppression of T cells, which are a component of the immune system. This suppression can last for several years after therapy, putting survivors at a higher risk of infection even after the white blood cell count has returned to normal. Despite this, no increase in life-threatening infections has been reported. Nonetheless, survivors should report any sign of infection (fever, new cough, non-healing wound or sore, etc.) to their healthcare provider immediately.

                                                                                                                                                                                                                                                                                                                                                                                                                                                     

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Practice good hand-washing and infection prevention.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report any signs of infection (fever, cough, non-healing wound or sore) to your healthcare team promptly.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Pneumococcal (pneumonia) vaccine Annual flu vaccine. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Understanding Chemo-brain

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Many survivors who have previously received or are currently undergoing chemotherapy report experiencing cognitive changes, often referred to as "chemo-brain." These changes include difficulty with short term memory, multi-tasking, new learning, reading comprehension, working with numbers and a decrease in concentration ability. For many years this was attributed, by physicians and researchers, to depression or anxiety over the diagnosis and treatment of cancer. More recently, researchers have begun to study and document what survivors have been saying all long; cognitive changes after chemotherapy are real. Although we are not yet able to pinpoint whether only certain chemotherapies are responsible, it seems certain that the effects are cumulative. That is, those who receive more chemotherapy tend to experience greater deficits. Studies have found that cognitive ability can improve over time in some survivors, but deficits are still present in many long term survivors, years after treatment.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some medications are being studied as potential treatments for cognitive changes, but there is not yet enough data to support their use. Some of the agents being studied include: methylphenidate (Ritalin), modafinil (a medication approved to treat narcolepsy), various antidepressants, herbal therapies, such as ginkgo biloba, ginseng and certain amino acids. Cognitive rehabilitation programs are structured programs utilizing exercise, tasks that use memory and puzzles to "rehabilitate" one's mind. These programs are typically used for people with brain injuries, but therapists have tailored programs for cancer survivors. Bookstores and websites offer memory training, which may be helpful to survivors. Puzzles using numbers, like Sudoku, may help "exercise" your brain. Fatigue can enhance cognitive problems, so avoiding fatigue by getting enough sleep, incorporating exercise into your life and eating a healthy diet may be helpful.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    It is important to remember that some very treatable problems can result in cognitive difficulties, such as thyroid dysfunction, depression and anxiety, so it is important to exclude or treat these diagnoses. Hypothyroidism (low thyroid hormone levels) is a common issue for survivors and can make you feel "fuzzy" or "out of it." This is easily treatable with supplemental thyroid hormone. Survivors who may be depressed or experiencing anxiety would benefit from consulting with a psychiatrist or psychologist experienced in working with cancer patients or survivors.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • There is no standard treatment for chemo brain, but cognitive rehabilitation / brain games, avoiding becoming fatigued, a healthy diet, and some medications can be helpful.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Use reminders, whether through lists, notes or smart phone alarms, to help you stay on track.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • If you believe you are experiencing chemo brain you should consult your care provider to rule out other health issues including thyroid problems, depression and anxiety. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Fertility Concerns for Female Survivors

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Resumption and preservation of fertility after cancer therapy is a very complex topic. It has not been very well studied, but is related to the doses and types of medications received, if radiation was also received, the age at time of treatment and, for women, the number of oocytes (eggs) present when therapy started. With all of these variables, there is no way to easily predict a survivor's reproductive health. In many studies, female survivors’ reproductive status was evaluated by the resumption of menses after therapy, but this is in no way a guarantee of fertility, making it difficult to interpret these results for women when discussing risk for infertility.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors who wish to become pregnant or evaluate their fertility should consider seeing a reproductive specialist who has experience working with cancer survivors. Testing may be performed to help evaluate fertility, including certain hormone levels and counting the number of developing follicles early in a woman’s cycle (called an antral follicle count). LIVESTRONG maintains a list of specialists and offers financial assistance to cancer survivors.  For survivors who have already completed therapy, The OncoFertility Consortium and The National Infertility Association’s website, Resolve, offers information on fertility treatments and testing, adoption, and deciding to not have children. This site also offers information on individual state laws about fertility coverage by insurers. Some experts suggest that women with a history of cancer and cancer treatment should be considered high risk for complications during pregnancy and should consider seeing a high risk obstetrician. This is particularly important if you received radiation to the abdominal area, had surgery involving female reproductive organs, or if you received chemotherapy that can cause heart damage.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Chemotherapy agents that are most strongly tied to infertility include: alkylating agents, cytarabine, vinca alkaloids, and bortezomib. Radiation fields that include the female pelvis or brain can also affect fertility. It is not well understood how many of the newer agents will affect long term fertility. Women who do resume menstruation after cancer therapy should be aware that they could still start menopause earlier than expected, which may be a consideration when planning a family. To learn more about fertility related to cancer treatment, please see OncoLink's section on sexuality and fertility or the OncoFertility Consortium.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Of equal importance is that cancer patients and survivors recognize that a gray zone exists after menstruation stops, when fertility may be possible. Even if a woman’s periods stop during treatment, she may be able to get pregnant. For this reason, use of birth control during cancer treatment for any premenopausal patient is essential. Accidental pregnancy during cancer treatment can be difficult to cope with, as it may limit the treatments available.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Survivors wishing to become pregnant should consider consulting with a fertility specialist familiar with cancer survivors.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Pregnant survivors should talk with their provider about whether or not they need to be followed by a high-risk obstetrician.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Cancer patients should be aware that getting pregnant may be possible even after menstruation has stopped. Because treatments such as chemotherapy and radiation may be dangerous to an unborn baby, all patients who were actively menstruating before beginning cancer treatment should use birth control during cancer treatment, even if periods have stopped.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Fertility and Sexuality Concerns for Male Survivors

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Resumption and preservation of fertility after cancer therapy is a very complex topic. It has not been very well studied, but is related to the doses and types of medications received, if radiation or surgery to reproductive organs was performed and the age at time of treatment. With all of these variables, there is no way to easily predict a survivor's reproductive health.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors who wish to father a child or assess their fertility should consider seeing a reproductive specialist who has experience working with cancer survivors. There is testing a specialist can perform to help evaluate fertility, including certain hormone levels and sperm counts. LIVESTRONG maintains a list of such specialists and offers financial assistance to cancer survivors. While they can be of help to many survivors, the organization’s main goal is to help in preserving fertility prior to cancer therapy. For survivors who have already completed therapy, The OncoFertility Consortium and The National Infertility Association’s website, Resolve, offers information on fertility treatments and testing, adoption and deciding to not have children. They also have information on individual state laws about fertility coverage by insurers.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Chemotherapy agents that are most strongly tied to infertility include: alkylating agents, temozolomide (in men), cytarabine, vinca alkaloids, and bortezomib. Radiation fields that include the testes, brain or TBI can also affect fertility. It is not well understood how many of the newer agents will affect long term fertility. To complicate things further, in many cases, azospermia (no sperm) or oligospermia (low sperm count) is temporary, with sperm production recovering in the months to as long as 4 years following cancer therapy. To learn more about fertility related to cancer treatment, please see OncoLink's section on sexuality and fertility or the OncoFertility Consortium.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sexuality concerns for male survivors can include erectile dysfunction (ED) and decreased libido. Many male survivors and their partners feel lucky to be alive and don’t realize there are many solutions available for their loss of intimacy. ED after radiation, surgery or chemotherapy can be temporary and take up to 2 years to resolve. Remaining sexually active, with the aid of medications or other devices, can improve the likelihood of regaining function. An important first step is acknowledging the problem and seeking the help of an urologist who specializes in erectile dysfunction. Men in committed relationships should have open communication with their partners about their fears and concerns. The Us Too Prostate Cancer Education & Support website has many helpful tips for men facing these issues.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Survivors wishing to become pregnant or father a child should consult with a fertility specialist familiar with cancer survivors.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Survivors dealing with erectile dysfunction (ED) should seek the help of an urologist who specializes in ED.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cardiac Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some medications, including interferon and mitomycin, can cause heart failure, a decrease in left ventricular function, and/or cardiomyopathy in patients receiving these medications. This risk is higher for those receiving other chemotherapies with cardiac side effects in conjunction with these medications. While we know that this can happen while receiving therapy, we do not have a good understanding of the long-term risk of having received these medications at this point. Survivors should report any symptoms of cardiac problems to their healthcare provider, including chest pain, shortness of breath, swelling (fluid retention), and exercise intolerance. Survivors and their healthcare providers should be aware of this risk and include cardiac screening in their annual physical exam. Due to the increased risk of heart disease with smoking, sedentary lifestyle and obesity, survivors should be counseled to live a healthy lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain healthy lifestyle
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Avoid smoking
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Maintain a healthy weight
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Exercise regularly
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat a well-balanced diet
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have an annual physical exam that includes a cardiac exam
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Survivors who develop symptoms should consider being seen in a survivorship clinic or by a cardio-oncology specialist.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report the following symptoms to your healthcare provider
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Shortness of breath (with or without exertion)
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Difficulty breathing when lying down
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Chest pain
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Palpitations
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Swelling of the arms or legs

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Epidermal Growth Factor Receptor (EGFR) Inhibitors

                                                                                                                                                                                                                                                                                                                                                                                                                                                    EGFR inhibitors are a relatively new class of medications, including erlotinib (Tarceva®) and gefitinib (Iressa®). Like many new medications, the long-term effects are not known. There is good information about the side effects that may occur after taking the medication for 1-2 years, but these will resolve when the drug is stopped. These side effects include paronychias (inflammation of the cuticle and nail bed) and trichomegaly (long, wavy eye lash growth). It will likely be quite a few years before we know all the long-term effects of these medications.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Short term side effects of these medications include paronychias and trichomegaly, which tend to resolve when the drug is discontinued.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Long term side effects are unknown at this time and research continues. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Risk of Cardiac (Heart) Problems Related to Cisplatin

                                                                                                                                                                                                                                                                                                                                                                                                                                                    There have been quite a few studies of the risk of cardiac complications in testicular cancer survivors who received cisplatin based chemotherapy. While the risk has not been well studied in other cancers, it should be on the radar screen of survivors who received cisplatin. Studies in testicular cancer survivors found increased risk of Raynaud’s phenomenon, hypertension, hypercholesterolemia and cardiac events, such as myocardial infarction (heart attack) and angina (chest pain).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors who received cisplatin, and their healthcare providers, should be aware of these risks and include cardiac screening (blood pressure, cholesterol) in their annual physical exam. Due to the increased risk of heart disease with smoking, sedentary lifestyle and obesity, survivors should be counseled on a healthy lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain healthy lifestyle 
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Avoid smoking
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Maintain a healthy weight
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Exercise regularly
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat a well-balanced diet
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Female survivors should consider a cardiac exam by a cardiologist prior to becoming pregnant
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have an annual physical exam that includes a cardiac exam 
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Evaluate blood pressure and cholesterol levels
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report the following symptoms to your healthcare provider 
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Shortness of breath (with or without exertion)
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Difficulty breathing when lying down
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Chest pain
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Palpitations
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Dizziness/lightheadedness
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Swelling of the arms or legs

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Side Effects while taking Aromatase Inhibitors

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Your OncoLife Care Plan focuses on late effects of therapy, or those that can occur months to years after completing therapy. Current hormone therapy regimens last anywhere from 5 to 10 years, so we felt it was important to include some information about the acute side effects of these agents.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Aromatase Inhibitors (AIs) commonly cause hot flashes and other symptoms of menopause. Avoiding triggers such as warm rooms, spicy, caffeinated or alcohol containing foods or beverages can help reduce hot flashes. Drink plenty of fluids, wear breathable clothing and exercise regularly. For some women, certain antidepressant medications can provide relief of hot flashes.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Many women taking AIs experience aching in their muscles, joints or bones, also known as arthralgias. In some cases, this side effect is troubling enough for the patient to stop therapy. The cause of this pain is not clear, but it may be related to the low estrogen levels while on these medications. Arthralgias may occur in as many as 60% of women taking AIs. Some patients experience pain that comes and goes, in others it is constant and some report noting worse stiffness and pain in the morning.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Treatments commonly used are acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDS, ibuprofen, naproxen), narcotic pain relievers, glucosamine and topical pain relieving ointments. Research studies have used vitamin D therapy or acupuncture with some success. Further research is needed to determine the best therapies to manage this common side effect.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • You may experience hot flashes and other symptoms of menopause, as well as, aching in your muscles, joints or bones. Let your healthcare provider know if these symptoms become troublesome.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Discuss side effects with your oncology team, as many of these are manageable. Optimal therapy can last 5-10 years, so management of side effects is critical to helping you stay on therapy.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Side Effects While taking Tamoxifen

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Your OncoLife Care plan focuses on late effects of therapy, or those that can occur months to years after completing therapy. Current hormone therapy regimens last anywhere from 5 to 10 years, so we felt it was important to include some information about the acute side effects of these agents.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tamoxifen commonly causes hot flashes and other symptoms of menopause. Avoiding triggers such as warm rooms, spicy, caffeinated or alcohol containing foods or beverages can help reduce hot flashes. Drink plenty of fluids, wear breathable clothing and exercise regularly. For some women, certain antidepressant medications can provide relief of hot flashes.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The more serious, though low risk, complications of tamoxifen include endometrial cancer and blood clots. Women should promptly report any menstrual irregularities, vaginal bleeding, pelvic pressure/pain, or any vaginal discharge, as these may be symptoms of endometrial cancer. An endometrial biopsy should be done to test for cancer if any of these symptoms occur.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Blood clots are rare, but most often occur in the calf or lung. Signs of a blood clot in the leg may include any of the following: leg pain, warmth, swelling of one leg more than the other. Signs of a blood clot in the lung could include: fever, shortness of breath that comes on you very quickly, racing heart, chest pain (that tends to be worse when you take a deep breath). Any of these symptoms should be reported to your physician immediately.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • You may experience hot flashes and other symptoms of menopause. Let your healthcare provider know if these symptoms become troublesome.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • There is a small risk of developing endometrial cancer. Be sure to report any irregular vaginal bleeding or pelvic pain/pressure promptly.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • There is a small risk of developing blood clots (typically in the in leg or lung). Notify your healthcare provider immediately if you experience any leg pain, warmth, swelling of one leg, fever, shortness of breath that comes on you very quickly, racing heart, or chest pain.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Discuss side effects with your oncology team, as many of these are manageable. Optimal therapy can last 5 years, so management of side effects is critical to helping you stay on therapy.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sexuality Concerns for Female Survivors

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Women of any age may have sexuality concerns after cancer treatment. Do not hesitate to talk with your oncology team about these common concerns. Chemotherapy agents are associated with vaginal dryness, painful intercourse, reduced sexual desire and ability to achieve orgasm. Many of these issues are caused by the sudden onset of menopause, which can occur with cancer therapy. This sudden change in hormone levels leads to physical changes such as vaginal atrophy (thinning and inflammation of the vaginal walls), loss of tissue elasticity and decreased vaginal lubrication. In addition, women may experience hot flashes, mood swings, fatigue and irritability.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Decreased lubrication leading to painful intercourse is a common concern for survivors. This can often be treated with vaginal lubricants and moisturizers and/or estrogen therapy (taken orally or used in the vagina). Women who have had a hormone dependent cancer should discuss current research on using these therapies with their healthcare team. Surgery and/or radiation therapy can result in scarring that may cause discomfort during intercourse. Open communication about position changes and alternative methods of expressing affection with your partner can help when resuming sexual activity after treatment.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Concerns about changes in your body, cancer recurrence, the stress and anxiety caused by cancer therapy or changes in your relationship with your partner can all effect how you feel about your sexuality. It is important to understand that sexual activity cannot cause cancer to recur, nor can you spread cancer to another person through sexual activity. If you find that your feelings are significantly impacting your sexuality, you should talk with your healthcare team about finding a therapist experienced in helping cancer survivors.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Of utmost importance in addressing sexuality issues is communication, both between partners and between survivors and their healthcare teams. Understand that these concerns are common and communication is the first step to finding the right solutions. Visit OncoLink's section on sexuality for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Chemotherapy agents are associated with vaginal dryness, painful intercourse, reduced sexual desire and ability to achieve orgasm. Many of these issues are caused by the sudden onset of menopause, which can occur with cancer therapy. OncoLink’s article on Vaginal Dryness and Painful Intercourse provides product suggestions and tips.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition, you may experience other symptoms of menopause, such as hot flashes, mood swings, fatigue and irritability.  Research has found that exercise, yoga and acupuncture all show benefit in relieving menopausal symptoms.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Talk to your healthcare team about tips to manage these issues.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Open communication with your healthcare team and partner are essential for regaining your sexuality and resolving issues. You may also consider talking with a therapist experienced in working with cancer survivors. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Vision Changes

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In clinical trials, some patients who received denileukin diftitox (Ontak) reported blurry vision and/or a loss of color vision. While this resolved in some patients, visual changes were persistent in most patients. It is not know if these will be permanent changes. You should report any changes in vision to your healthcare provider promptly and get an annual eye exam by an ophthalmologist.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • It is unknown if vision changes will be permanent.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report any worsening vision changes promptly to your healthcare provider.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have an eye exam by an ophthalmologist every year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Hypothyroidism

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some patients who received Tositumomab (Bexxar) developed hypothyroidism (low thyroid hormone levels) while on treatment. It is unclear if this side effect could continue after treatment, for how long or if could become permanent. Survivors should be evaluated for signs and symptoms of hypothyroidism, which include fatigue, sluggishness, increased cold sensitivity, constipation, puffy face, hoarse voice, unexplained weight gain, muscle aches, tenderness, stiffness, heavier menstrual periods, brittle hair and nails, and depression. Suvivors should have annual blood work to check TSH levels. Of note, survivors found to have hypothyroidism may also have high cholesterol levels related to the thyroid condition. These have been found to resolve once the thyroid levels are corrected.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual blood work to check TSH levels and cholesterol.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report any symptoms of hypothyroidism to your healthcare provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Hepatitis B Infection/Reactivation

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In clinical trials, some patients who received Ofatumumab (Arzerra) or Obinutuzumab (Gazyva) developed hepatitis B or reactivation of the virus (they had previously been infected with) due to the treatment. Small groups of patients who received rituximab (Rituxan) were found to have reactivation of the virus. There has not been further testing of this and we do not know if this happens only during treatment or after and for how long after treatment. We do not know if the hepatitis B vaccine can prevent the virus from developing. Hepatitis B is a virus that causes inflammation of the liver and can lead to cirrhosis and liver cancer. Hepatitis can be treated if it becomes chronic, but it is important to have it diagnosed early. Usually there are usually no early signs/symptoms, but blood tests should be done to check if you do have hepatitis. Symptoms of hepatitis can include: yellowing of eyes and skin, a longer than usual amount of time for bleeding to stop, easily bruising swollen stomach or ankles, tiredness, fever, nausea, loss of appetite, diarrhea, light-colored stools or dark colored urine.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Treatment with ofatumumab (Arzerra), obinutuzumab (Gazyva) or rituximab (Rituxan) can cause survivors to develop hepatitis B or reactivation of hepatitis B.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report any symptoms of hepatitis B to your healthcare provider.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Blood tests for hepatitis B should be done 6-12 months after treatment and then annually since it is unknown how long the risk lasts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Risk of Developing a Secondary Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    A secondary cancer is one that develops as a result of cancer treatment for another cancer. This is quite rare, but you should be aware of the risk. In most cases, secondary cancer related to chemotherapy is a blood cancer, though some medications have been linked to other cancer types.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Certain chemotherapy medications can cause damage to the blood cells in the bone marrow. In rare cases, this damage can cause leukemia or myelodysplasia (MDS) to develop years after therapy has been completed. Both diseases cause an abnormal production of poorly functioning blood cells, making it difficult for the body to fight infection, carry oxygen to the tissues and prevent bleeding. Because these conditions develop as a result of chemotherapy or radiation exposure, they are often more difficult to treat than typical leukemia or MDS. Leukemia and MDS caused by chemotherapy or radiation therapy typically occurs between 4-10 years after treatment, but can occur even later. One exception is those caused by etoposide (VP-16) or teniposide (two types of chemotherapy), which generally occur within 1-3 years after therapy.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Secondary lymphomas have also been seen in Hodgkin's disease survivors who received the MOPP (nitrogen mustard, vincristine, procarbazine, and prednisone) chemotherapy regimen. Bendamustine has been linked to secondary lung cancers.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • There is a small risk of developing leukemia, myelodysplastic syndrome, lymphoma or other cancer years after your treatment is completed.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report the following symptoms to your healthcare provider promptly: 
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • more tired or weaker than usual
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • shortness of breath
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • loss of appetite
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • weight loss
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • chills, fever, night sweats
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • painless swelling of a lymph node
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • easily bruising, nose bleeds, bleeding from the gums
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consider having a complete blood count with differential checked annually by your healthcare provider if you received high risk therapies.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    What We Do Not Know

                                                                                                                                                                                                                                                                                                                                                                                                                                                    There are many medications of which we do not know the long term effects. Because of the combination of multiple drugs for most cancer treatments, it is sometimes difficult to be certain which medication is the cause of a long term effect. Research is continuing and new information may become available. You should periodically talk to your healthcare team about new information or look for new information in reliable journals and/or internet sites.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, there have been many new therapies in the last ten years, including many of the biologic therapies, monoclonal antibodies and targeted therapies. We may not know the long term effects of these medications for many years. As a survivor, you should be an active participant in your healthcare and keep an ear out for new information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Many cancer treatments today have not been available long enough to determine what effects they may cause in years after treatment.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Always let your healthcare team know if you notice any new or worsening symptoms. Remember, you know your body best.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Periodically look for new information about your treatment and talk to your healthcare team to see if they have anything new to report. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Side Effects of Radiation

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Long term effects of radiation therapy vary greatly depending on the areas included in the field of radiation and the radiation techniques that were used, as these continue to develop and improve.  One issue that is consistent across all tissues is the possibility of developing a second cancer in or near the radiation field.  Secondary cancers develop as a result of the exposure of healthy tissue to radiation.  Newer radiation techniques are designed to limit this exposure, but it is not always possible to prevent all exposure and still achieve the desired outcomes.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation to Chest wall for breast cancer (after mastectomy)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Any patient who has had breast cancer is at risk for developing a second breast cancer in the opposite breast. Patients who have had mastectomy are also at risk for developing breast cancer recurrence in either the chest wall, the reconstructed breast, or the axilla (armpit). It is recommended that women who had single mastectomy undergo annual mammograms after treatment for breast cancer. Survivors who had single or double mastectomy should have a yearly breast and/or chest wall exam by a breast cancer specialist (medical oncology provider, radiation oncologist, or breast surgeon).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation to the chest wall after mastectomy may be performed either before or after breast reconstruction surgery. Regardless of this, radiation to the chest wall or reconstructed breast may cause permanent changes in the skin, including a darkening or "tanning." Radiation may also cause difficulty with wound healing, so surgery to the chest wall or reconstructed breast after radiation should be undertaken with caution.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Other long term effects of chest wall irradiation include damage to the nerves, leading to pain or loss of strength or feeling in the arm on the side that was irradiated. Damage to the drainage (lymphatic) system in the area can lead to chronic swelling, called lymphedema. Risk of lymphedema is highest for women who also had surgical lymph node dissections and, to a lesser extent, sentinel node biopsy. A survivor with lymphedema who develops pain or redness in the arm, especially with fever, should be evaluated as these signs may indicate infection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors of breast cancers, particularly left-sided breast cancers, may be at increased risk of cardiac complications. Please see the description of heart/ cardiovascular late effects for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms (for those who had single mastectomy).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual examination of breast tissue and/or chest wall by breast cancer specialist.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Caution when surgery is considered after radiation in the chest wall or reconstructed breast
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consideration of physical/ occupational therapy for arm pain, weakness, or swelling.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Rapid evaluation for new arm swelling, redness, or pain, especially with fever.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation for breast cancer (after lumpectomy)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Any patient who has had breast cancer is at risk for developing a second breast cancer in the opposite breast. Patients who have had mastectomy are also at risk for developing breast cancer recurrence in either the chest wall, the reconstructed breast, or the axilla (armpit). It is recommended that women who had single mastectomy undergo annual mammograms after treatment for breast cancer. Survivors who had single or double mastectomy should have a yearly breast and/or chest wall exam by a breast cancer specialist (medical oncology provider, radiation oncologist, or breast surgeon).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation to the chest wall after mastectomy may be performed either before or after breast reconstruction surgery. Regardless of this, radiation to the chest wall or reconstructed breast may cause permanent changes in the skin, including a darkening or "tanning." Radiation may also cause difficulty with wound healing, so surgery to the chest wall or reconstructed breast after radiation should be undertaken with caution.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Other long term effects of chest wall irradiation include damage to the nerves, leading to pain or loss of strength or feeling in the arm on the side that was irradiated. Damage to the drainage (lymphatic) system in the area can lead to chronic swelling, called lymphedema. Risk of lymphedema is highest for women who also had surgical lymph node dissections and, to a lesser extent, sentinel node biopsy. A survivor with lymphedema who develops pain or redness in the arm, especially with fever, should be evaluated as these signs may indicate infection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors of breast cancers, particularly left-sided breast cancers, may be at increased risk of cardiac complications. Please see the description of heart/ cardiovascular late effects for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms (for those who had single mastectomy).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual examination of breast tissue and/or chest wall by breast cancer specialist.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Caution when surgery is considered after radiation the chest wall or reconstructed breast.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consideration of physical/ occupational therapy for arm pain, weakness, or swelling.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Rapid evaluation for new arm swelling, redness, or pain, especially with fever.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation for Esophageal Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Esophageal cancer can be treated with surgery, chemotherapy, radiation, or a combination of these therapies. Radiation therapy for esophageal cancer can lead to the development of scar tissue months or years after therapy. This can result in a narrowing, or stricture, of the esophagus, making it difficult to swallow or causing a chronic feeling of food being "stuck" in the esophagus. Feelings of heartburn may also be associated. This complication can often be corrected through esophageal dilatation, a procedure that stretches the area that has narrowed, relieving the stricture. If survivors develop these symptoms, they should be seen in consultation by a gastroenterologist or surgeon. Nutrition should be monitored by a primary care physician, and a nutritionist should be seen in consultation by survivors who are unable to take in enough food and liquids to maintain their weight or prevent dehydration.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Because the heart is located behind the esophagus, radiation can damage the sac around the heart, causing it to tighten or scar. This can happen many years after therapy and can require surgery to correct. Symptoms of this problem can include difficulty breathing, racing heart or palpitations, lightheadedness, chest pain, and/or feelings of anxiety. In addition, cardiac disease can develop earlier than expected and without other risk factors (such as diabetes, high cholesterol levels). See the cardiac section for additional information on this risk.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Evaluation by gastroenterologist/ surgeon for difficulty swallowing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly (at least) monitoring of weight and nutrition by primary care provider.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Evaluation by a nutritionist for weight loss.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Head & Neck Cancer Radiation

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The radiation used to destroy cancer cells can also hurt normal cells in the surrounding area. Thus, side effects from radiation treatment are directly related to the area of the body being treated. Most side effects are temporary, disappearing gradually after therapy is complete. There are a few potential long-term side effects that are specific to head & neck cancer treatment. These can occur months to many years after cancer treatment and the risks vary depending on the area of treatment and the radiation techniques that were used, as these continue to develop and improve. Your radiation oncology provider can discuss which long-term effects are most concerning for your case. Some of the potential long-term side effects of radiation to the head & neck include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Some survivors experience long-term swallowing problems. In addition, radiation can result in the development of scar tissue months to years after treatment, which can lead to swallowing problems. Report any changes in swallowing to your oncology team. You may benefit from consultation with a speech and swallowing specialist.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Radiation fibrosis is a scarring of muscles that can occur in the area of treatment that can make the muscles feel stiff or tough.  These muscles can have spasms, stiffness, pain and/or become weak. Scarring of muscles in the neck can cause the head to be rotated and tilted to the side. Physical therapy, cancer rehabilitation, supportive devices and certain medications can be very helpful in managing these changes.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Similarly, nerves in the area that is radiated can be damaged or impinged by scar tissue, resulting in weakness or pain in the area.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Lymphedema of the face, chin and neck area occurs somewhat rarely.  Notify your healthcare provider if you notice swelling. Physical therapy is used to treat lymphedema. Learn more about reducing the risk of lymphedema on OncoLink.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Trismus is a chronic contraction of the muscle that controls opening and closing of the mouth (TMJ) that can occur after radiation treatment. Trismus results in an inability to open the mouth normally, which can make it difficult to eat, speak or perform dental care. Your oncology team can recommend jaw exercises to prevent or help improve trismus.  For some patients, jaw manipulation by a dentist or treatment by a cancer rehabilitation physician can be helpful.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    There are treatments available for many of these complications. Doctors who specialize in Cancer Rehabilitation Medicine (called physiatrists) can be very helpful in treating these concerns. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Because the head & neck treatment field can encompass several other structures and organs, the risks to these areas are discussed below.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Scar tissue caused by radiation can lead to a number of problems, dependent on the location of the radiation. Tell your care provider if you experience changes in swallowing, muscle strength and movement, swelling or pain in the head, face or neck, or difficulty opening your mouth, even years after treatment.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Long term side effects are often best managed when treated early.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Physical therapy, lymphedema (swelling) specialists and cancer rehabilitation specialists can be helpful in managing these long term and late effects.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radioiodine Therapy (I-131)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    I-131 therapy (also called radioactive iodine therapy or radioiodine therapy) is used to destroy (ablate) any remaining thyroid tissue not removed by surgery or to treat thyroid cancer that has spread to lymph nodes or other parts of the body. I-131 therapy will result in hypothyroidism. Thus, these survivors will need thyroid hormone replacement for the rest of their lives to replace the natural hormone thyroxine.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    When taking thyroid hormone replacement (the medication is called levothyroxine), frequent bloodwork is needed to ensure the medication dose is sufficient, initially every 6-8 or 8-12 weeks and then every 6-12 months once levels are regulated on medication. The goal of the medication is to suppress TSH. Therefore, it is important that the correct dose be taken as directed and monitored. By taking levothyroxine and thus keeping TSH suppressed, the growth of any remaining thyroid cancer cells slows down, which lowers the chance of a recurrence or, in other words, the chance that the disease will return.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Levothyroxine should be taken in the morning one hour prior to eating. Levothyroxine can interact with other medications, so please check with your healthcare provider about restrictions prior to beginning any new medication. A high-fiber diet, soy-containing supplements, and walnuts can also interfere with the effects of levothyroxine. This medication seldom causes side effects when given at the correct dose. However, a few patients may get a rash or lose some of their hair during the first months of treatment. Your health care provider will closely monitor the level of thyroid hormone in the blood during follow-up visits. Too much thyroid hormone may cause patients to lose weight, become irritable, have sleep disturbances, changes in appetite, increase in frequency of bowel movements, decreased menstrual flow, tremors, muscle weakness, and to feel hot and sweaty. It may also cause chest pain, cramps, and diarrhea. These are symptoms of hyperthyroidism. If the thyroid hormone level is too low, the patient may gain weight, feel tired, fatigued, depressed, experience reduced concentration, hoarseness, joint pains, muscle cramps, constipation, menstrual cycle disturbances, feel cold, have dry skin, or brittle hair. This condition is called hypothyroidism. Survivors should report any of these symptoms to their healthcare provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Levothyroxine can cause problems for those with heart disease, clotting disorders, diabetes, and disorders of the adrenal or pituitary glands. Please be sure to tell your provider if you have or if you develop one of these conditions. Levothyroxine is safe to take while pregnant and breast feeding, but one may need more frequent monitoring of blood work during this time. It is important to communicate closely with your healthcare provider so that you are feeling well and the thyroid hormone replacement is managed correctly.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    There are some long-term risks of continued TSH suppression. Leovthyroxine can affect the heart, causing atrial fibrillation (an irregular heartbeat) and an exacerbation of angina (chest pain) in patients with some types of heart disease. In addition, women may be at an increased risk for osteoporosis, especially those who are postmenopausal.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    A survivor whose follow-up care is complicated or difficult to manage, for example a person with continued abnormal thyroid function tests or someone with new or recurrent symptoms, may benefit from referral to an endocrinologist to manage thyroid levels, replacement treatment, and on-going care.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Hypoparathyroidism

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For those who have received I-131 therapy, hypoparathyroidism can also be a lasting result of therapy. Hypoparathyroidism is a result of damage to or removal of the parathyroid glands, which are located behind the thyroid gland. Loss of these glands results in a lack of parathyroid hormone, which is responsible for regulation of calcium and phosphorus in the blood. Symptoms of hypoparathyroidism, resulting from low blood calcium, include numbness and tingling of the area around the lips, or fingers and toes, muscle cramps or spasms. Management of hypoparathyroidism includes vitamin D and calcium supplements. Monitoring of parathyroid hormone levels, blood calcium, phosphorus, and magnesium levels are required. Initially, these blood tests will be weekly to monthly and eventually will be done just twice a year. An Electrocardiogram (ECG or EKG) may be donetodetect arrhythmias (irregular heart beats) associated with low calcium levels and hypoparathyroidism. A bone density test, which evaluates the bones for osteoporosis and osteopenia, may also be conducted, often as a base-line prior to starting treatment.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    I-131 therapy is most often used in those with papillary and follicular (differentiated) thyroid cancer. Patients with medullary thyroid cancer or anaplastic thyroid cancer generally do not receive I-131 treatment. These types of thyroid cancer rarely respond to I-131 therapy. Long lasting side effects of I-131 are not common. A rare side effect in men who received large doses of I-131 is a decrease in sperm count or loss of fertility. Temporary changes to a woman's menstrual cycle, either infrequent or very light menstruation or absence of menstrual periods, may occur for up to one year after therapy. In women, I-131 does not typically cause loss of fertility, but it is recommended that women avoid pregnancy for one year after I-131 therapy. No ill effects have been noted in children whose parents received radioactive iodine in the past. Researchers have reported that a very small number of patients may develop leukemia years after treatment with high doses of I-131. A very low risk of second malignancies has been reported such as bone and soft tissue malignancy, colorectal cancer, and salivary tumors. There appears to be an increased risk of breast cancer in women with thyroid cancer, but it is unclear whether or not this is related to treatment or other factors. Other possible, but not common or long-lasting side effects from radioiodine treatment may be salivary gland damage which can cause dry mouth (xerostomia) and an increased risk for dental cavities, or obstruction of the tear duct(s) causing dry eyes or excessive tearing which may need to be repaired surgically.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Survivors should have thyroid exam and a history and physical performed annually. A neck ultrasound should be done initially at 6 and 12 months after treatment and then annually for 3-5 years or longer depending on stage and type of cancer.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual blood work to check thyroid function tests should also be done by the health care provider. Bloodwork may be more frequent if on replacement medication.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Contact your healthcare provider if you are on thyroid replacement medication and start to experience any changes in how you are feeling as this may be an indication that the replacement is not at the correct dose.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Brain

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Research has shown that young children who received radiation to the brain can have problems ranging from learning disabilities to actual declines in IQ, depending on the doses received, the tumor being treated and the time since treatment. Less is known about the long term effects for adults. Possible effects include short-term memory loss, dementia, persistent sleepiness, loss of intellectual ability or learning capacity, and gait abnormalities.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    If the radiation damages the pituitary gland, which controls secretion of numerous hormones, long term hormone replacement may be necessary. Unexplained weight gain or loss, changes in sexual function/ libido, extreme fatigue, depression, and difficulty with temperature regulation (always feeling hot or cold) may signify hormonal abnormalities and should be discussed with a physician. Further testing of hormone levels in the blood may be helpful.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consider neurocognitive testing for memory loss, dementia, or loss of intellectual function.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consider physical/ occupational therapy for gait abnormalities or other areas of muscle weakness or neurologic deficit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consider endocrine (hormonal) evaluation with blood testing for the symptoms such as weight gain or loss, loss of libido, and change in growth patterns.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Spinal cord

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation to the spinal cord can cause damage to nerves, leading to a loss of strength, feeling or coordination of the arms or legs, paralysis or problems with bowel or bladder control. Occasionally, nerve damage can cause a sensation of electric shock spreading down the limbs.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Damage to bones of the spine (vertebrae) included in the radiation field can result in a reduction in height or curvature of the spine. Radiation to these bones can also put them at risk for fracture. Any new back pain should be evaluated urgently with x-rays and, if necessary, other studies.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • X-ray evaluation for any new back pain, loss of bowel or bladder control, paralysis, weakness of arms or legs.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Evaluation by a neurologist for chronic, shock-like pains in the arms/ legs.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Evaluation by an orthopedist for any new curvature of the spine.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Eyes

                                                                                                                                                                                                                                                                                                                                                                                                                                                    If the radiation field includes the eyes, patients are at long term risk of developing cataracts at an early age. Survivors should report any symptoms of cataracts and have an eye exam performed by an ophthalmologist every 1-5 years. Symptoms of cataracts include: blurry vision, light sensitivity, poor night vision, double vision in one eye, seeing "halos" around objects, needing brighter light to read or fading or yellowing of colors.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Fields including the eyes can also damage the lacrimal glands, resulting in a loss of or decrease in tear production and chronically dry eyes. An ophthalmologist can recommend artificial tears or medications to stimulate tear production. Patients with dry eyes from radiation treatment may be at increased risk for corneal infections. Any eye pain should be evaluated by a healthcare provider in a timely fashion.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Other possible effects include shrinkage or loss of the eye, corneal abrasions and ulcers, glaucoma and damage to the optic nerve, leading to vision loss or blindness.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Opthalmologic evaluation every 1-5 years, or more frequently if symptoms are troublesome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Ears

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Damage to the cochlea, or organ of the inner ear, may result from brain radiation. Especially in children who have received chemotherapies such as cisplatin or carboplatin, this may lead to hearing loss. Radiation damage to the ears can also lead to dryness of the ear canal and fluid collection in the inner ear. This may lead to dizziness, ringing in the ears (tinnitus), and/or vertigo (sensation of loss of balance). Occasionally, thee problems may lead to nausea and vomiting that may be worse in the morning. Survivors should report any hearing difficulties, ear pain, ringing in the ears, or vertigo. Audiogram (hearing test) or consult with an audiologist should be initiated with any sign of toxicity.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    More commonly, survivors report a feeling of "fullness" or "clogging" in the ears after brain radiation. Usually, this gets better with time, but should still be discussed with a healthcare provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Audiogram (hearing test) for any loss of hearing, pain, ringing in the ears, or vertigo.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Salivary glands (Parotid)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The largest of the salivary glands are the parotid glands, located just behind the jaw, below and in front of the ears, as well as in the floor of the mouth. Depending on the extent of the glands that were exposed and the amount of radiation they received, radiation can cause loss of, or decrease in, saliva production. This may be permanent or temporary. Long term loss of saliva can make eating and speaking difficult, for which saliva substitutes and/or pilocarpine may provide some relief. Dental health is extremely important for survivors of head and neck cancers, as saliva is important for killing bacteria in the mouth and on the teeth. This loss of saliva can result in more rapid tooth decay, so dental visits, including cleanings every 6 months, oral exams annually and a baseline panoramic x-ray are important to detect problems early. Fluoride treatments are also recommended.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Children/ adolescents who received radiation prior to the development of permanent teeth are at risk for a failure of teeth to develop or root and enamel abnormalities.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Patients who received radiation to the jaw are at risk for osteoradionecrosis (ORN) of the jawbone. This rare complication is an inability of bone to heal after minor trauma. It may occur after a dental procedure (such as pulling a tooth) or present as jaw pain or an inability to open the jaw. You should report any symptoms and let your dentist know that you have had radiation to the jaw, so they can monitor for ORN.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Changes in or a loss of the ability to taste or smell can occur during treatment, and can become permanent.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Dental cleaning every 6 months.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual dental exam with X-rays.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Further evaluation of any chronic or severe jaw pain.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual fluoride treatments.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Excellent home dental care with brushing twice daily and flossing daily.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Nutritional evaluation if eating is difficult due to decreased saliva, decreased taste/ smell, or difficulty chewing or swallowing.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sinuses

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation to the sinuses can lead to chronic sinusitis. Symptoms of sinusitis (post nasal drip, nasal discharge, facial pain, and headaches) should be evaluated by an otolaryngologist.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Evaluation by an otorhinolaryngologist (ENT doctor) for chronic sinus headaches or post-nasal drip.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Throat / Upper Airway

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation fields that include the upper airway and throat (upper esophagus) can lead to scarring or swelling making breathing, speaking, and swallowing difficult. Patients who have severe trouble breathing may require tracheostomy (tube through the neck to allow breathing). Patients may also notice hoarse voice and/ or chronic cough. Any worsening of these symptoms or coughing of blood should be reported to a doctor's office immediately. Difficulty swallowing may make eating difficult. All cancer survivors should have their weight and nutrition monitored by a primary care doctor. Survivors who lose weight without meaning to or have electrolyte imbalances or dehydration may need to see a nutritionist. He or she may recommend high calorie dietary supplements such as Boost or Ensure. If difficulty swallowing prevents the survivor from taking adequate food, a PEG tube (entering the stomach through the skin) may be required.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly (at least) monitoring of weight and nutrition.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Evaluation by a nutritionist if difficulty swallowing prevents intake.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Evaluation by an otorhinolaryngologist (ENT doctor) for difficulty breathing due to upper airway problems, hoarse voice, or new/ worsening cough.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Thyroid

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The thyroid gland is located in the neck, just below the larynx (voice box). Radiation fields that include the thyroid gland can result in a variety of thyroid problems, including hypothyroidism, hyperthyroidism, and thyroid nodules/tumors. Although risk continues for the life of a survivor, peak incidence of hypo and hyperthyroidism has most often been seen at 2-5 years after treatment, while thyroid nodules are typically seen 10 years or more after treatment. Risk increases with the amount of radiation received to the area. Symptoms of hypothyroidism (the most common complication) include fatigue, weight gain, constipation, dry skin, brittle hair or cold intolerance. Those with extensive thyroid damage are at risk hypoparathyroidism, a condition resulting from damage to the parathyroid glands (located in the same area as the thyroid). Survivors should have a thyroid exam and a history and physical performed annually by their healthcare provider to evaluate for symptoms suggestive of thyroid issues. If the thyroid was directly in the radiation field, screening with TSH (thyroid stimulating hormones) levels may be considered. Survivors who develop thyroid problems can benefit from consultation with an endocrinologist to manage hormone levels.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly history and examination of thyroid by a physician.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly thyroid testing (TSH) if symptoms arise or if the thyroid was radiated directly, with evaluation by an endocrinologist if tests are abnormal.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Heart / Cardiovascular

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Potential late effects of radiation fields including the heart include premature coronary artery disease and hypertension (high blood pressure), valve abnormalities, fibrosis or scarring of the cardiac tissue resulting in decreased heart function, pericarditis (inflammation of the heart sac), heart failure and myocardial infarction (heart attack). The actual risk varies greatly depending on the total dose of radiation, number of fractions (doses), amount of radiation actually delivered to the heart, time since radiation and whether or not chemotherapy agents with known cardiac toxicity were also given. Survivors at risk should have a yearly history and physical by a healthcare provider to evaluate cardiac function and blood pressure and should be counseled on lifestyle choices including exercise, tobacco avoidance and a healthy diet. High risk survivors may benefit from yearly EKG and screening echocardiogram to evaluate heart function.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors should also be especially aware of other factors that increase risk of heart disease and death from heart attack. These include high cholesterol, obesity, high blood pressure, diabetes, smoking, and illegal drug use (cocaine). Screening for all of these risk factors can allow for early intervention.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Avoidance of tobacco and illegal drug use.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly history and physical exam with monitoring of cholesterol levels, blood pressure, and blood sugar by primary care physician to reduce risk of heart disease/ attack.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly EKG and/ or echocardiogram for high-risk patients.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast as part of other field

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation therapy fields that include breast tissue can lead to breast cancers later on. Recommendations for young adult women who received radiation to the chest include annual mammograms starting at age 25, or 8 years after radiation, whichever is later. In addition, survivors should under go breast examination by a healthcare provider annually until age 25, and then every 6 months, along with self breast exams monthly. These guidelines were developed for younger women and childhood cancer survivors who have had chest radiation, but can be used to guide screening in adult survivors as well. The American Cancer Society recently updated its recommendations for women at high risk of developing breast cancer, including those who received radiation to the chest wall between the ages of 10 and 30. These women should undergo annual screening with breast MRI in conjunction with their annual mammogram.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Male breast cancers are much less common than female breast cancers, and data regarding risk of breast cancer for men who have received radiation to the chest is fairly limited. As a result, clear recommendations do not exist. Men who have had radiation to the chest should be aware of potentially increased risk of development of breast cancer, and should report any abnormal symptoms or findings, such as lumps, skin changes, or nipple discharge, to a healthcare provider immediately. Men should also undergo a yearly exam of the breast and axillary (armpit) tissue by a professional.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual breast exam by a professional regardless of age or sex.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Particular awareness of any abnormal findings, such as lumps, masses, skin change, or nipple discharge, which should be reported to a healthcare provider.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms for women, beginning at age 25, or 8 years after radiation.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms for any female patient over 40 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly breast MRI for women who received radiation to the chest wall between the ages of 10 and 30.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation fields involving the lung can lead to scarring (fibrosis), inflammation (pneumonitis), and restrictive or obstructive lung disease. Risk for these problems is increased with higher doses of radiation and radiation given in combination with certain chemotherapies (bleomycin, busulfan, BCNU and CCNU) and for those survivors who also had part of the lung surgically removed (lobectomy). Survivors who have had radiation to the lung are strongly encouraged not to smoke, as this can greatly increase the risk of problems. Annual history and physical by a healthcare provider should include a pulmonary exam and review of possible symptoms (cough, shortness of breath, wheezing). Survivors should receive annual flu vaccines and the pneumococcal vaccine. Physicians may consider chest x-rays or pulmonary function tests for those at highest risk or a change in pulmonary status.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Scarring within the lungs can result from radiation, and uncommonly this scarring may affect blood vessels. Any survivor coughing up blood should be evaluated immediately by a healthcare provider, either in the office or the emergency room.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Of note, the Children's Oncology Group recommends survivors not scuba dive without medical clearance from a diving medicine specialist. The National Comprehensive Cancer Network recommends Hodgkins Disease survivors who received chest irradiation consider annual chest x-ray or CT scan to screen for lung cancer, beginning 5 years after treatment. We should note that studies have not yet been done to support this recommendation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual influenza vaccine.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Pneumococcal vaccine every 5 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Tobacco avoidance/ smoking cessation.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Chest X-ray for new cough or shortness of breath.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Immediate evaluation of hemoptysis (coughing up blood).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Esophagus

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation to the esophagus (tube connecting the mouth to the stomach) can lead to scarring of the tissue, causing difficulties with swallowing as well as symptoms of heartburn. If survivors develop these symptoms, they should be seen in consultation by a gastroenterologist or surgeon. Nutrition should be monitored by a primary care physician, and a nutritionist should be seen in consultation for survivors who are unable to take enough food and liquids to maintain their weight or prevent dehydration.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Evaluation by gastroenterologist/ surgeon for difficulty swallowing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly (at least) monitoring of weight and nutrition by primary care provider.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Evaluation by a nutritionist for weight loss.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Bone

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Damage to the bone from radiation can cause small cracks (fractures) in that bone. The ribs are more susceptible to fracture after radiation, although these fractures will almost always heal normally. If radiation is given in the area of a joint, permanent stiffness, pain and arthritis can develop in that joint.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Rapid evaluation for fractures after trauma (for example, after a motor vehicle accident).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Physical/ Occupational therapy for arthritis.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Non-steroidal inflammatory medicines for arthritis.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation can lead to permanent changes in the skin. This can include changes in the color or texture of the skin, scars, and changes in the color, texture of hair or permanent loss of the hair in the treated area. The soft tissue and muscles under the skin can develop scarring and/or shrinkage, which can lead to a loss of flexibility and movement or chronic swelling. Some patients develop chronic or recurring ulcers of the skin in the area treated. Blood vessels of this skin may become dilated and more noticeable, although this is not harmful. If the skin feels tight or sore, regular use of vitamin E applied to the skin can be helpful.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After radiation the skin is more sensitive to sunlight, and survivors should be especially cautious to use sunscreens when outdoors.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Diligent use of sunscreen.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Evaluation by a wound care specialist or surgeon for non-healing ulcers.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Stomach

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Damage to the stomach caused by radiation can include persistent indigestion/heartburn, and can increase risk of gastritis (irritation of the stomach wall) and ulcers. Survivors with symptoms of heartburn or abdominal pain should be seen by a gastroenterologist, and may require endoscopy for evaluation. Medications to reduce the acid produced by the stomach or to coat the stomach may also be prescribed.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Evaluation by gastroenterologist for abdominal pain, blood in vomit, or blood in stools.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Acid-reducing medicines or medicines to coat the stomach for heartburn symptoms.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Spleen

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The spleen is an organ located in the upper abdomen that functions somewhat like a filter, removing bacteria and dead red blood cells from the blood stream. Radiation directly to the spleen can result in a non-functional spleen. This can put a survivor at a higher risk for infections caused by encapsulated bacteria, of which Streptococcus pneumoniae and Haemophilus influenzae type b are the most common. An infection can rapidly progress to sepsis and can lead to death if not treated quickly with antibiotics. Some experts believe survivors should have antibiotics on hand to be started at the first sign of infection, prior to being evaluated by the healthcare team. These survivors must be aware of the importance of reporting a fever (temperature > 100.4 °) or any sign of infection to their healthcare team right away, or to go to an emergency room for evaluation if their doctor is not available. They must be sure to let any healthcare provider caring for them know that they do not have a spleen.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors should wear a medic-alert bracelet noting this condition ("asplenia") and should receive annual influenza vaccines, as well as the pneumococcal and Hepatitis B vaccines. They should also receive the meningococcal and H. influenzae type b vaccines (this is not the same as the annual flu vaccine), and if bitten by a dog, cat or rodent, antibiotics are required to prevent infection with Capnocytophaga canimorsus bacteria.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    If traveling to an area with malaria, taking medication to prevent infection with malaria and the use of a mosquito repellent are important. If you notice you have been bitten by a tick, please contact your healthcare provider as soon as possible as ticks may transmit Lyme disease. If traveling to or living in Cape Cod or Nantucket Island in Massachusetts, you may be more likely to have complications from an infection caused by deer ticks called Babesia.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Wear medic alert bracelet noting asplenia (no functioning spleen).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Notify your healthcare team right away if you develop a temperature greater than 100.4 ° or any signs of infection (sore throat, cough, burning with urination, ear pain, rash or shortness of breath).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Receive annual flu vaccine as well as pneumococcal, haemophilis influenza type b (HIb), meningococcal and hepatitis vaccines (per CDC guidelines).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • When traveling outside the U.S., evaluate need for additional vaccines or antibiotics.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • See your doctor for any tick or animal bites.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Liver

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation to the liver can lead to abnormal liver function or liver failure. Baseline liver function tests should be done before and after the completion of therapy. Annual history and physical exam should be performed by an oncologist or primary care provider to evaluate for signs of liver damage, and liver function testing should be performed at any sign of liver disease. Survivors with abnormalities may benefit from consultation with a gastroenterologist. Survivors who have had radiation to the liver should avoid alcohol use as this increases the risk of radiation-induced liver injury.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Liver function testing before and after treatment.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual history/ physical exam to evaluate for liver disease.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Avoid alcohol.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Further liver function testing or evaluation by gastroenterologist for signs of liver disease.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Gall Bladder

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation to the gall bladder can lead to gall stones. Factors that can increase this risk include obesity and family history of gall stones. Gall stones can cause abdominal pain that is generally worse after eating. Any survivor with these symptoms should discuss them with a primary care provider or oncologist.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report any family/personal history of gall stones to your healthcare provider.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Increased risk of developing gallstones.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Bowel

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The bowel is a radiation sensitive organ, and several late effects may occur after radiation to the rectum, colon, or small bowel:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Scarring and strictures can lead to bowel obstruction, which is most commonly seen in patients who had surgery and/ or radiation to the abdomen. Any signs of bowel problems should be reported to a physician, including abdominal pain, constipation, vomiting, weight loss and bloating. A survivor with severe abdominal pain accompanied by vomiting and constipation should be seen by a physician immediately, either in the office or the emergency department. A patient who has a bowel obstruction will likely need to be admitted to the hospital. If this occurs, the survivor should be followed later on by a gastroenterologist or surgeon.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Ulceration/ bleeding can occur after radiation as the delicate tissue of the bowel may be damaged. Any bright red blood in the stools, toilet water, or toilet paper, as well as dark black stools, should be reported immediately to a physician. These may be signs of radiation colitis or proctitis, and may require evaluation with colonoscopy.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Chronic diarrhea/ poor absorption can result from radiation to the tissue of the bowel. Diarrhea accompanied by weight loss or malnutrition should be evaluated by a gastroenterologist. Anti-diarrheals or anti-spasmodics may be useful, and evaluation by a nutritionist may be useful for survivors who continue to lose weight or have electrolyte abnormalities.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Fistula formation: A fistula is a connection between two body cavities that does not normally exist. A fistula can form between the bowel and bladder, bowel and female reproductive system (uterus/ vagina), or the bowel and the skin. A fistula between the bowel and bladder may cause a survivor to pass gas through the urethra (tube that drains urine). Any abnormal passage of urine, feces, or blood should be immediately reported to a healthcare provider, and will likely need evaluation by a surgeon.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    As is true when any part of the body received radiation, research indicates that radiation to the bowel can lead to colon cancer. Unfortunately, this risk is not well understood, nor is there an established guideline for screening. Survivors should certainly undergo screening colonoscopies. The Children's Oncology Group guidelines for childhood cancer survivors recommends beginning screening 10 years after radiation, or at age 35, whichever is later, with repeat colonoscopy every 5 years. Screening of the general population begins at age 50, and adult cancer survivors should consider these 2 guidelines when deciding to start colon cancer screening. Survivors who may require earlier screening include those with irritable bowel disease, chronic diarrhea or bleeding, ulcerative colitis, familial colon cancer syndromes or previous gastrointestinal cancers or polyps.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Immediate medical evaluation for severe abdominal pain, especially if accompanied by nausea/ vomiting and constipation.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Immediate medical evaluation for bleeding from the rectum or dark stools.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Use of anti-diarrheals for chronic diarrhea.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consultation by a nutritionist for weight loss or nutritional deficits.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Immediate medical evaluation for new bleeding or abnormal passage of urine or feces.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy 10 years after radiation therapy (or at age 35, whichever is later) for screening followed by colonoscopy every 5 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Screening colonoscopy at age 50 for all patients.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Nerve damage

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation can cause permanent damage to nerves. This is most often seen when the nerves that supply the arms or legs are in the radiation field. This can lead to pain, loss of strength, decreased feeling (sensation), loss of coordination, or loss of movement of the limb. This is often referred to as neuropathy. This toxicity can cause difficulties with fine motor skills such as buttoning a shirt, sensation of hot or cold (causing a safety hazard) or difficulty walking, which may require physical, occupational and medical therapy as well as adaptive changes and education to ensure safety and maintain function. The risk of neuropathy may be increased with certain chemotherapies. Neuropathy can also cause pain ("nerve pain") that is not treated well with traditional pain medications. Tricyclic antidepressants, Carbamazepine and Gabapentin (Neurontin) are the most commonly used medications for the treatment of neuropathic pain. Survivors with uncontrolled pain may benefit from referral to a pain specialist.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consider physical/ occupational therapy for difficulty with motor skills, temperature, or loss of balance.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Treatment with tricyclic antidepressants, carbamazepine, or neurontin for neuropathic pain.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Referral to pain specialist if pain does not improve.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Kidney

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation including the kidney can result in renal insufficiency (decreased kidney function) and hypertension (high blood pressure). This risk is increased in people with diabetes, those with only one kidney or preexisting hypertension, and treatments that include other medications known to cause kidney damage. Annual history and physical by a healthcare provider should evaluate blood pressure. Kidney function should be checked periodically through laboratory tests, and survivors should have annual testing of renal function and urinalysis. Survivors should also have strict control of blood pressure with medications, if necessary, and any survivor with diabetes should have strict control of blood sugar levels.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual screening for hypertension and diabetes mellitus.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual basic metabolic panel and urinalysis.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Strict control of blood pressure and blood sugar.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Evaluation by a nephrologist if kidney disease develops.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Bladder

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Late effects to the bladder can include scarring, leading to a decrease in the bladder capacity. If given in conjunction with chemotherapy agents known to cause bladder damage (cyclophosphamide, ifosfamide), late effects can include hemorrhagic cystitis, a condition characterized by bleeding from the bladder lining. Symptoms of hemorrhagic cystitis include urinary frequency and urgency, blood in the urine and pain. Survivors at risk should report these symptoms to their healthcare provider right away. Persistent bleeding should be evaluated with cystoscopy.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation to the bladder may also cause the survivor to be more susceptible to urinary tract infection. This type of infection can be treated with antibiotics given by mouth. Any symptoms of urinary burning, frequency, or blood in the urine should be reported immediately.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, radiation to the bladder can increase the risk of developing bladder cancer. Symptoms may include blood in the urine, urinary frequency and urgency, urinating at night and incontinence. Any of these symptoms should be discussed with a physician. Survivors should also avoid alcohol use and smoking as these may increase risk of bladder cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Urinalysis for any urinary symptoms, and treatment with antibiotics if infection is shown.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Cystoscopy (small camera to evaluate bladder) for persistent bladder pain/ bleeding.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Immediate evaluation of any bladder/ urinary symptoms with awareness that survivor may be at increased risk of bladder cancer.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Avoidance of alcohol and smoking.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Male pelvis

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation to the pelvis in a male patient may cause erectile dysfunction. This risk is highest in men who have erectile dysfunction before beginning radiation therapy. Remaining sexually active during radiation treatment may be helpful in preventing or minimizing erectile dysfunction. This symptom may be very distressing, and the survivor should discuss it with his physician. Medicine such as sildenafil (Viagra) may be useful. If these medicines are not helpful, the survivor should be seen by a Urologist. The MUSE system may assist men in having erections. Men may also consider penile implants or pumps.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation to the groin area may cause damage to the lymph nodes, which can cause the genital area and legs to be permanently swollen. In these cases, physical therapy may be helpful.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly sexual history by a professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Medications for sexual dysfunction if survivor feels these would be helpful.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Referral to a Urologist if medicines are not helpful for discussion of implants or pump systems.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Physical therapy for genital or groin swelling.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Testicles

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Long term effects of radiation to the testes vary depending on the dose received, shielding and fractionation. The primary concerns are the risk of infertility caused by damage to germ cells (which become sperm) and damage to the Leydig cells, which produce testosterone. Without testosterone, a young boy may not achieve puberty or an adult male may have a loss of secondary sex characteristics (facial hair, mature genitals and deep voice) or loss of sexual function. Because germ cells are far more sensitive to the effects of radiation than Leydig cells, a man may have normal sexual characteristics and function while being infertile.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation doses as small as 0.1Gy to the testes can result in decreased sperm counts and doses of 1.5-4Gy can result in permanent sterility. As previously noted, the Leydig cells (responsible for testosterone production) are less sensitive to the effects of radiation, with damage occurring at 30Gy in mature males (20Gy in prepubescent males). Because of the risk of damage to sperm, men should not have unprotected sex within six months of completing radiotherapy during which the testicles may have been exposed.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    If the testicles are not the primary radiation target, shielding can be used. This technique protects the testicle(s) from receiving radiation. Occasionally, a testicle may be moved to another part of the body to avoid radiation exposure, and replaced in the scrotum after radiation is completed. Before a man begins radiation to or near his testicles, he may undergo sperm banking. This can allow his sperm to be preserved and used to produce pregnancy later on.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Possible physical changes to the testes include changes in the skin, hair loss and atrophy (shrinking).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Evaluation by an infertility specialist if pregnancy is not achieved and is desired.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Evaluation by an endocrinologist if secondary sex characteristics are absent or change (loss of facial hair, genital changes, voice changes, erectile dysfunction).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Female pelvis

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation to a woman's pelvis can cause long term changes to the vagina and uterus. Survivors may suffer from vaginal dryness, shrinkage, atrophy (decrease in size), pain, bleeding and painful intercourse. Use of personal lubricants can be helpful and allow more comfortable intercourse, and regular use of vitamin E may help to strengthen tissues and reduce friction to sensitive tissues. Scarring in the vaginal vault may cause the size of the vagina to decrease. Use of vaginal dilators which are placed in the vagina for short periods of time is recommended for all female survivors who have had radiation to the pelvic area. Lastly, medicines such as amitriptyline (tricyclic antidepressants) may be useful for vulvar pain syndromes.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation to the groin area may cause damage to the lymph nodes, which can cause the genital area and legs to be permanently swollen. In these cases, physical therapy may be helpful.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation to the uterus (womb) can lead to decrease in uterine size as well as decrease in elasticity (stretch) and scarring. These changes in the uterine muscle can cause survivors to be at increased risk of miscarriage, preterm labor and low birth weight infants. Survivors who wish to become pregnant should be followed by a high risk pregnancy specialist.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Radiation fields that include the ovaries can result in damage to a woman's supply of eggs (oocytes). The risk of sterility is increased with higher doses of radiation. Older women are also at increased risk of infertility from radiation, although fertility after radiation is an individual outcome, and is quite difficult to predict. For most women, menses will stop during treatment, but are likely to return in younger women (<40). Those women who do regain menses are still at risk for premature menopause.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Use of personal lubricants and/ or vitamin E if vaginal area is painful, dry, or tender during intercourse.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Use of vaginal dilators for scarring causing decrease in size of vagina.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Treatment of vulvar pain syndromes.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Physical therapy for swelling of genital or legs.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Evaluation by high-risk pregnancy specialist for survivors who wish to become pregnant.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Evaluation by an endocrinologist for hormonal abnormalities and/ or premature menopause.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Total Body Irradiation

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Total body irradiation (TBI) may be used to treat leukemias and lymphomas, or may be given to patients who are undergoing bone marrow transplant. Although radiation is given to every part of the body during TBI, doses are much lower than those used to treat some other cancers. As a result, some side effects are different.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Total body irradiation can affect the organs and glands within the head and neck. It may damage the salivary glands and cause dry mouth and increased risk of cavities. Survivors should be followed with regular dental visits. Artificial saliva may also be helpful. Survivors may also notice chronically dry eyes, and may use artificial tears for comfort. TBI also places survivors at increased risk for development of cataracts. For these reasons, survivors should be seen by an ophthalmologist yearly.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Total body irradiation can result in various thyroid problems, including hypothyroidism, hyperthyroidism, and thyroid nodules/tumors. Symptoms of hypothyroidism (the most common complication) include fatigue, weight gain, constipation, dry skin, brittle hair or cold intolerance. Survivors should be followed with annual examination of the thyroid and thyroid function testing (TSH level). They may benefit from referral to an endocrinologist.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Total body irradiation can also cause long-term damage to the liver. Patients with liver damage may experience abdominal pain, swelling of the abdomen (ascities), weight gain, and/ or yellowing of the skin (jaundice). Any of these symptoms should be reported to a physician immediately. Patients should have yearly blood tests done to evaluate liver function, and should be seen by a specialist for any abnormality. Additionally, survivors should avoid heavy alcohol use, as this may increase the risk of liver disease.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Total body irradiation may cause long-term damage to the kidneys. This can result in renal insufficiency (decreased kidney function) and hypertension (high blood pressure). This risk is increased in people with diabetes, as well as those who receive cisplatin or carboplatin chemotherapies. For all patients, yearly history and physical by a healthcare provider should evaluate blood pressure. Kidney function should be checked periodically through blood tests, and survivors should have annual testing of renal function and urinalysis. Survivors should also have strict control of blood pressure with medications, if necessary, and any survivor with diabetes should have strict control of blood sugar levels.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors who have received TBI may have scarring of the lungs from radiation. All survivors are strongly encouraged not to smoke as this increases the risk of lung complications. Yearly history and physical by a healthcare provider should include a pulmonary exam and review of possible symptoms (cough, shortness of breath, wheezing). Survivors should receive annual flu vaccines and the pneumococcal vaccine. Physicians may consider chest x-rays or pulmonary function tests for those at highest risk or a change in pulmonary status.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Total body irradiation almost always causes damage to the reproductive organs. For men, the primary concerns are the risk of infertility caused by damage to germ cells (which become sperm) and damage to the Leydig cells, which produce testosterone. Without testosterone, a young boy may not achieve puberty or an adult male may have a loss of secondary sex characteristics (facial hair, mature genitals and deep voice) or loss of sexual function. If these effects are noticed, the survivor should be seen by an endocrinologist (hormonal specialist). He may need medication with testosterone. For women, damage to the ovaries may cause infertility and premature ovarian failure. Failure of the ovaries to produce enough hormones may cause a survivor to experience symptoms of menopause, such as loss of periods, hot flashes, vaginal dryness, and loss of bone density (osteoporosis). Female survivors who experience these symptoms should also be seen by an endocrinologist and be counseled about their risk for developing osteoporosis.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    After radiation the skin is more sensitive to sunlight, and survivors should be especially cautious to use sunscreen, wear hats and protect themselves from sun exposure when outdoors.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lastly, TBI with chemotherapy increases a survivor's risk of developing a second cancer. Survivors should be especially cautious to undergo regular cancer screening, including having regular mammograms and colonoscopy. Recommendations for young adult women who received radiation include annual mammograms starting at age 25, or 8 years after radiation, whichever is later. In addition, survivors should undergo breast examination by a physician annually until age 25, and then every 6 months, along with self breast exams monthly.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Opthalmologic evaluation yearly.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Dental cleaning every 6 months.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual dental exam with X-rays.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual fluoride treatments.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Excellent home dental care with brushing twice daily and flossing daily.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly thyroid testing with TSH level.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Liver function testing before and after treatment, with evaluation by a gastroenterologist for abnormalities.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual history/ physical exam and blood testing to evaluate for liver disease.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Avoidance of alcohol.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual screening for hypertension and diabetes mellitus.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual basic metabolic panel and urinalysis, with evaluation by a nephrologist for abnormalities.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Strict control of blood pressure and blood sugar.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual influenza vaccine.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Pnuemococcal vaccine (1 or 2 doses, depending on age and condition).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Tobacco avoidance/ smoking cessation.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Chest X-ray for new cough or shortness of breath.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Immediate evaluation of hemoptysis (coughing up blood).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms beginning at age 25, or 8 years after radiation.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms for any patient over 50 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual breast exam by a professional regardless of age.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Diligent use of sunscreen.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy 10 years after radiation therapy (or at age 35, whichever is later) for screening followed by colonoscopy every 5 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Evaluation by an endocrinologist for symptoms of decreased sex hormone production.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lymph nodes

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The removal of lymph nodes from the axillary (underarm) abdominal or groin areas can lead to decreased drainage in the closest limb causing lymphedema (a swelling of the limb) to result. Survivors who have also received radiation therapy to the area are at greater risk of developing lymphedema which can occur years after therapy. While sentinel node biopsy can decrease the risk of developing subsequent lymphedema, it does not completely eliminate the risk. Lymphedema can cause pain, disfigurement, and functional limitations, and may increase the risk of a serious infection in that limb. A Certified Lymphedema Therapist should be consulted at the first sign of swelling to achieve the best outcomes. Survivors should be aware of this potential complication, given information on self-care, and instructed to notify the healthcare team with any signs of swelling or infection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgery to remove the lymph nodes (or sentinel node) can result in injury to the nerves in that area. Nerve damage can cause pain numbness tingling decreased sensation or strength in the area or limb. For instance axillary (underarm) lymph node removal can result in these symptoms on the chest wall under the arm (armpit) or in the arm and/or hand on the treated side. Injuries like this could be aggravated by scar tissue formation after radiation therapy to the area. This type of pain is called nerve pain and is treated with different medications than other types of pain. Survivors with this type of pain may benefit from a consult with a pain specialist.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Radiation increases the risk of lymphedema over surgery alone. A Certified Lymphedema Therapist should be consulted at the first sign of swelling for best outcomes.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Survivors should be educated about self care and to notify the healthcare team with any signs of infection. Instructions for survivors on risk reduction are available from the NLN.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Radiation and/or surgery can damage nerves, which can be further aggravated by scar formation and result in neuropathic pain. Survivors with this pain may benefit from seeing a pain specialist.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Partial Breast Irradiation with MammoSite or other radioactive implant

                                                                                                                                                                                                                                                                                                                                                                                                                                                    MammoSite and other radioactive implants are devices that allow delivery of radiotherapy to the region of the breast from which a tumor was removed. Immediately following treatment with a radioactive implant survivors may be at increased risk for wound infection. Later they may be at risk for skin changes or thickening or hardening of the breast tissue (fibrosis). Survivors having breast pain or discomfort should report this immediately to a healthcare provider especially if the pain is associated with redness swelling or tissue hardening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Other long term effects of breast implant irradiation include damage to the drainage (lymphatic) system in the axilla (armpit) that can lead to chronic swelling called lymphedema. Risk of lymphedema is highest for women who also had surgical lymph node dissections and to a lesser extent sentinel node biopsy. A survivor with lymphedema who develops pain or redness in the arm especially with fever should be evaluated as these signs may indicate infection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors of breast cancers particularly left-sided breast cancers may be at increased risk of cardiac complications. Please see the description of heart/ cardiovascular late effects for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Any patient who has had breast cancer is at risk for developing a second breast cancer in either the treated breast or the opposite breast. All breast cancer survivors should undergo mammography every year and should have a yearly breast exam by a breast cancer specialist (medical oncology provider, radiation oncologist or breast surgeon).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual examination of breast tissue by breast cancer specialist.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consideration of physical/ occupational therapy for arm pain weakness or swelling.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Rapid evaluation for new breast or arm swelling redness or pain especially with fever.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgery Side Effects

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sentinel Node Biopsy

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The removal of lymph nodes from the axilla (underarm), abdomen, or groin area can lead to decreased drainage in the closest limb, causing lymphedema (a swelling of the limb) to result. In the case of head and neck cancers, the swelling can involve the neck and face. Survivors who have also received radiation therapy to the area are at greater risk of developing lymphedema, which can occur years after therapy. While sentinel node biopsy can decrease the risk of developing subsequent lymphedema, the risk is not completely eliminated. Lymphedema can cause pain, disfigurement, functional limitations and increase the risk of a serious infection in that limb. A Certified Lymphedema Therapist should be consulted at the first sign of swelling to achieve the best outcomes. Survivors should be aware of this potential complication, given information on self-care and instructed to notify the healthcare team with any signs of swelling or infection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Signs of lymphedema may include the following changes in the area near surgery (arm, leg, abdomen, genitals): full or heavy feeling, skin changes (reddened, warm, cool, dry, hard, stiff), aching/discomfort, tightness, or less movement/flexibility in nearby joints. You may also experience difficulty fitting into clothes like the sleeve of a jacket or pant leg, or feel your socks are too tight. In addition, you may notice jewelry feels tight even though you have not gained any weight. Lymphedema can occur right after surgery, weeks, months, or even years later. The possibility of developing lymphedema continues throughout a person’s lifetime. Survivors should be vigilant in monitoring for early signs of swelling and practice prevention. If swelling develops, prompt, proper management and therapy allows for the best outcomes. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    To help prevent and control lymphedema, survivors should try to avoid infections, burns, cuts, excessive hot/cold or injury to the limb that is at risk. Avoid insect bites by using insect repellent. Use lotion to prevent dry, chapped skin. Use sunscreen with SPF 15 or higher and try to avoid the sun during the hottest time of day. Avoid pressure or constriction of the limb. Avoid tight fitting clothes and jewelry.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Those at risk for lymphedema can and should exercise. Start with low intensity exercise and gradually increase intensity while monitoring for changes in your limb including swelling or redness. If any swelling or redness occurs, stop the exercise and consult your physician. The person at risk for lymphedema should consider wearing a compression garment with vigorous or very strenuous exercise.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Whenever possible, have blood drawn, IVs placed, and shots/vaccinations given and blood pressure taken in the unaffected arm. For more information on what you can do to help prevent lymphedema, look at the Lymphedema Self Care Tip Sheet on the Oncolink website. The National Lymphedema Network is also a great resource for information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgery to remove the lymph nodes (or sentinel node/s) can result in injury to the nerves in that area. Nerve damage can cause pain, numbness, tingling, decreased sensation or strength in the area or limb. For instance, axillary (underarm) lymph node removal can result in these symptoms on the chest wall, under the arm (armpit) or in the arm and/or hand on the treated side. Injuries like this could be aggravated by scar tissue formation after radiation therapy to the area, which can develop years after therapy. This type of pain is called nerve pain and is treated with different medications than other types of pain. Survivors with this type of pain may benefit from a consult with a pain specialist.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report any signs of swelling in the at risk limb to your healthcare provider, and see a certified lymphedema therapist promptly if these symptoms develop.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Practice preventive measures to decrease the risk of developing or worsening lymphedema. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Permanent Colostomy or Ileostomy

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Every case is different when it comes to cancers in the abdomen. In some, a permanent colostomy or ileostomy may be necessary, which is a life long change and can cause significant psychological distress, skin problems around the stoma and issues with relationships. That being said, many people live long, healthy and fulfilling lives with an ostomy! Survivors with an ostomy should be known to an ostomy nurse, who can help with the many aspects of an ostomy, including healing, appliance use, complications and changes in the stoma over time. Many people find great comfort and support in a support group, whether it is in person or online. There are quite a few wonderful virtual communities that address the issues a person with an ostomy faces (just search for "ostomy support"). Survivors should find a place they can get reliable information and assistance, as situations may arise years after getting the ostomy and you need to know where to turn for help.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consult an ostomy nurse for concerns with your ostomy.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Connect with other survivors with stomas via support groups or online communities (just search for "ostomy support").

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgery for Ovarian, Primary Peritoneal, Fallopian Tube, Endometrial/Uterine and Cervical Cancers

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgical procedures vary, so be sure to clarify with your surgeon which organs were removed during your surgical procedure. Removal of the ovaries causes a woman to go into menopause (if she is not already menopausal), leading to side effects including hot flashes, irritability, vaginal dryness and decreased sexual desire. This early lack of estrogen increases the risk of a woman developing osteoporosis (weakening of the bones) and heart disease. Replacement of estrogen with hormone replacement therapy may decrease these side effects, but the potential risks of this therapy, which include an increased risk of certain cancers, stroke, and heart attack, must be considered prior to taking hormone replacement therapy. Sometimes, vaginal estrogen creams or suppositories may be used to alleviate vaginal dryness with lower risk of other side effects compared to oral (pill) forms of hormone replacement therapy. Removal of the ovaries also results in infertility. While less so, there is a risk of infertility when only one ovary is removed, particularly if radiation to the abdomen and/or chemotherapy was also given. A consult with a fertility specialist who is experienced in working with cancer survivors is warranted if the woman wishes to explore fertility preservation options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Women who have had their cervix removed during hysterectomy should continue to have pap tests and pelvic exams, as these tests can also detect vaginal tissue abnormalities. Even after surgery to remove the reproductive organs, a woman is still at risk for recurrent disease. The most common sign of recurrence is vaginal bleeding, which should be reported immediately to a healthcare provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The removal of lymph nodes during surgery can increase the risk of lymphedema developing in the genitals or legs. Radiation therapy can further increase the risk of developing lymphedema (see lymphedema information). In addition, abdominal surgeries can put survivors at risk for bowel obstructions (due to scarring), hernia (due to cutting the abdominal muscle) and changes in bowel patterns. Radiation therapy to the abdomen and pelvis can increase the risk of these complications.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Depending on the type and extent of surgery, sexual function may be affected. Sometimes after surgery to remove the uterus and/or cervix, the vagina is shorter than it used to be, and this may result in pain during intercourse. Pelvic floor therapy with a trained physical therapist may help women with these symptoms. When cancer has caused pain or bleeding with intercourse, some surgeries to remove the cancer may actually improve a woman's sexual functioning by stopping these symptoms. You may not feel like yourself for several months after surgery. Some women say it takes a year or two to adjust completely to the changes that have occurred. You should discuss these issues with your healthcare provider in order to determine when it is safe to resume sexual activity.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors who have also received radiation, will be at a greater risk for other changes. Again, this depends on the type of cancer and the area that was irradiated. Pelvic radiation may cause scar tissue to form in the vagina. The scar tissue can make the vagina shorter or more narrow (called vaginal stenosis). Vaginal stenosis can impair sexual function and make intercourse uncomfortable and even painful. Women who received pelvic radiation should use vaginal dilators to prevent and treat vaginal stenosis. A dilator is a plastic or rubber tube used to stretch the vagina. It feels much like putting in a large tampon for a few minutes. It works by stretching the walls of the vagina and can be used starting 2-4 weeks after radiation is completed. Dilators should be used for life. Even if a woman is not interested in staying sexually active, keeping the vagina normal in size will make pelvic exams more comfortable. Pelvic radiation can increase vaginal dryness and cause pain with intercourse. Vaginal lubricants and moisturizers can help to relieve these discomforts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Risk of Developing Osteoporosis

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Osteoporosis and osteopenia (the precursor to osteoporosis) are decreases in bone density, which increases the risk of fracture of the affected bones. Long term use of corticosteroids (dexamethasone or prednisone, > 5mg per day for more than 2 months), receiving chemotherapy medications (including methotrexate, ifosfamide, cytoxan, fluorouracil and interferon alpha) or radiation to weight bearing bones (spine, hips, legs) all increase the risk of developing osteoporosis.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Women who develop premature menopause, have their ovaries removed before menopause or those who take aromatase inhibitors (anastrozole, letrozole and exemestane) are at increased risk for osteoporosis. Men who receive hormone therapy for prostate cancer or undergo orchiectomy are at greater risk. In addition, patients who have undergone gastrectomy (removal of the stomach) are at increased risk to develop osteoporosis.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    As for lifestyle risks, smokers, people who consume excessive alcohol and those who do not participate in weight bearing exercise have an increased risk of developing osteoporosis. Therefore, it is very important that survivors not drink alcohol or smoke. In addition, survivors should engage in weight-bearing exercise such as walking, weight lifting, riding a stationary bicycle, jogging, dancing, and any exercise where the legs are supporting the body's weight. These efforts, combined with increasing calcium and vitamin D in your diet and taking calcium and vitamin D supplements, will greatly help to reduce your risk of developing osteoporosis.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors at risk should have adequate intake of calcium (1200-1500mg total per day, taken in divided doses) and vitamin D (400-800 international units per day if under age 50, and 800-1000 international units per day if over age 50). Calcium supplements are an easy way to get the recommended daily amount and come in 2 forms: calcium carbonate and calcium citrate. The body does have some trouble absorbing large amounts of calcium, so supplements should be split into 2 or more doses per day. Calcium carbonate requires stomach acid to be absorbed by the body, therefore people that take acid reducers (such as Zantac, Tagamet) and/or proton pump inhibitors (such as Prilosec, Prevacid, etc) should use calcium citrate. If you have trouble tolerating your calcium supplement, talk to your doctor or nurse; there may be another formulation you can tolerate more easily. It is important to take Vitamin D with the calcium supplements because it helps your body to absorb calcium better. Survivors should talk to their healthcare provider about screening with DEXA scan (a test used to assess bone density) and options for treatment, if necessary.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Seek help for sexual side effects, which may include pain and/or dryness during intercourse. Vaginal estrogen creams, vaginal dilators, and pelvic floor therapy may assist with these symptoms.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their cervix removed during hysterectomy should continue to have pap tests and pelvic exams, as this test can also detect vaginal tissue abnormalities.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Notify your healthcare provider if you notice signs or symptoms suggestive of recurrence: vaginal bleeding, abdominal or pelvic pain, persistent cough, or unexplained weight loss.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • For prevention of osteoporosis:
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Avoid smoking and excessive alcohol intake.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Perform weight bearing exercise 2-3 times per week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Calcium intake of 1200-1500mg per day plus Vitamin D 400-800iu or 800-1000iu per day (either in dietary intake or supplements).
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Consider screening with DEXA scan.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgery for Vaginal and Vulvar Cancers

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgical procedures vary, so be sure to clarify with your surgeon which organs were removed during your surgery. Survivors who have undergone surgery for vaginal or vulvar cancers have very specific needs and you should talk to your healthcare providers with questions pertaining to your surgery, sexual function, and any complications that may arise as a result of  surgery.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    If all or most of the vagina must be removed, it is possible to rebuild (reconstruct) a vagina with tissue from another part of the body, allowing the woman to have intercourse. The new vagina will produce little or no natural lubricant when a woman becomes sexually excited. Therefore, you should prepare for intercourse by using a lubricating gel inside the vagina. Initially, the woman may feel strange sensations when the vagina is touched or "stimulated" because it was created from tissue taken from another part of the body. These feelings usually become less distracting over time. Emotional and psychological support is critical and survivors should consider joining support groups (in person or online) and seeking psychological counseling support.

                                                                                                                                                                                                                                                                                                                                                                                                                                                     Surgery for vulvar cancer (vulvectomy) can be very disfiguring and can have more of an impact on sexual function than other surgeries for gynecologic cancers. After surgery, women may find it difficult to wear tight pants or jeans because of the lack of "padding" around vaginal area. In addition, lymphedema is more likely to occur after vulvectomy than with other gynecologic cancer surgery. Support stockings or special compression devices and physical therapy may greatly help to reduce swelling. Some healthcare providers recommend wearing support stockings for 12 months after surgery to help with the drainage of lymph fluid. It may be difficult for women who have had a vulvectomy to reach orgasm because the outer genitals have been removed or altered. In addition, women may experience numbness in the genital area, especially if lymph nodes were also removed in surgery. This numbness may last for months after surgery and resolves slowly. When touching the area around the vagina, light caressing and use of a lubricant can help prevent painful irritation. Scar tissue may narrow the entrance to the vagina making penetration painful. Vaginal dilators may help stretch the opening as previously discussed. Emotional and psychological support is critical and survivors should consider joining support groups (in person or online) and seeking psychological counseling support.

                                                                                                                                                                                                                                                                                                                                                                                                                                                     

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The removal of lymph nodes during surgery can increase the risk of lymphedema developing in the genitals or legs. Radiation therapy can further increase the risk of developing lymphedema (see lymphedema information). In addition, abdominal surgeries can put survivors at risk for bowel obstructions (due to scarring), hernia (due to cutting the abdominal muscle) and changes in bowel patterns. Radiation therapy to the abdomen and pelvis can increase the risk of these complications.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sexual function will be affected because of surgery, the degree of which will depend on the type and extent of surgery. Sometimes after surgery pain may occur during intercourse. Pelvic floor therapy with a trained physical therapist may help women with these symptoms. When cancer has caused pain or bleeding with intercourse, some surgeries to remove the cancer may actually improve a woman’s sexual functioning by stopping these symptoms. You may not feel like yourself for several months after surgery. Some women say it takes a year or two to adjust completely to the changes that have occurred. You should discuss these issues with your healthcare provider in order to determine when it is safe to resume sexual activity. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors who have also received radiation, will be at a greater risk for other changes. Again, this depends on the type of cancer and the area that was irradiated. Pelvic radiation may cause scar tissue to form in the vagina. The scar tissue can make the vagina shorter or more narrow (called vaginal stenosis). Vaginal stenosis can impair sexual function and make intercourse uncomfortable and even painful. Women who received pelvic radiation should use vaginal dilators to prevent and treat vaginal stenosis. A dilator is a plastic or rubber tube used to stretch the vagina. It feels much like putting in a large tampon for a few minutes. It works by stretching the walls of the vagina and can be used starting 2-4 weeks after radiation is completed. Dilators should be used for life. Even if a woman is not interested in staying sexually active, keeping the vagina normal in size will make pelvic exams more comfortable. Pelvic radiation can increase vaginal dryness and cause pain with intercourse. Vaginal lubricants and moisturizers can help to relieve these discomforts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    •  Be open with your healthcare provider in terms of questions and side effects from surgery so that they can help you achieve and maintain an acceptable quality of life after surgery.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Risk of Developing Osteoporosis

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Osteoporosis and osteopenia (the precursor to osteoporosis) are decreases in bone density, which increases the risk of fracture of the affected bones. Long term use of corticosteroids (dexamethasone or prednisone, > 5mg per day for more than 2 months), receiving chemotherapy medications (including methotrexate, ifosfamide, cytoxan, fluorouracil and interferon alpha) or radiation to weight bearing bones (spine, hips, legs) all increase the risk of developing osteoporosis.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Women who develop premature menopause, have their ovaries removed before menopause or those who take aromatase inhibitors (anastrozole, letrozole and exemestane) are at increased risk for osteoporosis. Men who receive hormone therapy for prostate cancer or undergo orchiectomy are at greater risk. In addition, patients who have undergone gastrectomy (removal of the stomach) are at increased risk to develop osteoporosis.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    As for lifestyle risks, smokers, people who consume excessive alcohol and those who do not participate in weight bearing exercise have an increased risk of developing osteoporosis. Therefore, it is very important that survivors not drink alcohol or smoke. In addition, survivors should engage in weight-bearing exercise such as walking, weight lifting, riding a stationary bicycle, jogging, dancing, and any exercise where the legs are supporting the body's weight. These efforts, combined with increasing calcium and vitamin D in your diet and taking calcium and vitamin D supplements, will greatly help to reduce your risk of developing osteoporosis.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors at risk should have adequate intake of calcium (1200-1500mg total per day, taken in divided doses) and vitamin D (400-800 international units per day if under age 50, and 800-1000 international units per day if over age 50).   Calcium supplements are an easy way to get the recommended daily amount and come in 2 forms: calcium carbonate and calcium citrate. The body does have some trouble absorbing large amounts of calcium, so supplements should be split into 2 or more doses per day. Calcium carbonate requires stomach acid to be absorbed by the body, therefore people that take acid reducers (such as Zantac, Tagamet) and/or proton pump inhibitors (such as Prilosec, Prevacid, etc) should use calcium citrate. If you have trouble tolerating your calcium supplement, talk to your doctor or nurse; there may be another formulation you can tolerate more easily. It is important to take Vitamin D with the calcium supplements because it helps your body to absorb calcium better. Survivors should talk to their healthcare provider about screening with DEXA scan (a test used to assess bone density) and options for treatment, if necessary.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Seek help for sexual side effects, which may include pain and/or dryness during intercourse. Vaginal estrogen creams, vaginal dilators, and pelvic floor therapy may assist with these symptoms.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Notify your healthcare provider if you notice signs or symptoms suggestive of recurrence: vaginal bleeding, abdominal or pelvic pain, persistent cough, or unexplained weight loss.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • For prevention of osteoporosis:
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Avoid smoking and excessive alcohol intake.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Perform weight bearing exercise 2-3 times per week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Calcium intake of 1200-1500mg per day plus Vitamin D 400-800iu or 800-1000iu per day (either in dietary intake or supplements).
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Consider screening with DEXA scan.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Isolated Limb Perfusion (ILP) / Isolated Limb Infusion (ILI)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Isolated limb perfusion (ILP) and isolation (ILI) is a technique used to treat tumors in the extremities. Short and long-term effects may be more common, and possibly more severe, after ILP than ILI. Most patients will have experienced redness, swelling, blistering and peeling skin, and loss of hair growth within a week of the treatment. The majority of these complications will typically resolve over a few months.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Long-term effects in the treated limb can include chronic swelling, a difference in the skin color, stiffness of the joints, numbness, tingling or stinging sensations. These effects can interfere with your daily functioning. Consultation with a cancer rehabilitation specialist, physical and/or occupational therapists may be beneficial to improve your functional ability. It is not uncommon for survivors to be troubled by the cosmetic appearance of the limb.If these concerns interfere with your life, consider discussing them with a counselor who has experience in working with cancer survivors.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consult with a cancer rehabilitation specialist, physical and/or occupational therapist for chronic limb problems.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgery for Appendiceal Cancer (Removal of appendix / Appendectomy)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    An appendectomyis the removal of the appendix, a small pouch attached to the large intestine (colon). The appendix is found in the lower right section of the abdomen and is an organ whose function is not clearly understood. It is part of the bowel, and thought to have once functioned as part of the digestive system. It is now considered to be a non-essential organ.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Removal of the appendix can be done by a laparoscopic approach or by an open laparotomy. In the laparoscopic procedure, the surgeon makes four small incisions in the abdomen and then passes a camera and special instruments through these incisions. This surgery is typically well-tolerated and long term effects are very minimal, if any. An open laparotomy is a more involved abdominal surgery involving a much larger incision and longer surgery time. An open laparotomy, like many other abdominal surgeries, may be more likely to cause long term effects, including bowel obstructions (due to scarring), hernia (due to cutting the abdominal muscle) and changes in bowel patterns. Radiation therapy to the abdomen and pelvis can increase the risk of these complications. Surgery for appendiceal cancer often requires the removal of several surrounding lymph nodes during surgery; this can increase the risk of lymphedema developing in the genitals or legs. Radiation therapy can further increase the risk of developing lymphedema.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Depending on whether your tumor had spread outside of the appendix, surgery may have been more extensive and required the removal of parts of the intestine, omentum (lining of the abdominal cavity), ovaries and uterus. This, in turn, may lead to other long-term complications associated with these other surgeries.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Survivors are at risk for bowel obstructions, hernia (due to cutting the abdominal muscle for surgery) and changes in bowel patterns. Radiation therapy to the abdomen and treatment with chemotherapy agents that cause motility issues (vincristine, vinorelbine, or vinblastine) can increase the risk of complications.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgery for Gall Bladder Cancer (gall bladder removal / cholecystectomy)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    A cholecystectomy is the removal of the gall bladder. The gall bladder is a small pear-shaped organ attached to the liver and found in the upper right section of the abdomen. It is responsible for storing bile, a fluid made in the liver that helps the body digest the fat from food as it moves through the small intestine during digestion. The gall bladder is connected to the small intestine and the liver by bile ducts. Since the liver also can release bile, the gallbladder is not an essential organ. Removal of the gallbladder can be done by a laparoscopic approach or by an open laparotomy.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In the laparoscopic procedure, the surgeon makes four small incisions in the abdomen and then passes a camera and special instruments through these incisions. This surgery is typically well-tolerated and long term effects are very minimal, if any. An open laparotomy is a more involved abdominal surgery involving a much larger incision and longer surgery time. An open laparotomy, like many other abdominal surgeries, may be more likely to cause long term effects, including bowel obstructions (due to scarring), hernia (due to cutting the abdominal muscle) and changes in bowel patterns. Radiation therapy to the abdomen and pelvis can increase the risk of these complications. Surgery to remove cancer of the gallbladder also often requires the removal of several surrounding lymph nodes during surgery; this can increase the risk of lymphedema developing in the genitals or legs. Radiation therapy can further increase the risk of developing lymphedema.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Depending on whether or not your tumor has spread outside of the gall bladder, surgery may be more complicated and require the removal of a portion of the liver, pancreas, or intestine. This, in turn, may lead to other long-term complications associated with these other surgeries.\

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Survivors are at risk for bowel obstructions, hernia (due to cutting the abdominal muscle for surgery) and changes in bowel patterns. Radiation therapy to the abdomen and treatment with chemotherapy agents that cause motility issues (vincristine, vinorelbine, or vinblastine) can increase the risk of complications.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Liver Resection

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The liver is the largest organ in the abdomen and plays an essential role in the digestion of food and removal of harmful substances from the blood. Surgery involving the liver can have immediate complications such as hemorrhage/bleeding, liver failure, infection, ascites (fluid in the abdomen), or portal hypertension. These complications can be worsened if a person has cirrhosis or other liver disease. Once a person has recovered successfully from surgery there are typically no long-term side effects following liver resection. The remaining liver can regrow within a few months of the operation and carry out all its normal functions.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Survivors are at risk for bleeding and liver failure, especially if cirrhosis is present as well.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgery for Mesothelioma

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Pleurectomy / Decortication

                                                                                                                                                                                                                                                                                                                                                                                                                                                    A pleurectomy is a surgery that may be done for the treatment of mesothelioma. It involves removing the tumor and part, or all, of the pleura (lining of the lung) and the lung tissue surrounding it. It is used to help stop the build-up of fluid in the lung and to help with shortness of breath and pain. This surgery can free a collapsed lung, allowing it to reinflate, improving shortness of breath.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Pneumonectomy

                                                                                                                                                                                                                                                                                                                                                                                                                                                    A pneumonectomy is a surgery that may be done for those with mesothelioma. This is an extensive surgery that involves the removal of the affected lung and the lining surrounding it, and recovery can be a long process. It can take up to six months for the healthy lung to learn to do the job of both lungs. Shortness of breath is a considerable problem after surgery and it many take several months to resume normal activity. Complications are worsened in smokers, especially those who continue to smoke after surgery.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors who have had either of these procedures may develop chronic pain, shortness of breath (particularly with exertion), fatigue and/or generalized weakness. Survivors should not smoke, as this can clearly increase the risk of developing infections, such as bronchitis and pneumonia, and long term lung problems.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report any symptoms of cough, shortness of breath or wheezing to your healthcare provider.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not smoke. Talk to your healthcare team about quitting if you do. Avoid exposure to second hand smoke.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Receive the pneumoccocal vaccine and an annual flu vaccine.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgery for Thymoma or Thymic Carcinoma

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The thymus is a small organ located just behind the breast bone (sternum) in front of and above the heart. The thymus is part of the immune system and produces and matures lymphocytes (a type of white blood cells). However, once a person reaches adolescence, the thymus has completed this job and has little function. A total thymectomy is the removal of the thymus gland during a surgery called a median sternotomy where the sternum (breast bone) is cut, exposing the thymus. It is thought that removal of the thymus in adults has no affect on a person’s immune system because the thymus is no longer functioning.   Due to the location of the thymus, parts of the pleura (tissue coating the lung), pericardium (the sac containing the heart), nerves, the superior vena cava (a large vein leading to the heart), and/or lung may need to be removed, depending if the cancer has extended beyond the thymus. This, in turn, may lead to other long-term complications associated with these surgeries. Radiation therapy may cause additional or worsen existing side effects.  

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Thymomas, especially thymic carcinoma, are can reoccur, even 10–15 years following surgery. It is important to follow the recommendations of your oncologist for future follow-up.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • If you experience a persistent cough, hoarseness, difficulty breathing, chest pain, or difficulty swallowing, notify your health care provider immediately.  

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgery for Penile Cancer (Moh’s surgery/full or partial penectomy / Removal of the penis)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgery for penile cancer can vary depending on the stage of the cancer and its exact location. Moh’s sugery is often performed for early stage penile cancer. During a Moh’s procedure the goal is to remove the cancer cells and as little healthy tissue as possible. There are a few possible long-term complications with the Moh’s surgery.  The surgery will result in a scar, although the extent of the scar can depend on the location, how much tissue was removed, and if you have a tendency to have abnormal scarring (such as keloids).  Scars can take a year to complete the healing process, and will change in appearance over this time.  Though rare, if nerves or muscles are cut during the Moh’s procedure, you may develop decreased sensation, numbness or weakness, which can either improve over time or become permanent.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    If your surgery required a skin graft, you may notice decreased sensation or a lack of hair growth in the area of graft.  As the graft heals, it can contract or shrink, which may cause a feeling of tightness. If this occurs, you may benefit from seeing a cancer rehabilitation specialist. Another surgery to treat penile cancer is a partial or total removal of the penis (penectomy). In many cases, reconstruction (a separate surgery) may be an option to give the appearance of a penis, and surgeons may be able to reconnect some of the nerves in order to provide sensation and the necessary blood flow to allow the reconstructed penis to become erect. The degree to which function of the penis is affected depends on the amount of tissue taken to ensure that the cancer has been removed and success of reconstruction. Many survivors will have sexual and fertility concerns.  You should discuss these with your surgeon, who can provide advice and referrals to therapists when needed. Radiation therapy may cause additional side effects or worsen existing side effects. In addition to the physical side effects of this surgery, many men have difficulty with social and emotional issues. It is important to speak with your healthcare provider, social worker and therapist, who can help you cope with these concerns and emotions.   

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report any changes in the appearance of the penile and groin areas, including swelling, redness and rash. Report any difficulty urinating, blood in the urine or pain to your healthcare team right away.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Seek counseling and support for the emotional and social concerns associated with surgery for penile cancer. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Laryngectomy

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Laryngectomy is the surgical removal of the larynx.  The person who had the procedure is called a "laryngectomee".  The larynx is the "voice box" or vocal cords, which vibrate as air passes over them during exhalation, and this sound is made into our speech by the parts of our mouth.  If the larynx is removed, no speech sounds can be made.  A partial laryngectomy may allow speech, though in many cases it will be different than the speech was before surgery and may be more difficult for people to understand.  In addition, the trachea (breathing tube) is redirected with removal of the larynx, resulting in a stoma (hole) in the neck that the laryngectomee breathes through.  This is referred to as a "neck breather".  These changes bring about some long-term practical and safety concerns of which you should be aware.

                                                                                                                                                                                                                                                                                                                                                                                                                                                     

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Safety Concerns

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Notify your local 911 and EMS service of your condition so that they will respond even if you do not speak when you call.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get a medical alert bracelet identifying you as a "neck breather".  This is important because CPR breathing or oxygen given through your mouth is ineffective.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Carry something that can be used as an alarm in an emergency when you would otherwise yell for help. For example, an alarm for a keychain or bell can call attention to you.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • If you cannot speak or speech is difficult to understand, carry paper and pen to write messages.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Because the air you breathe is not going through your nose, you will have decreased ability to smell, which can have safety implications. You may not smell smoke from a fire, natural gas or sour food, for example. Make sure you have working smoke detectors and change the batteries every 6 months.

                                                                                                                                                                                                                                                                                                                                                                                                                                                     

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Practical Concerns

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Showering: You need to avoid getting water in the stoma. Options to keep water out: foam filters, stoma covers, other things use to cover the stoma like a washcloth or baby bib. Many laryngectomees get comfortable with showering over time and require nothing to cover the stoma.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clean Air: Remember that the air going into the stoma when you breathe goes directly to your lungs. Be cautious about dust, pet hair, aerosol sprays, etc. – anything that can be in the air and inhaled.  You may want to use a stoma cover for certain activities where the risk of inhaling something is higher.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Humidification: Prior to surgery, the air you were breathing was humidified by your nose and mouth.  After surgery, you no longer have this built in humidifier and this dry air results in increased mucus production as the lungs try to moisten the air. You will need to learn how to increase the moisture level in the air you breathe and retain this moisture.  Tools to do this include using a cool-mist humidifier when sleeping, saline squirts and stoma covers. You can learn much more about humidification from your healthcare team or at the resources listed below.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Speech & Swallowing

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Issues with speech and swallowing are common after laryngectomy, but these issues can arise at any point in a survivor’s life. If you experience any difficulty swallowing at any time, notify your oncology team. A speech language pathologist (SLP) can help manage swallowing difficulties and help with devices and techniques to assist with your speech. SLPs can be accessed at any time in a survivor’s life for new concerns or to explore newer technologies for speech.

                                                                                                                                                                                                                                                                                                                                                                                                                                                     

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Finding Answers

                                                                                                                                                                                                                                                                                                                                                                                                                                                    As you recover from surgery and get back to life, you are sure to encounter situations for which you weren’t prepared.  Your healthcare team is there to support you and answer questions.  The following resources can provide lots of practical tips from other survivors who have "been there".

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Web Whispers: Throat Cancer and Laryngectomee Rehabilitation - Offers advice, tips and education from survivors.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Support for People with Oral Head & Neck Cancer (SPOHNC): Provides support groups, buddy programs, education and awareness.

                                                                                                                                                                                                                                                                                                                                                                                                                                                     

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Address safety concerns, including: notifying local 911 and EMS that you are unable to talk, medical alert bracelet, carry something to use as an alarm to get help in an emergency, pen and paper, and working smoke detectors, as your sense of smell will be impacted.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Practical concerns include using filters and covers to protect your stoma when showering, ensuring you are in a clean air environment, and using a humidifier.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Work with a speech language pathologist to manage both speech and swallowing concerns. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Head and Neck Surgeries

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgery involving the head and neck encompasses a wide variety of procedures. These can result in difficulty chewing, swallowing, speaking, and breathing. Other complications are aspiration (the inhalation of food or liquids into the lungs, which can lead to pneumonia), decreased range of motion in the neck, lymphedema (swelling as a result of lymph nodes removed in surgery), dry mouth (xerostomia), and alterations in taste, smell and hearing. These effects may be partial or complete losses and may be temporary, lasting for months after treatment, or permanent. In addition, head and neck surgeries can dramatically alter appearance and voice. Various therapy disciplines can help in managing and treating these side effects and changes, including physical and occupational therapy, lymphedema therapy, speech and swallowing experts, dieticians, plastic surgeons, prosthetic manufacturers, pain management and orthodontic specialists.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    It is important for survivors of head and neck cancers to have close follow-up that includes a comprehensive physical exam with particular attention to the head, mouth, neck, and area lymph nodes. Follow-up should occur frequently, but the actual time points and any necessary blood work, endoscopy, and imaging studies should be determined by your oncologist based on the cancer type and stage. Survivors of head and neck cancers are at high risk for recurrence and/or developing a second malignancy. Be aware of signs and symptoms of recurrence, which may include weight loss, coughing or spitting-up blood, difficulty swallowing, difficulty opening the mouth fully, sores in the mouth that do not heal, or ear ache (particularly when swallowing). Contact your healthcare provider if any concerning symptoms occur.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Adequate nutritional support is essential for preventing weight loss in patients and survivors of head and neck cancer. If a survivor has difficulty eating and/or maintaining their weight, they should consult with an oncology dietician for help in managing this concern. Sometimes, survivors benefit from having a feeding tube to assist with nutrition if eating and/or swallowing are extremely difficult. Survivors should stop smoking l, if they have not yet done so, as smoking may drastically increase the risk of a second cancer or recurrence. Survivors are also advised to refrain from heavy or daily alcohol use.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Good dental care and regular follow-up with a dentist is especially important for survivors who had surgery and/or radiation. These survivors are at a greater risk of developing tooth decay (cavities) because of the persistent dry mouth that often results from surgery and/or radiation. Survivors who have undergone radiation are also at greater risk for osteoradionecrosis, which is damage to the jaw bone that can result in a fractured bone. The main symptom of this is pain in the jaw. Osteoradionecrosis is more common after tooth infection, extraction or trauma and may require surgery to repair the damage.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Quality of life can be drastically altered in survivors of head and neck cancers. Depression is common and survivors should feel free to discuss any difficulty coping, anxieties, or depressed thoughts/mood with their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Comprehensive physical exam with particular attention to the head, mouth, neck, and regional lymph nodes at least once per year. The frequency of physical exams by your healthcare provider, bloodwork and imaging studies should be determined by the oncologist based on tumor type, stage and treatment received.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report any signs/symptoms concerning for recurrence, including weight loss, expectorating blood, difficulty swallowing, difficulty opening the mouth, persistent sores in the mouth, or earache (especially when swallowing).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consult a dietician for any nutrition concerns.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consider seeing specialists for bothersome symptoms, including physical and occupational therapists, lymphedema therapists, speech and swallowing experts, prosthetic manufacturers, pain management specialists and orthodontic specialists.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • See a dentist twice a year and practice meticulous oral care. Your dentist may recommend frequent fluoride treatments.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not smoke. Talk to your healthcare team about quitting if you do. Refrain from heavy alcohol use.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report any concerns of depression or anxiety to your healthcare provider. Consider counseling or support groups to help you cope with any concerns.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Various therapy disciplines can help in managing the side effects of treatment, including physical and occupational therapy, speech and swallowing experts, dieticians, plastic surgeons and prosthetic manufacturers and orthotics specialists.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Removal of the Thyroid (thyroidectomy)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The thyroid gland is located in the neck, just below the larynx (voice box), and is responsible for converting iodine to thyroid hormones. Partial removal of the thyroid (usually performed in patients with papillary or follicular type thyroid cancer) puts a survivor at risk of developing hypothyroidism (a low level of thyroid hormone production). Removal of the entire thyroid renders the survivor with hypothyroidism that will require lifelong treatment. After surgery to remove part or all of the thyroid and nearby lymph nodes, tissues or organs, such as the parathyroid glands, patients may need to take medicine (thyroid hormone) and vitamin and mineral supplements (vitamin D and calcium) to replace the lost functions of these organs. In some cases, certain nerves or muscles may be damaged or removed during surgery. If this happens, the patient may have voice changes, such as hoarseness or loss of voice, or one shoulder may hang lower than the other.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Regardless of the type of surgery, once disease free, survivors should have a thyroid exam and a history and physical performed annually by their healthcare provider to evaluate for symptoms suggestive of thyroid issues, such as hypothyroidism. Survivors should be cared for either by a primary care doctor familiar with caring for thyroid cancer survivors or an endocrinologist. In addition, survivors should have a neck ultrasound initially at 6 and 12 months after treatment and then annually for 3-5 years or longer depending on stage and type of cancer. Those with metastatic disease may require imaging with CT scan or MRI. The survivor will need annual blood work to check thyroid function tests, including TSH (thyroid stimulating hormone) and T4 (thyroxine), and thyroglobulin. Bloodwork may be more frequent if the survivor is taking replacement medication (see below).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Nearly all patients who have part or the entire thyroid removed will take thyroid hormone pills to replace the natural hormone thyroxine. Survivors needing thyroxine replacement therapy, a medication called levothyroxine, may require more frequent bloodwork, initially every 6-8 or 8-12 weeks to ensure the medication dose is sufficient and then every 6-12 months once levels areregulated on medication. The goal of the medication is to suppress TSH. Therefore, it is important that the correct dose be taken and monitored. By taking levothyroxine and thus keeping TSH suppressed, the growth of any remaining thyroid cancer cells slows down, which lowers the chance of a recurrence or, in other words, the chance that the disease will return.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Levothyroxine should be taken in the morning one hour prior to eating. Levothyroxine can interact with other medications, so please check with your healthcare provider about restrictions prior to beginning any new medication. A high-fiber diet, soy-containing supplements, and walnuts can also interfere with the effects of levothyroxine. This medication seldom causes side effects when given at the correct dose. However, a few patients may get a rash or lose some of their hair during the first months of treatment. Your health care provider will closely monitor the level of thyroid hormone in the blood during follow-up visits. Too much thyroid hormone may cause patients to lose weight, become irritable, have sleep disturbances, changes in appetite, increase in frequency of bowel movements, decreased menstrual flow, tremors, muscle weakness, and to feel hot and sweaty. It may also cause chest pain, cramps, and diarrhea. These are symptoms of hyperthyroidism. If the thyroid hormone level is too low, the patient may gain weight, feel tired, fatigued, depressed, experience reduced concentration, hoarseness, joint pains, muscle cramps, constipation, menstrual cycle disturbances, feel cold, have dry skin, or brittle hair. This condition is called hypothyroidism. Survivors should report any of these symptoms to their healthcare provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Levothyroxine can cause problems for those with heart disease, clotting disorders, diabetes, and disorders of the adrenal or pituitary glands. Please be sure to tell your provider if you have or if you develop one of these conditions. Levothyroxine is safe to take while pregnant and breast feeding, but one may need more frequent monitoring of blood work during this time. It is important to communicate closely with your healthcare provider so that you are feeling well and the thyroid hormone replacement is managed correctly.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    There are some long-term risks of continued TSH suppression. Leovthyroxine can affect the heart, causing atrial fibrillation (an irregular heartbeat) and an exacerbation of angina (chest pain) in patients with some types of heart disease. In addition, women may be at an increased risk for osteoporosis, especially those who are postmenopausal.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    A survivor whose follow-up care is complicated or difficult to manage, for example a person with continued abnormal thyroid function tests or someone with new or recurrent symptoms, may benefit from referral to an endocrinologist to manage thyroid levels, replacement treatment, and on-going care.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Hypoparathyroidism

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For those with complete removal of the thyroid (thyroidectomy), or those who have received radiation and/or I-131 therapy, hypoparathyroidism can also be a lasting result of therapy. Hypoparathyroidism is a result of damage to or removal of the parathyroid glands, which are located behind the thyroid gland. Loss of these glands results in a lack of parathyroid hormone, which is responsible for regulation of calcium and phosphorus in the blood. Symptoms of hypoparathyroidism, resulting from low blood calcium, include numbness and tingling of the area around the lips, or fingers and toes, muscle cramps or spasms. Management of hypoparathyroidism includes vitamin D and calcium supplements. Monitoring of parathyroid hormone levels, blood calcium, phosphorus, and magnesium levels are required. Initially, these blood tests will be weekly to monthly and eventually will be done just twice a year. An Electrocardiogram (ECG or EKG) may be donetodetect arrhythmias (irregular heart beats) associated with low calcium levels and hypoparathyroidism. A bone density test, which evaluates the bones for osteoporosis and osteopenia, may also be conducted, often as a base-line prior to starting treatment.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    A special note for survivors of  Medullary Thyroid Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    A survivor of medullary thyroid cancer (MTC) should undergo genetic testing and counseling. One out of five MTCs results from a genetic abnormality or familial syndrome. Genetic testing can find the mutation in the RET gene seen in familial MTC and MEN-2 (multiple endocrine neoplasia type 2) syndromes. People with MEN-2 syndromes are at increased risk for development of tumors called pheochromocytoma and parathyroid adenoma. If a person has one of these mutations it is very important that his/her family is also tested including children and pre-teens. Almost all children and adults with a positive genetic test will develop MTC. Some hereditary forms of MTC affect children and young adults. It is recommended that those with a positive genetic test undergo a total thyroidectomy so as to prevent cancer from developing.

                                                                                                                                                                                                                                                                                                                                                                                                                                                     Survivors of MTC should also have additional blood work checked. Along with thyroid function tests and thyroglobulin levels, calcitonin and carcinoembryonic antigen (CEA) should be checked. If these levels begin to rise, a CT scan or MRI may be performed to determine if there is disease recurrence. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    A special note for survivors of Papillary or Follicular Thyroid Cancers

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Since the thyroid gland has been completely removed and ablated, a radioactive iodine scan will be done 6-12 months after the initial therapy is completed. If this scan shows no evidence of disease, most likely you will not need another scan unless symptoms or other abnormalities arise.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    •  Survivors should have thyroid exam and a history and physical performed annually. A neck ultrasound should be done initially at 6 and 12 months after treatment and then annually for 3-5 years or longer depending on stage and type of cancer. 
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual blood work to check thyroid function tests should also be done by the health care provider. Bloodwork may be more frequent if on replacement medication.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Contact your healthcare provider if you are on thyroid replacement medication and start to experience any changes in how you are feeling as this may be an indication that the replacement is not at the correct dose.  

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lymph Node Removal (Dissection)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The removal of lymph nodes from the axilla (underarm), abdomen, groin or head and neck area can lead to decreased drainage in the closest limb (arm or leg), causing lymphedema (a swelling of the limb) to result. In the case of head and neck cancers, the swelling can involve the neck and face. Survivors who have also received radiation therapy to the area where lymph nodes were removed are at greater risk of developing lymphedema, which can develop years after therapy. While sentinel node biopsy decreases the risk of developing lymphedema, the risk is not completely eliminated. Lymphedema can cause pain, disfigurement, functional limitations and increase the risk of a serious infection in the area. A Certified Lymphedema Therapist should be consulted at the first sign of swelling for the best outcomes. Survivors should be aware of this potential complication, given information on self-care, and instructed to notify the healthcare team with any signs of swelling or infection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Signs of lymphedema may include the following changes in the area near surgery (face, arm, leg, abdomen, genitals): full or heavy feeling, skin changes (reddened, warm, cool, dry, hard, stiff), aching/discomfort, tightness, or less movement/flexibility in nearby joints. You may also experience difficulty fitting into clothes like the sleeve of a jacket or pant leg, or feel your socks are too tight. In addition, you may notice jewelry feels tight even though you have not gained any weight. Lymphedema can occur right after treatment, weeks, months, or even years later. The possibility of developing lymphedema continues throughout a person's lifetime. Survivors should be vigilant in monitoring for early signs of swelling and practice prevention. If swelling develops, prompt, proper management and therapy allows for the best outcomes.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    To help reduce risk and/or control lymphedema, survivors should try to avoid infections, burns, cuts, excessive hot/cold, or injury to the limb that is at risk. Avoid insect bites by using insect repellent. Use lotion to prevent dry, chapped skin. Use sunscreen with SPF 15 or higher and try to avoid the sun during the hottest time of day. Avoid pressure or constriction of the limb. Avoid tight fitting clothes and jewelry.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Those at risk for lymphedema can and should exercise. Start with low intensity exercise and gradually increase intensity while monitoring for changes in your limb including swelling or redness. If any swelling or redness occurs, stop the exercise and consult your healthcare provider. A person at risk for lymphedema should consider wearing a compression garment with vigorous or very strenuous exercise.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Whenever possible, have blood drawn, IVs placed, shots/vaccinations given, and blood pressure taken in the unaffected arm/leg. For more information on what you can do to help prevent lymphedema, look at the Lymphedema Self Care Tip Sheet on the Oncolink website. The National Lymphedema Network is a great resource for information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgery to remove the lymph nodes (or sentinel node/s) can result in injury to the nerves in that area. Nerve damage can cause pain, numbness, tingling, decreased sensation or strength in the area or limb. For instance, axillary (underarm) lymph node removal can result in these symptoms on the chest wall, under the arm (armpit) or in the arm and/or hand on the treated side. Injuries like this could be aggravated by scar tissue formation after radiation therapy to the area, which can develop years after therapy. This type of pain is called nerve pain and is treated with different medications than other types of pain. Survivors with this type of pain may benefit from a consult with a pain specialist.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report any signs of swelling in the at risk limb to your healthcare provider, and see a certified lymphedema therapist promptly if these symptoms develop.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Practice preventive measures to decease the risk of developing or worsening lymphedema.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgery to Remove Female Reproductive Organs (hysterectomy, oopherectomy)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgical procedures vary, so be sure to clarify which organs were removed. Removal of the ovaries causes a woman to go into menopause (if she is not already menopausal), leading to side effects including hot flashes, irritability, vaginal dryness and decreased sexual desire. This early lack of estrogen increases the risk of a woman developing osteoporosis (weakening of the bones) and heart disease. Removal of the ovaries also results in infertility. While less so, there is also risk of infertility when only one ovary is removed, particularly if combined with radiation to the abdomen or chemotherapy. A consult with a reproductive endocrinologist with experience in working with cancer survivors is warranted if the woman wishes to explore fertility options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Risk of Developing Osteoporosis

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Osteoporosis and osteopenia (the precursor to osteoporosis) are decreases in bone density, which increases the risk of fracture of the affected bones. Long term use of corticosteroids (dexamethasone or prednisone, > 5mg per day for more than 2 months), receiving chemotherapy medications (including methotrexate, ifosfamide, cytoxan, fluorouracil and interferon alpha) or radiation to weight bearing bones (spine, hips, legs) all increase the risk of developing osteoporosis.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Women who develop premature menopause, have their ovaries removed before menopause or those who take aromatase inhibitors (anastrozole, letrozole and exemestane) are at increased risk for osteoporosis. Men who receive hormone therapy for prostate cancer or undergo orchiectomy are at greater risk. In addition, patients who have undergone gastrectomy (removal of the stomach) are at increased risk to develop osteoporosis.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    As for lifestyle risks, smokers, people who consume excessive alcohol and those who do not participate in weight bearing exercise have an increased risk of developing osteoporosis. Therefore, it is very important that survivors not drink alcohol or smoke. In addition, survivors should engage in weight-bearing exercise such as walking, weight lifting, riding a stationary bicycle, jogging, dancing, and any exercise where the legs are supporting the body's weight. These efforts, combined with increasing calcium and vitamin D in your diet and taking calcium and vitamin D supplements, will greatly help to reduce your risk of developing osteoporosis.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors at risk should have adequate intake of calcium (1200-1500mg total per day, taken in divided doses) and vitamin D (400-800 international units per day if under age 50, and 800-1000 international units per day if over age 50).   Calcium supplements are an easy way to get the recommended daily amount and come in 2 forms: calcium carbonate and calcium citrate. The body does have some trouble absorbing large amounts of calcium, so supplements should be split into 2 or more doses per day. Calcium carbonate requires stomach acid to be absorbed by the body, therefore people that take acid reducers (such as Zantac, Tagamet) and/or proton pump inhibitors (such as Prilosec, Prevacid, etc) should use calcium citrate. If you have trouble tolerating your calcium supplement, talk to your doctor or nurse; there may be another formulation you can tolerate more easily. It is important to take Vitamin D with the calcium supplements because it helps your body to absorb calcium better. Survivors should talk to their healthcare provider about screening with DEXA scan (a test used to assess bone density) and options for treatment, if necessary.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their cervix removed during hysterectomy for cancer should continue to have pap tests and pelvic exams, as this test can also detect vaginal tissue abnormalities.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • For prevention of osteoporosis:
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Avoid smoking and excessive alcohol intake
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Perform weight bearing exercise 2-3 times per week
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Calcium intake of 1200-1500mg per day plus Vitamin D 400-800iu or 800-1000iu per day (either in dietary intake or supplements)
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Consider screening with DEXA scan

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Splenectomy (Removal of Spleen)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The spleen is an organ located in the upper abdomen that functions somewhat like a filter, removing bacteria and dead red blood cells from the blood stream. Removal of the spleen results in a survivor being at higher risk for certain infections caused by encapsulated bacteria, of which Streptococcus pneumoniae and Haemophilus influenzae type b are the most common. An infection can rapidly progress to sepsis and can lead to death if not treated quickly with antibiotics. Some experts believe survivors should have antibiotics on hand to be started at the first sign of infection, prior to being evaluated by the healthcare team. These survivors must be aware of the importance of reporting a fever (temperature > 100.4 °) or any sign of infection to their healthcare team right away, or to go to an emergency room for evaluation if their doctor is not available. They must be sure to let any healthcare provider caring for them know that they do not have a spleen.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors should wear a medic-alert bracelet noting this condition ("asplenia") and should receive annual influenza vaccines, as well as the pneumococcal and Hepatitis B vaccines. They should also receive the meningococcal and H. influenzae type b vaccines (this is not the same as the annual flu vaccine), and if bitten by a dog, cat or rodent, antibiotics are required to prevent infection with Capnocytophaga canimorsus bacteria.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    If traveling to an area with malaria, taking medication to prevent infection with malaria and the use of a mosquito repellent are important. If traveling to or living in Cape Cod or Nantucket Island in Massachusetts, you may be more likely to have complications from an infection caused by deer ticks called Babesia. If you notice you have been bitten by a tick, please contact your healthcare provider as soon as possible as this species of tick may transmit Lyme disease.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, abdominal surgeries can put survivors at risk for bowel obstructions (due to scarring), hernia (due to cutting the abdominal muscle) and changes in bowel patterns. Radiation therapy to the abdomen and pelvis can increase the risk of these complications.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Wear medic alert bracelet noting asplenia (no functioning spleen).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Notify your healthcare team right away if you develop a temperature greater than 100.4 ° or any signs of infection (sore throat, cough, burning with urination, ear pain, rash or shortness of breath).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Receive annual flu vaccine as well as pneumococcal, haemophilis influenza type b (HIb), meningococcal and hepatitis vaccines (per CDC guidelines).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • When traveling outside the U.S., evaluate need for additional vaccines or antibiotics.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • See your doctor for any tick or animal bites.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Amputation (Removal of a Limb)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The removal of a limb can result in the obvious physical challenges for survivors, but can also lead to psychological problems. It is appropriate that survivors may feel depressed, anxious, or have low self esteem given the disability and body image disturbance that results with amputation. A way to think about amputation is as an option for treatment and not as a failure. It is often a good option because, over time, if the cancer and limb were not removed, other more serious problems would result. As the cancer grows in the limb that is affected by the cancer, the limb would not function as it had, many other medical problems and complications could arise, and some degree of disfigurement and disability would result even if it was not amputated. Support groups may be beneficial to help cope with the changes and challenges associated with amputation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Physical problems associated with amputation can include phantom sensations and pain, early arthritis and pain in other joints and muscles bearing the load. Survivors often experience fatigue of the remaining limb due to the extra workload this limb is carrying. After amputation (particularly lower extremity), a survivor expends much more energy for the same task as someone without amputation and usually at a slower pace. Physical therapy and rehabilitation specialists are critical early in the treatment course to ensure a good recovery and a return to a fulfilling and productive life. These therapists may be useful even years later if pain develops. A poorly fitted prosthesis can lead to blisters, bruising or skin breakdown/wounds. Therefore, survivors should be counseled about the importance of prosthetic fit and care of the limb. A prosthesis can be expensive and may need to be replaced after some time. There are several organizations that can help to supplement this cost. A social worker can help you to get in contact with these organizations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Survivors require education regarding the care and maintenance of their prosthesis and limb.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual physical with a healthcare provider should assess for symptoms of phantom, neuropathic and arthritic pain.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Resection

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors who have had part of the lung removed may develop chronic pain, shortness of breath (particularly with exertion), fatigue and/or generalized weakness. Risks are greatest for those who also receive radiation to the lung and/or chemotherapy with known pulmonary toxicities (bleomycin, busulfan, BCNU, CCNU). Survivors should be counseled to not smoke, as this can clearly increase the risk of developing infections, such as bronchitis and pneumonia, and long term lung problems.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The timing of follow-up will depend on the stage and type of cancer in the lung. The following are general recommendations and you should discuss your specific continued surveillance with your oncologist. A history and physical by a healthcare provider should include a pulmonary exam and review of possible symptoms (cough, shortness of breath, wheezing). Physicians may consider chest x-rays or pulmonary function tests for those at highest risk for disease recurrence or those with concerning symptoms. Survivors should receive annual flu vaccines and the pneumococcal vaccine. Of note, the Children's Oncology Group recommends childhood cancer survivors who have had therapies with pulmonary toxicity not scuba dive without medical clearance from a diving medicine specialist.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report any symptoms of cough, shortness of breath or wheezing to your healthcare provider.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not smoke. Talk to your healthcare team about quitting if you do. Avoid exposure to second hand smoke.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Receive the pneumoccocal vaccine and an annual flu vaccine.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Removal of the Prostate (Prostatectomy)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Prostatectomy (surgical removal of the prostate) can result in long term effects due to nerve damage during the procedure. These effects can include incontinence and erectile dysfunction. Risk may be greater for those who also had radiation therapy (external beam and brachytherapy). Incontinence can have lasting negative effects on physical, emotional, and social well-being and should be addressed with the healthcare team. There are different degrees of incontinence and there is no one right way to cope with incontinence. Consultation with a pelvic floor specialist (therapist) can help survivors learn exercises to strengthen the pelvic floor muscles to better control urine flow. There are medications to help with certain types of incontinence. If these treatments are not successful, implantable devices that can physically close off urine flow are available and survivors can speak with their urologist about these devices. There are several types of products to help manage and live with incontinence so that your quality of life is not so drastically altered by prostate cancer surgery. Incontinence products, such as pads worn under your clothing and adult briefs and undergarments, can help you return to your normal daily activities without people knowing you have incontinence.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    There are some simple things you can do to help make incontinence less of a problem: empty your bladder before bedtime or before strenuous activity, avoid drinking too much fluid before bedtime or when you know you will need to be out of the house for an extended period of time, avoid fluids that contain caffeine or alcohol because they can make you have to urinate more often. Talk to your healthcare provider if you are having difficulty managing or coping with incontinence. Often survivors dealing with incontinence feel fear, anxiety, and anger. These feelings can be relieved if the incontinence is managed correctly and you can live life more fully.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Occasionally, men may develop a narrowing, or stricture, of the urethra (the tube that drains the bladder through the penis and out of the body). This can lead to difficulty passing urine, and may put survivors at increased risk for urinary tract infection. If you develop difficulty passing urine, see blood in your urine, or experience pain or burning with urination, call a healthcare professional immediately.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men will suffer some degree of erectile dysfunction (ED) after surgery, even with nerve sparing procedures. It can take several months to as long as three years to regain function, if at all. Early intervention, sometimes as soon as 6 weeks after surgery, with medications is important to prevent muscle wasting (the penis is a muscle) and improve the chances of recovery of function. In cases where erectile function does not return, survivors should discuss other options available to allow them to return to as normal a sexual life as possible. Learn more about ED treatment options at the Us Too Prostate Cancer Education & Support website. Most prostate cancer specialists (urologists) can manage this aspect of care.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Once able to resume sexual activity and achieve erection, the sensation of orgasm should continue to be pleasurable, but most likely there will be decreased or no ejaculation of semen. The orgasm will be "dry" because during surgery the glands that make most of the fluid were removed. Survivors who have undergone a radical prostatectomy can no longer father a child by natural means because the connection to where the sperm is produced is cut during the surgery.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    A rare but possible complication from surgery due to lymph node removal can be lymphedema. This can result in fluid build-up in the legs or genital region over time causing swelling and pain. Lymphedema can be treated, but it is very important to report this to your healthcare provider at the first sign of swelling or discomfort to ensure the best treatment outcome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Prostate cancer survivors are at an increased risk to develop osteoporosis (thinning of the bones). Men who receive hormone therapy for prostate cancer or undergo orchiectomy (removal of testes) are at greater risk. Discuss supplementation of Calcium and Vitamin D with your healthcare provider. A DEXA, or bone density, scan can determine if you have signs of osteoporosis.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Incontinence and erectile dysfunction can persist long after prostatectomy. There are things that you can do to manage these issues. Discuss options for treatment with your healthcare team.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report any symptoms of difficulty passing urine, blood in the urine, or pain/burning with urination to your healthcare provider, as these may be signs of infection or stricture.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Be aware that prostate cancer survivors may be at increased risk for osteoporosis. DEXA scan, to assess bone density, may be indicated.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Removal of the Testicle(s) (Orchiectomy)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Testicular cancer survivors who had one or both testicles removed may be at risk for hypogonadism (testes produce little or no testosterone). This risk is higher for those who had both testicles removed. Testicular cancer survivors who were also treated with chemotherapy and/or radiation therapy may also be at increased risk for hypogonadism. Testosterone deficiency may result in infertility, erectile dysfunction, decreased sex drive (libido), fatigue, muscle loss or weakness, gynecomastia (enlargement of breast tissue), decreased beard and body hair growth, higher BMI (body mass index, a measure of height and weight), elevated blood pressure and osteoporosis. Testosterone deficiency can have an impact on a survivor's quality of life and some experts recommend that all testicular cancer survivors have screening for hypogonadism. This entails a simple blood test that measures testosterone, FSH (follicle stimulating hormone) and LH (luteinizing hormone) levels. These are pituitary hormones that stimulate the testes to produce testosterone. If a deficiency is noted, the pros and cons of testosterone supplementation and the decision to treat should be discussed on an individual basis with the healthcare team.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some testicular cancer survivors have low sperm counts prior to cancer treatment, which is likely an effect of the disease. However, many survivors are found to have normal sperm counts within a few years after treatment. In addition, men with low counts have been reported to father children; therefore it is important that survivors use protection if they do not wish to father a child. Those who wish to have children may benefit from an evaluation by a fertility specialist. If both testicles are removed, you can no longer make sperm cells and thus become infertile. Losing a testicle has no effect on a man's ability to get an erection or have sex as long as enough testosterone is being made.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Risk of Developing Osteoporosis

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Osteoporosis and osteopenia (the precursor to osteoporosis) are decreases in bone density, which increases the risk of fracture of the affected bones. Long term use of corticosteroids (dexamethasone or prednisone, > 5mg per day for more than 2 months), receiving chemotherapy medications (including methotrexate, ifosfamide, cytoxan, fluorouracil and interferon alpha) or radiation to weight bearing bones (spine, hips, legs) all increase the risk of developing osteoporosis.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Women who develop premature menopause, have their ovaries removed before menopause or those who take aromatase inhibitors (anastrozole, letrozole and exemestane) are at increased risk for osteoporosis. Men who receive hormone therapy for prostate cancer or undergo orchiectomy are at greater risk. In addition, patients who have undergone gastrectomy (removal of the stomach) are at increased risk to develop osteoporosis.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    As for lifestyle risks, smokers, people who consume excessive alcohol and those who do not participate in weight bearing exercise have an increased risk of developing osteoporosis. Therefore, it is very important that survivors not drink alcohol or smoke. In addition, survivors should engage in weight-bearing exercise such as walking, weight lifting, riding a stationary bicycle, jogging, dancing, and any exercise where the legs are supporting the body's weight. These efforts, combined with increasing calcium and vitamin D in your diet and taking calcium and vitamin D supplements, will greatly help to reduce your risk of developing osteoporosis.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors at risk should have adequate intake of calcium (1200-1500mg total per day, taken in divided doses) and vitamin D (400-800 international units per day if under age 50, and 800-1000 international units per day if over age 50). Calcium supplements are an easy way to get the recommended daily amount and come in 2 forms: calcium carbonate and calcium citrate. The body does have some trouble absorbing large amounts of calcium, so supplements should be split into 2 or more doses per day. Calcium carbonate requires stomach acid to be absorbed by the body, therefore people that take acid reducers (such as Zantac, Tagamet) and/or proton pump inhibitors (such as Prilosec, Prevacid, etc) should use calcium citrate. If you have trouble tolerating your calcium supplement, talk to your doctor or nurse; there may be another formulation you can tolerate more easily. It is important to take Vitamin D with the calcium supplements because it helps your body to absorb calcium better. Survivors should talk to their healthcare provider about screening with DEXA scan (a test used to assess bone density) and options for treatment, if necessary.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consider testing for hypogonadism by checking testosterone, FSH and LH levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consider evaluation by a fertility specialist for those wishing to father a child.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Avoid smoking and excessive alcohol intake
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Perform weight bearing exercise 2-3 times per week
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Calcium intake of 1200-1500mg per day plus Vitamin D 400-800iu or 800-1000iu per day (either in dietary intake or supplements)
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consider screening with DEXA scan

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Removal of a Section of the Bowel

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Fortunately, we have 5 to 6 feet of large bowel, so if a section is removed, the remaining bowel can often perform the necessary tasks to regain normal bowel function. This is not always the case and survivors are at risk for bowel obstructions, hernia (due to cutting the abdominal muscle for surgery) and changes in bowel patterns. Radiation therapy to the abdomen and treatment with chemotherapy agents that cause motility issues (vincristine, vinorelbine, or vinblastine) can increase the risk of complications.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Many survivors report needing to move their bowels frequently and/or urgently, having loose bowels, gas / bloating and being intolerant of certain foods. These problems can have a big affect on quality of life, but some planning may help. Start by keeping a food diary. Record what and when you eat, what side effects you experience, and when they occur in relation to meals. This may give you a clear idea of what foods you need to avoid, but can be very helpful to guide a meeting with a Registered Dietician, who can help you with meal planning and other interventions.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, abdominal surgeries can put survivors at risk for bowel obstructions (due to scarring), hernia (due to cutting the abdominal muscle) and changes in bowel patterns. Radiation therapy to the abdomen and pelvis can increase the risk of these complications.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Eat frequent, small meals (5 to 6 times daily)
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • The diet should consist of mostly complex carbohydrates, which are whole plant foods such as fruits, vegetables, and whole grains.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • This should comprise 50 to 60% of the total daily calories.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Include lean protein from sources such as the white meat of poultry, fish, and lean meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • No more than 20 to 30% of the diet should be fat. The healthiest types of fat are from plant sources such as olive oil & canola oil.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Include 5-7 servings of fruits and vegetables per day. Canned fruit and cooked vegetable such as green beans, beets, and carrots can be eaten if fresh fruit and vegetables are not tolerated.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Simple carbohydrates/sugars should be minimized. Examples of simple sugars are fruit juices and beverages and food items with sugar or high fructose corn syrup listed as one of the first 3-4 ingredients
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Foods should be well-chewed
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Fiber and vitamin supplementation may be indicated

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Removal of the Bladder (cystectomy, bladder resection)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Removal of the bladder necessitates the formation of a "pouch" or reservoir to collect urine that may or may not be connected to a urostomy. This alteration in the natural anatomy and the possible need for chronic catheterization can lead to frequent or chronic urinary tract infections, reflux of urine into the kidneys (which can also cause infection), kidney dysfunction and hydronephrosis (swelling of the kidney). Survivors who have undergone cystectomy with any type of bladder reconstruction should be followed by an urologist for life.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some surgical procedures create a "continent diversion", which uses a piece of the bowel to produce a "bladder" that is connected internally or to an ostomy. These include the Indiana and Kock pouch and orthotopic neobladder. Any reconstruction that utilizes a portion of the bowel can cause some long term problems related to the urine coming into contact with bowel tissue and/or the loss of some functioning bowel, including a loss of bone density or osteoporosis, vitamin B12 deficiency, kidney stones and metabolic acidosis (a condition which makes the body too acidic and is managed with alkaline medications). The portion of bowel continues to produce mucus, which can interfere with draining of the bladder. In addition, this mucus can cause a positive pregnancy test (in men or women!); so female survivors should not rely on urine pregnancy tests. There is a risk of developing colon polyps or cancer in the portion of bowel used and this risk is known to be higher than the risk of colon tumors in the general population. There are no clear recommendations on screening for these polyps or tumors, which are thought to develop 5 or more years after the surgery.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Another factor predictive of long term problems is the part of the bowel used to create the urinary diversion. The removal of the end of the small bowel (ileum) and the valve between the small and large bowels (ileocecal valve), which is used to create a continent "bladder", results in some chronic bowel issues. These include poor digestion of fats, decreased vitamin absorption, gall and kidney stones and bowel changes, including frequent, looser stools and incontinence. It is important for an urologist knowledgeable in these procedures and their potential complications to follow survivors with continent diversions for life.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some bladder cancer survivors will have undergone surgery where an ileal conduit was formed and urine now drains from a stoma/ostomy made from a part of intestine that was brought through an opening on the abdomen. The urine drains constantly from the stoma into an external pouch or bag. It is important to learn proper care for the stoma and surrounding skin to prevent complications and skin breakdown. Observe the stoma for changes in color and any swelling and report these changes to your healthcare provider immediately. Sexual concerns and concerns over changes in physical appearance arise for many survivors and usually improve with time as one becomes more accepting of the urine pouch. There are pouch covers available to help cover the pouch during intimate moments or one may use some type of cloth or sash. Choosing sexual positions that are comfortable and have minimal pressure on the bag is also encouraged to prevent any problems or leakage and help one feel more relaxed during intimate moments.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Many cystectomy procedures result in sexuality issues. In men, nerve damage can lead to erectile dysfunction and in women, the resection may include all or part of the vagina, resulting in a smaller vagina or no vagina. We will briefly address these issues, which survivors dealing with these complications should discuss with their healthcare team. In men who experience erectile dysfunction (ED), it can take several months to several years to regain function, if at all. Early intervention with medications is important to prevent muscle wasting (the penis is a muscle) and improve the chances of recovery of function. In cases where erectile function does not return, survivors should discuss other options available to allow them to return to as normal a sexual life as possible. Learn more about ED treatment options at the Us Too Prostate Cancer Education & Support website. Most urologists can manage this aspect of care. Some types of bladder surgeries may also remove the prostate gland. In these survivors, semen will no longer be produced so orgasm will be "dry."

                                                                                                                                                                                                                                                                                                                                                                                                                                                    If all or most of the vagina must be removed, it may be possible to rebuild (reconstruct) a vagina with tissue from another part of the body, allowing the woman to have intercourse. The new vagina will produce little or no natural lubricant when a woman becomes sexually excited. Therefore, these survivors should prepare for intercourse by using a lubricating gel inside the vagina. Initially, the woman may feel strange sensations when the vagina is touched or "stimulated" because it was created from tissue taken from another part of the body. These feelings will become less distracting over time. Emotional and psychological support is critical and survivors should consider joining support groups (in person or online) and psychological counseling support.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, abdominal surgeries can put survivors at risk for bowel obstructions (due to scarring), hernia (due to cutting the abdominal muscle) and changes in bowel patterns. Radiation therapy to the abdomen and pelvis can increase the risk of these complications.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Survivors who have undergone cystectomy with any type of bladder reconstruction or with continent diversions should be followed for life by an urologist knowledgeable in these procedures and their potential complications.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Many cystectomy procedures result in sexuality issues for both men and women. Survivors should talk to their healthcare team and consider support groups to help find ways to overcome these issues.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Removal of the Kidney (Full or Partial Nephrectomy)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgery is usually performed for treating kidney cancer. Even if the cancer has spread outside of the kidney, removing the kidney may still be beneficial. The type of surgery done will depend on the stage of cancer and the overall health of the patient. Most commonly, a radical nephrectomy (removal of the entire kidney, adrenal gland, nearby lymph nodes and in some cases nearby veins) or partial nephrectomy (removal of only part of the kidney) are done to treat kidney cancer. There are not many complications from surgery for survivors since, fortunately, our bodies can function with only one kidney. However, in recent years, the long term outcomes of patients undergoing a nephrectomy have been the focus of numerous studies. The development of chronic renal insufficiency (CRI) is significant and though this rarely progresses to complete kidney failure requiring dialysis, should be taken seriously. Complications of CRI include hypertension (high blood pressure), anemia, neuropathy and an increased risk of heart disease. Specialty cancer centers have been performing partial nephrectomy (also called nephron sparing surgery), where the tumor is removed and the normal functioning kidney is left intact. This appears to dramatically reduce the risk of CRI in survivors, though it is not an option for all tumors.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Risk of kidney problems is increased for survivors who have had radiation to the kidney/abdomen or chemotherapy that can cause kidney damage (platin drugs, ifosfamide and methotrexate). Other factors found to increase the risk of kidney problems include diabetes, high blood pressure, smoking and being over 60 years of age. Kidney cancer survivors should have an annual physical by their healthcare provider, assuring that their blood pressure and blood sugar is normal (or well controlled on medication). Survivors should not smoke, given the additional stress this puts on the remaining kidney. Kidney damage may present as a decrease in kidney function, protein in the urine or hypertension (high blood pressure).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors who only have one kidney should be particularly careful to avoid damage to the remaining kidney. This includes avoiding contact sports (such as football and rugby) in which the remaining kidney could be damaged. As is true for anyone, survivors should wear seatbelts to minimize risk of organ damage in a car accident. In addition, abdominal surgeries can put survivors at risk for bowel obstructions (due to scarring), hernia (due to cutting the abdominal muscle) and changes in bowel patterns. Radiation therapy to the abdomen and pelvis can increase the risk of these complications.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have an annual history & physical by a healthcare provider, including blood pressure check.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not smoke. Seek assistance with cessation if currently smoking.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Take measures to reduce risk of damage to the remaining kidney, including avoiding contact sports.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lumpectomy

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgery for breast cancer can include mastectomy (removal of the entire breast) or lumpectomy (sometimes called breast conserving surgery, where only the breast mass (lump) and a surrounding area of normal tissue is removed). The surgeries can result in cosmetic deformities. In some cases, these can be corrected with breast reconstruction performed by a plastic surgeon. There is a risk of nerve damage during breast surgeries, which can lead to pain in the chest wall and/or pain and tingling in the arm/hand on the side of the surgery. Injuries like this can be aggravated by scar tissue formation after radiation therapy to the area, which can develop years after therapy. Neuropathic (nerve) pain is often described as burning or electric and can also include numbness, tingling and decreased strength or sensation. Survivors who develop chronic pain may benefit from a consult with a pain specialist.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Those who undergo a modified radical mastectomy, and sometimes those undergoing lumpectomy, may also have lymph nodes removed during surgery. The removal of lymph nodes increases the risk of developing lymphedema. In addition, patients, who have undergone lymph node dissection, may also develop nerve damage (as described previously), pain in the shoulder, or limitations in movement of the arm and shoulder. These complications may be temporary, but could become permanent. Exercises to promote shoulder mobility may be of help, and can be described and taught by a physical therapist.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors of breast cancer should speak with their health care provider regarding the possibility of a genetic or family syndrome. If there does appear to be a family history or possible genetic link, genetic counseling and testing may be warranted for the survivor and his or her family.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Be vigilant for signs/symptoms of lymphedema and ensure early and proper management.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Remember to do monthly self-breast exam. Get a mammogram on remaining breast(s) every year.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report pain the breast or chest wall to your healthcare provider.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consider physical therapy for decreased range of motion in the shoulder.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Whipple Procedure (pancreatectomy)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    A Whipple procedure is a surgical procedure (also called pancreaticoduodenectomy) that removes part of the pancreas, small bowel, gall bladder, bile duct, and stomach along with surrounding tissues, and is used to treat pancreatic cancer. The pancreas has two key functions: providing enzymes to aid in digestion of food, and the production of insulin. If a survivor is not producing enough enzymes for digestion due to removal of the pancreas or part of the pancreas, s/he can suffer from bloating, gas, fatty diarrhea which floats and is pale in color (steatorrhea) or weight loss. Survivors often need to take supplemental pancreatic enzymes, in pill form, to reduce these side effects. In about 15% of cases, the pancreas does not make enough insulin, and in those cases, survivors become diabetic and may need to receive insulin injections. This is usually discovered within a few days after surgery.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Other complications that can result after surgery are dumping syndrome (nausea and abdominal cramping followed by diarrhea), delayed emptying of the stomach leading to a feeling of fullness after only a couple of bites, bloating, heartburn, abdominal pain, and nausea/vomiting. To manage these problems, it may be best to consume small, frequent meals and avoid high-fat and high-fiber foods. It is very important for survivors to maintain adequate nutrition. Working with a dietician can be very helpful to manage problems and maintain good nutrition. Survivors should seek help from a dietician and alert their healthcare provider if they find they are not able to maintain weight. In addition, abdominal surgeries can put survivors at risk for bowel obstructions (due to scarring), hernia (due to cutting the abdominal muscle) and changes in bowel patterns. Radiation therapy to the abdomen and pelvis can increase the risk of these complications.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Complications regarding inadequate nutrition can result after pancreatectomy or partial pancreatectomy. Supplemental pancreatic enzymes may be helpful for survivors experiencing bloating, gas, or pale, floating stools.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Symptoms of diabetes after pancreatectomy may require insulin injections.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Nutrition is of utmost importance. Make sure to work with a dietician and healthcare provider to ensure proper nutrition and manage problems resulting from surgery.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgery Involving the Brain or Spinal Cord

                                                                                                                                                                                                                                                                                                                                                                                                                                                    It would be impossible to address every possible effect of surgery to the brain or spinal cord because these may be so dependent on the location of the surgery. In general, the survivor may have impairments related to the function of the area of the surgery. For instance, if a brain tumor is removed from the speech center, the survivor may have impaired speech. Survivors should be seen and evaluated by cancer rehabilitation specialists soon after surgery to develop a rehabilitation plan. Survivors may be on anti-seizure and/or steroid medication to help manage symptoms from the tumor or surgery. These medications can have interactions with other medications. Be sure to check with your healthcare provider before beginning any new medications (prescription or over the counter), vitamins, or herbal treatments.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report any changes in neurological function, pain, and/or side effects from medications to your healthcare provider.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Survivors on anti-seizure and/or steroid medication should be sure to check with a healthcare provider and/or pharmacist before beginning any new medications (prescription or over the counter), vitamins, or herbal treatments, as there may be an interaction with the new medication.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgery to Remove the Stomach (Gastrectomy)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Removal of all (gastrectomy) or part of the stomach (partial gastrectomy) leads to changes in absorption of nutrients and digestion. Survivors should be followed by a dietician. Vitamin B12 is absorbed by the stomach and will need to be supplemented by injections of B12 once or twice a month for life. Survivors may require supplemental calcium, folate and iron. When the stomach is removed, the esophagus is connected directly to the small bowel, changing the way food is digested. This will require the person to eat smaller, more frequent meals, with more proteins and fewer sugars and carbohydrates, to prevent complications such as nausea, vomiting and diarrhea. Dumping syndrome, nausea and abdominal cramping followed by diarrhea shortly after a meal, can also occur in survivors. This syndrome can be managed with dietary changes including eating small, frequent meals that are high in protein and low in carbohydrates, and taking-in minimal fluids while eating food so as to not flush out the food before nutrients are absorbed.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Heartburn or reflux may also be experienced by survivors especially early after treatment. It may be beneficial to remain in an upright sitting position for at least one hour after meals to help prevent reflux. Medications may also be beneficial in reducing reflux and maintaining esophageal health. Given the changes from surgery and other cancer treatment, survivors often have difficulty maintaining weight and getting adequate nutrition. A dietician can help with adapting to dietary changes, which can sometimes become less restrictive over time.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, abdominal surgeries can put survivors at risk for bowel obstructions (due to scarring), hernia (due to cutting the abdominal muscle) and changes in bowel patterns. Radiation therapy to the abdomen and pelvis can increase the risk of these complications.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Risk of Developing Osteoporosis

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Osteoporosis and osteopenia (the precursor to osteoporosis) are decreases in bone density, which increases the risk of fracture of the affected bones. Long term use of corticosteroids (dexamethasone or prednisone, > 5mg per day for more than 2 months), receiving chemotherapy medications (including methotrexate, ifosfamide, cytoxan, fluorouracil and interferon alpha) or radiation to weight bearing bones (spine, hips, legs) all increase the risk of developing osteoporosis.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Women who develop premature menopause, have their ovaries removed before menopause or those who take aromatase inhibitors (anastrozole, letrozole and exemestane) are at increased risk for osteoporosis. Men who receive hormone therapy for prostate cancer or undergo orchiectomy are at greater risk. In addition, patients who have undergone gastrectomy (removal of the stomach) are at increased risk to develop osteoporosis.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    As for lifestyle risks, smokers, people who consume excessive alcohol and those who do not participate in weight bearing exercise have an increased risk of developing osteoporosis. Therefore, it is very important that survivors not drink alcohol or smoke. In addition, survivors should engage in weight-bearing exercise such as walking, weight lifting, riding a stationary bicycle, jogging, dancing, and any exercise where the legs are supporting the body's weight. These efforts, combined with increasing calcium and vitamin D in your diet and taking calcium and vitamin D supplements, will greatly help to reduce your risk of developing osteoporosis.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors at risk should have adequate intake of calcium (1200-1500mg total per day, taken in divided doses) and vitamin D (400-800 international units per day if under age 50, and 800-1000 international units per day if over age 50). Calcium supplements are an easy way to get the recommended daily amount and come in 2 forms: calcium carbonate and calcium citrate. The body does have some trouble absorbing large amounts of calcium, so supplements should be split into 2 or more doses per day. Calcium carbonate requires stomach acid to be absorbed by the body, therefore people that take acid reducers (such as Zantac, Tagamet) and/or proton pump inhibitors (such as Prilosec, Prevacid, etc) should use calcium citrate. If you have trouble tolerating your calcium supplement, talk to your doctor or nurse; there may be another formulation you can tolerate more easily. It is important to take Vitamin D with the calcium supplements because it helps your body to absorb calcium better. Survivors should talk to their healthcare provider about screening with DEXA scan (a test used to assess bone density) and options for treatment, if necessary.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Complications regarding inadequate nutrition can result after gastrectomy, in particular Vitamin B12 deficiency. Make sure to work with dietician and healthcare provider to ensure proper nutrition and to help manage problems resulting from surgery.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Medications and behavioral adjustments may help with symptoms of dumping syndrome and reflux.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Osteoporosis prevention strategies include:
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Avoid smoking and excessive alcohol intake
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Perform weight bearing exercise 2-3 times per week
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Calcium intake of 1200-1500mg per day plus Vitamin D 400-800iu or 800-1000iu per day (either in dietary intake or supplements)
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Consider screening with DEXA scan

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgery for Rectal or Anal Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Modern surgical techniques have allowed many rectal and anal cancers to be resected without requiring a colostomy. While many have assumed this would lead to better quality of life for survivors, this has not proven to be true in studies. In many cases the survivor has traded the colostomy for a different set of challenges with their bowels. Survivors commonly report needing to move their bowels frequently and/or urgently, having loose bowels or incontinence, gas / bloating and being intolerant of certain foods. These problems can have a big affect on quality of life, but some planning may help. Start by keeping a food diary. Record what and when you eat, what side effects you experience, and when they occur in relation to meals. This may give you a clear idea of what foods you need to avoid, but can be very helpful to guide a meeting with a Registered Dietitian, who can help you with meal planning and other interventions.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, abdominal surgeries can put survivors at risk for bowel obstructions (due to scarring), hernia (due to cutting the abdominal muscle) and changes in bowel patterns. Radiation therapy to the abdomen and pelvis can increase the risk of these complications.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Eat frequent, small meals (5 to 6 times daily).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • The diet should consist of mostly complex carbohydrates, which are whole plant foods such as fruits, vegetables, and whole grains. This should comprise 50 to 60% of the total daily calories.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Include lean protein from sources such as the white meat of poultry, fish, and lean meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • No more than 20 to 30% of the diet should be fat. The healthiest types of fat are from plant sources such as olive oil & canola oil.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Include 5-7 servings of fruits and vegetables per day. Canned fruit and cooked vegetable such as green beans, beets, and carrots can be eaten if fresh fruit and vegetables are not tolerated.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Simple carbohydrates/sugars should be minimized. Examples of simple sugars are fruit juices or beverages and food items with sugar or high fructose corn syrup listed as one of the first 3-4 ingredients.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Foods should be well-chewed.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Fiber and vitamin supplementation may be indicated.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Removal of the Esophagus (Esophagectomy)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Esophagectomy is a surgery to remove all or part of the esophagus and surrounding lymph nodes. The esophagus is the tube that food moves through on its way from the mouth to the stomach. When the esophagus is removed, the stomach is pulled up into the chest and reattached to keep the food passageway intact. This stretching of the stomach takes away the ability to eat large meals, as there is no longer a large "holding area" for food to be digested. Nutrition is an important consideration for survivors, who should be followed closely by a dietician to address problems early.  Eating small, frequent meals will help to maintain adequate nutrition and prevent further weight loss. Other symptoms that may be experienced after esophagectomy include nausea/vomiting, feeling of fullness, difficulty swallowing, chronic heartburn/reflux, gas, and bloating. Medications may help with many of these symptoms. Dumping syndrome, which is nausea, a feeling of fullness, and abdominal cramping followed by diarrhea, all of which typically occurs shortly after a meal, can also be a lingering side effect after surgery. Survivors can find very useful information about problems that develop after surgery and diet recommendations that may help to prevent and manage these problems in the OncoLink Post Esophagectomy Diet article.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Long term survivors can continue to feel full early (called early satiety), making it difficult to keep up with nutritional needs. Nutritional status should be monitored by a primary care physician, and a dietician should be seen in consultation by survivors who are unable to take in enough food and liquids to maintain their weight or prevent dehydration.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Swallowing difficulties can occur after esophagectomy and can often be attributed to abnormalities of the pharyngeal phase of swallowing. This problem with swallowing consists of the feeling of food being "stuck", aspiration (the inhalation of food or liquids into the lungs, which can lead to pneumonia) and cough. Pharyngeal phase abnormalities typically resolve 1- 6 months after surgery.   However, some survivors will develop scar tissue over time as a result of surgery or radiation that can cause esophageal stricture, a narrowing of the esophagus that makes it difficult to swallow or causes a chronic feeling of food being "stuck". This complication can be corrected through esophageal dilatation, a procedure that stretches the area that has narrowed, relieving the stricture and/or the insertion of a stent to keep the area open. If survivors develop these symptoms, they should be evaluated by a gastroenterologist or surgeon.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, abdominal surgeries can put survivors at risk for bowel obstructions (due to scarring), hernia (due to cutting the abdominal muscle) and changes in bowel patterns. Radiation therapy to the abdomen and pelvis can increase the risk of these complications.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Adequate nutrition is essential to maintain weight and evaluation and/or ongoing consultation with a dietician may be useful.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report any swallowing difficulties, weight loss or pain to your healthcare providers.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report feelings of abdominal discomfort, including nausea, vomiting, heartburn, gas, or diarrhea to your healthcare providers, as medications may be available to treat these symptoms.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Excision or Moh's Surgery

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The goal of surgery for skin cancer is to remove all of the cancer cells, while preserving a good cosmetic outcome to the greatest extent possible.  When the cancer is melanoma, the surgeon may have removed a portion of healthy tissue from around the cancer, called a margin.  During a Moh's procedure, which is used most often to treat non-melanoma skin cancers, the goal is to remove the cancer cells and as little healthy tissue as possible.  Surgery to remove skin cancers can vary in difficulty depending on where the cancer is located. An area on the leg may be less complex for the surgeon than something on the face or near a structure like the eye. There are a few possible long-term complications with either procedure.  These procedures will result in a scar, although the extent of the scar can depend on the location, how much tissue was removed, and if you have a tendency to have abnormal scarring (such as keloids).  Scars can take a year to complete the healing process, and will change in appearance over this time.  Though rare, if nerves or muscles are cut during the procedure, you may develop decreased sensation, numbness or weakness, which can either improve over time or become permanent. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    If your surgery required a skin graft, you may notice decreased sensation or a lack of hair growth in the area of graft.  As the graft heals, it can contract or shrink, which may affect your ability to move that limb. If this occurs, you may benefit from seeing a cancer rehabilitation specialist.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Notify your healthcare provider if you notice any changes to the area of the excision, such as swelling, redness, or a new lesion or nodule (bump).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Retroperitoneal Lymph Node Dissection (RPLND) for Testicular Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Retroperitoneal lymph node dissection (RPLND) may be performed as part of the treatment of testicular cancer for two reasons – removal of lymph nodes in the pelvis that may be involved with tumor, and to provide staging information. The procedure can be performed before or after chemotherapy, with those having more advanced disease more likely to undergo RPLND after chemotherapy. The risk of complications is higher for patients having the procedure after chemotherapy. The reason for this increased risk is multifold: In some cases, patients having a RPLND after chemotherapy may have more advanced disease, with a larger volume of disease needing to be removed during RPLND. These patients may not be as fit prior to surgery because of treatment with chemotherapy and thus at higher risk for surgical complications.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    RPLND can result in short term complications such as infection and wound complications, hernia, leaking at the anastamosis (the point of surgical connection), ascites (fluid accumulation in the abdomen) or cyst formation, injury to the bowel, and urethral stricture (narrowing due to scarring). In the hands of a skilled surgeon these complications are quite rare and in almost all cases, they are repaired or diminish with in a few months of the surgery.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    RPLND rarely results in long term complications, but survivors should be aware of potential problems that may develop. Due to the number and complexity of nerves (including the spinal cord) in the area of the surgery, injury to these structures is possible. This can result in pain, weakness or paralysis. In a very small number of patients, the main return blood vessel for the lower extremities (inferior vena cava) is involved with tumor, which requires surgical removal. This is very rare and can result in chronic swelling of the lower extremities. In most cases, this swelling is isolated to the feet and resolves within a few months, but it can become a chronic issue.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sympathetic nerves in the retroperitoneum (lower abdomen) are responsible for sperm emission (release) and normal ejaculation. Up until the early 1980's, RPLND resulted in almost complete resection of these nerves, leading to dry ejaculation (or retrograde ejaculation, which means the ejaculate enters the bladder instead of exiting through the penis). The introduction of nerve sparing RPLND has made this a relatively rare complication, with rates ranging from 2-10%, depending on surgical skill and experience and the extent of the disease.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, abdominal surgeries can put survivors at risk for bowel obstructions (due to scarring), hernia (due to cutting the abdominal muscle) and changes in bowel patterns. Radiation therapy to the abdomen and pelvis can increase the risk of these complications.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • RPLND rarely results in long term complications, but survivors should be aware of potential problems that may develop. Due to the number and complexity of nerves (including the spinal cord) in the area of the surgery, injury to these structures is possible. This can result in pain, weakness or paralysis.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In a very small number of patients, the main return blood vessel for the lower extremities (inferior vena cava) is involved with tumor, which requires surgical removal. This is very rare and can result in chronic swelling of the lower extremities. In most cases, this swelling is isolated to the feet and resolves within a few months, though it can become a chronic issue.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Mastectomy

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Surgery for breast cancer can include mastectomy (removal of the entire breast) or lumpectomy (sometimes called breast conserving surgery, where only the breast mass (lump) and a surrounding area of normal tissue is removed). The surgeries can result in cosmetic deformities. In some cases, these can be corrected with breast reconstruction performed by a plastic surgeon. There is a risk of nerve damage during breast surgeries, which can lead to pain in the chest wall and/or pain and tingling in the arm/hand on the side of the surgery. Injuries like this can be aggravated by scar tissue formation after radiation therapy to the area, which can develop years after therapy. Neuropathic (nerve) pain is often described as burning or electric and can also include numbness, tingling and decreased strength or sensation. Survivors who develop chronic pain may benefit from a consult with a pain specialist.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Those who undergo a modified radical mastectomy, and sometimes those undergoing lumpectomy, may also have lymph nodes removed during surgery. The removal of lymph nodes increases the risk of developing lymphedema. In addition, patients, who have undergone lymph node dissection, may also develop nerve damage (as described previously), pain in the shoulder, or limitations in movement of the arm and shoulder. These complications may be temporary, but could become permanent. Exercises to promote shoulder mobility may be of help, and can be described and taught by a physical therapist.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors of breast cancer should speak with their health care provider regarding the possibility of a genetic or family syndrome. If there does appear to be a family history or possible genetic link, genetic counseling and testing may be warranted for the survivor and his or her family.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Key Takeaways

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Be vigilant for signs/symptoms of lymphedema and ensure early and proper management.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Remember to do monthly self-breast exam. Get a mammogram on remaining breast(s) every year.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Report pain in the breast or chest wall to your healthcare provider.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Consider physical therapy for decreased range of motion in the shoulder.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Living After Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Survivors often wonder what steps they can take to live healthier after cancer. There is no supplement or specific food you can eat to assure good health, but there are things you can do to live healthier, prevent other diseases, and detect any subsequent cancers early. 
                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition to medical problems and screening, cancer survivors also sometimes have issues with insurance, employment, relationships, sexual functioning, fertility and emotional issues because of their treatment and we will discuss those in this care plan. 
                                                                                                                                                                                                                                                                                                                                                                                                                                                    No matter what, it is important to have a plan for who will provide your cancer-focused follow up care (an oncologist, survivorship doctor or primary care doctor). You have taken the first step by developing a survivorship plan of care. If you would like to find a survivorship doctor to review your care plan you can contact cancer centers in your area to see if they have a survivor's clinic or search for a clinic on OncoLink's survivorship clinic list

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after ALL

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Acute Myeloid Leukemia

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Anal Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Appendiceal Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Bladder Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Brain Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Breast Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Cervical Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    **If you had a hysterectomy for your cancer treatment, your uterus and cervix were removed. Talk to your provider about your need for screening tests for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after CLL

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after CML

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Colon Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Endometrial Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Esophageal Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Gall Bladder / Cholangiocarcinoma

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Head & Neck Cancer: Tongue, Lip, Oropharynx, Nasopharynx

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Kidney Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Liver Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Lung Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Lymphoma

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Melanoma

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Multiple Myeloma

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Non-Melanoma Skin Cancers

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Ovarian Cancer / Primary Peritoneal Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    **If you had a hysterectomy for your cancer treatment, your uterus and cervix were removed and you do not need screening for those cancers. Talk to your provider about your need for screening tests for cervical and endometrial cancers based on the treatments you received.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Pancreatic Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Rectal Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Sarcoma

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Stomach Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Thymoma or Thymic Carcinoma

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Thyroid Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens.  In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population. The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Hodgkin Lymphoma

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    If you received radiation to the chest or axilla (armpit), you should follow these breast cancer screening reccomendations:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Annual breast exam by a healthcare professional, and monthly self-breast exam.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Begin annual mammograms 8-10 years post therapy, or at age 40, whichever is earlier.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Breast MRI, in addition to the annual mammogram, for women who had chest irradiation between the ages of 10 and 30 years.    

                                                                                                                                                                                                                                                                                                                                                                                                                                                    If you did not receive radiation to the chest/axilla, follow these recommendations:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS document, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Mesothelioma

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Uterine Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    **If you had a hysterectomy for your cancer treatment, your uterus and cervix were removed. Talk to your provider about your need for screening tests for cervical and endometrial cancers.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Vaginal and Vulvar Cancers

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    **If you had a hysterectomy for your cancer treatment, your uterus and cervix were likely removed and you would not need screening for those cancers. Talk to your provider about your need for screening tests for cervical and endometrial cancers based on the treatments you received.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Fallopian Tube Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    **If you had a hysterectomy for your cancer treatment, your uterus and cervix were likely removed and you would not need screening for those cancers. Talk to your provider about your need for screening tests for cervical and endometrial cancers based on the treatments you received.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Women after Myelodysplastic Syndrome

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for women. While these guidelines vary slightly between different organizations, they cover the same basic screening tests for breast, cervical and colorectal cancers, and are recommended to begin as early as the late teens. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In addition, during routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth and thyroid. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you, and at what age you begin them. Therefore, you should discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular type of cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society (ACS) recommends these screening guidelines for women:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Breast Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly mammograms are recommended starting at age 40, and continuing for as long as a woman is in good health.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Clinical breast exam (CBE), performed by a healthcare professional, about every 3 years for women in their 20s and 30s, and every year for women 40 and over.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • In addition to mammograms and CBE, a monthly breast self-exam (BSE) is a good way to monitor breast health. Women should know how their breasts normally look and feel, and report any change promptly to their health care provider.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that some women - because of their family history, a genetic tendency, or certain other factors - be screened with MRI in addition to mammograms. The number of women who fall into this category is small- less than 2% of all US women.  Talk with your doctor about your personal history and whether you should have additional tests at an earlier age. For more information, see the ACS article, Breast Cancer: Early Detection. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cervical Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    All women should begin cervical cancer screening at age 21 using the following methods:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 21-29: Pap testing done every 3 years. HPV testing is used only to follow up abnormal Pap results.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Age 30-65: Pap testing and HPV test done every 5 years. Alternatively, a woman could have a Pap test alone every 3 years.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Over age 65: women who have had normal Pap results can stop testing all together.  Women who have had a history of a serious cervical pre-cancer should continue to be tested for 20 years after that diagnosis, even if this continues past age 65.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had their uterus & cervix removed for reasons not related to cervical cancer and have no history of cervical cancer or pre-cancer do not need testing.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Women who have had HPV vaccination should still have Pap testing per the above guidelines.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Some women, because of their history, may need to have a different screening schedule for cervical cancer. Please see the ACS document, Cervical Cancer Screening Guidelines for more information.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Endometrial (Uterine) Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The ACS recommends that at the time of menopause, all women should be informed about the risks and symptoms of endometrial cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may want to consider having a yearly endometrial biopsy. Please talk with your doctor about your past medical and gynecologic history to determine whether you are at increased risk for endometrial cancer.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general cancer screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Men after Acute Lymphocytic Leukemia (Male)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for men. While these guidelines vary slightly between different organizations, they cover the same basic screening tests, including those for prostate and colorectal cancers. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    During routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth, thyroid and testes. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you and at what age you begin them. Therefore, be sure to discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Prostate Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Prostate screening recommendations from the American Cancer Society (ACS) recommend that men discuss the risks and benefits of prostate cancer screening with their physician, and make an informed decision about whether to be screened or not. Men at average risk for prostate cancer should have this discussion starting at age 50. Men with a father or brother who had prostate cancer before age 65, and all African American men, should have this talk starting at age 40 or 45. If you decide to be tested, you should have a PSA blood test with a digital rectal exam. How often you are tested will depend on your PSA result and family history. For more information, please see the document, Prostate Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Testicular Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The majority of testicular cancers occur between the ages of 15 and 45. All men should examine their testicles regularly, be familiar with their normal look and feel, and report any changes to their healthcare provider for further investigation. Visit the ACS for a guide to performing a testicular self-exam.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Men after Acute Myeloid Leukemia

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for men. While these guidelines vary slightly between different organizations, they cover the same basic screening tests, including those for prostate and colorectal cancers. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    During routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth, thyroid and testes. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you and at what age you begin them. Therefore, be sure to discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Prostate Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Prostate screening recommendations from the American Cancer Society (ACS) recommend that men discuss the risks and benefits of prostate cancer screening with their physician, and make an informed decision about whether to be screened or not. Men at average risk for prostate cancer should have this discussion starting at age 50. Men with a father or brother who had prostate cancer before age 65, and all African American men, should have this talk starting at age 40 or 45. If you decide to be tested, you should have a PSA blood test with a digital rectal exam. How often you are tested will depend on your PSA result and family history. For more information, please see the document, Prostate Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Testicular Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The majority of testicular cancers occur between the ages of 15 and 45. All men should examine their testicles regularly, be familiar with their normal look and feel, and report any changes to their healthcare provider for further investigation. Visit the ACS for a guide to performing a testicular self-exam.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Men after Anal Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for men. While these guidelines vary slightly between different organizations, they cover the same basic screening tests, including those for prostate and colorectal cancers. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    During routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth, thyroid and testes. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you and at what age you begin them. Therefore, be sure to discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Prostate Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Prostate screening recommendations from the American Cancer Society (ACS) recommend that men discuss the risks and benefits of prostate cancer screening with their physician, and make an informed decision about whether to be screened or not. Men at average risk for prostate cancer should have this discussion starting at age 50. Men with a father or brother who had prostate cancer before age 65, and all African American men, should have this talk starting at age 40 or 45. If you decide to be tested, you should have a PSA blood test with a digital rectal exam. How often you are tested will depend on your PSA result and family history. For more information, please see the document, Prostate Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Testicular Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The majority of testicular cancers occur between the ages of 15 and 45. All men should examine their testicles regularly, be familiar with their normal look and feel, and report any changes to their healthcare provider for further investigation. Visit the ACS for a guide to performing a testicular self-exam.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Men after Appendiceal Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for men. While these guidelines vary slightly between different organizations, they cover the same basic screening tests, including those for prostate and colorectal cancers. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    During routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth, thyroid and testes. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you and at what age you begin them. Therefore, be sure to discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Prostate Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Prostate screening recommendations from the American Cancer Society (ACS) recommend that men discuss the risks and benefits of prostate cancer screening with their physician, and make an informed decision about whether to be screened or not. Men at average risk for prostate cancer should have this discussion starting at age 50. Men with a father or brother who had prostate cancer before age 65, and all African American men, should have this talk starting at age 40 or 45. If you decide to be tested, you should have a PSA blood test with a digital rectal exam. How often you are tested will depend on your PSA result and family history. For more information, please see the document, Prostate Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Testicular Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The majority of testicular cancers occur between the ages of 15 and 45. All men should examine their testicles regularly, be familiar with their normal look and feel, and report any changes to their healthcare provider for further investigation. Visit the ACS for a guide to performing a testicular self-exam.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Men after Bladder Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for men. While these guidelines vary slightly between different organizations, they cover the same basic screening tests, including those for prostate and colorectal cancers. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    During routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth, thyroid and testes. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you and at what age you begin them. Therefore, be sure to discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Prostate Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Prostate screening recommendations from the American Cancer Society (ACS) recommend that men discuss the risks and benefits of prostate cancer screening with their physician, and make an informed decision about whether to be screened or not. Men at average risk for prostate cancer should have this discussion starting at age 50. Men with a father or brother who had prostate cancer before age 65, and all African American men, should have this talk starting at age 40 or 45. If you decide to be tested, you should have a PSA blood test with a digital rectal exam. How often you are tested will depend on your PSA result and family history. For more information, please see the document, Prostate Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Testicular Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The majority of testicular cancers occur between the ages of 15 and 45. All men should examine their testicles regularly, be familiar with their normal look and feel, and report any changes to their healthcare provider for further investigation. Visit the ACS for a guide to performing a testicular self-exam.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Men after Brain Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for men. While these guidelines vary slightly between different organizations, they cover the same basic screening tests, including those for prostate and colorectal cancers. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    During routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth, thyroid and testes. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you and at what age you begin them. Therefore, be sure to discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Prostate Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Prostate screening recommendations from the American Cancer Society (ACS) recommend that men discuss the risks and benefits of prostate cancer screening with their physician, and make an informed decision about whether to be screened or not. Men at average risk for prostate cancer should have this discussion starting at age 50. Men with a father or brother who had prostate cancer before age 65, and all African American men, should have this talk starting at age 40 or 45. If you decide to be tested, you should have a PSA blood test with a digital rectal exam. How often you are tested will depend on your PSA result and family history. For more information, please see the document, Prostate Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Testicular Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The majority of testicular cancers occur between the ages of 15 and 45. All men should examine their testicles regularly, be familiar with their normal look and feel, and report any changes to their healthcare provider for further investigation. Visit the ACS for a guide to performing a testicular self-exam.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Men after Breast Cancer

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for men. While these guidelines vary slightly between different organizations, they cover the same basic screening tests, including those for prostate and colorectal cancers. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    During routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth, thyroid and testes. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you and at what age you begin them. Therefore, be sure to discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Prostate Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Prostate screening recommendations from the American Cancer Society (ACS) recommend that men discuss the risks and benefits of prostate cancer screening with their physician, and make an informed decision about whether to be screened or not. Men at average risk for prostate cancer should have this discussion starting at age 50. Men with a father or brother who had prostate cancer before age 65, and all African American men, should have this talk starting at age 40 or 45. If you decide to be tested, you should have a PSA blood test with a digital rectal exam. How often you are tested will depend on your PSA result and family history. For more information, please see the document, Prostate Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Testicular Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The majority of testicular cancers occur between the ages of 15 and 45. All men should examine their testicles regularly, be familiar with their normal look and feel, and report any changes to their healthcare provider for further investigation. Visit the ACS for a guide to performing a testicular self-exam.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommends adults have their eyes examined every 2 years until age 60, then annually. People who wear glasses or corrective lenses or are at “high risk” for eye problems (i.e. diabetics, family history of eye disease) should be seen more frequently.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Dental Association recommends adults see their dentist at least once a year.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Genetic Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer is a condition where certain cells in the body are no longer growing and dividing normally. Genes are the instruction manuals contained in all of our cells. Cells receive many instructions from genes about when to grow and divide, and when to stop growing. If certain genes are not working properly (they have a mutation) then cells may not get the proper instructions about when to grow and divide and, as a result, cancer can develop.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    In families with hereditary forms of cancer risk, a mutation is present in a single, very important gene, and is present at birth in all cells in the body. A child may inherit this gene mutation from a parent. Inheriting a mutation in a gene that plays a very important role in controlling normal cell growth substantially increases cancer risk. However, these cancer risk genes in no way guarantee that cancer will develop; inheriting a mutation in a cancer risk gene means only that your risk is higher than someone who does not carry such a mutation in their cells.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Society of Clinical Oncology suggests that you consider genetic testing if your personal or family history is suggestive of a genetic mutation, including:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Cancer diagnosed at an unusually young age.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Several types of cancer in the same person.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Cancer in both organs in a set of paired organs, for example, both breasts or kidneys.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Several close blood relatives with the same type of cancer (mother, sisters, daughter).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Unusual cases of a specific cancer (for instance, breast cancer in a male).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Presence of birth defects related to an inherited cancer syndrome (which can include skin growths or skeletal abnormalities).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Being a member of a racial or ethnic group with a known higher risk of a hereditary cancer syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Not every family that has multiple cancer cases is found to have a genetic mutation. If you are concerned that your family may have such a mutation, you should consult with a genetic counselor. These trained professionals will review your detailed family history, discuss the risks, benefits, and limitations of genetic testing and help you decide what is right for you. If you do undergo genetic testing, the genetic counselor will help you understand how the results affect you and your family. They will also help you outline a plan for cancer screening that is tailored to your level of risk.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    General Cancer Screening for Men after CLL

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Cancer screening tests are designed to find cancer or pre-cancerous areas before there are any symptoms and, generally, when treatments are most successful. (Learn more about screening tests) Various organizations have developed guidelines for cancer screening for men. While these guidelines vary slightly between different organizations, they cover the same basic screening tests, including those for prostate and colorectal cancers. 

                                                                                                                                                                                                                                                                                                                                                                                                                                                    During routine health exams (at any age) your healthcare provider may also evaluate for cancers of the skin, mouth, thyroid and testes. Not all screening tests are right for everyone.  Your personal and family cancer history, and/or the presence of a known genetic predisposition, can affect which tests are right for you and at what age you begin them. Therefore, be sure to discuss these with your healthcare provider. Your care plan will also include a section on follow up care for your type of cancer, and these recommendations override the general screening recommendations for that particular cancer in the general population.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Prostate Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Prostate screening recommendations from the American Cancer Society (ACS) recommend that men discuss the risks and benefits of prostate cancer screening with their physician, and make an informed decision about whether to be screened or not. Men at average risk for prostate cancer should have this discussion starting at age 50. Men with a father or brother who had prostate cancer before age 65, and all African American men, should have this talk starting at age 40 or 45. If you decide to be tested, you should have a PSA blood test with a digital rectal exam. How often you are tested will depend on your PSA result and family history. For more information, please see the document, Prostate Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Testicular Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The majority of testicular cancers occur between the ages of 15 and 45. All men should examine their testicles regularly, be familiar with their normal look and feel, and report any changes to their healthcare provider for further investigation. Visit the ACS for a guide to performing a testicular self-exam.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For More Information:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Visit the American Cancer Society to learn more about general screening recommendations.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Colon and Rectal Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Most men and women over the age of 50 should undergo routine screening for colon and rectal cancer. Testing may be appropriate for younger people with a high-risk personal or family health history.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Options for colon cancer screening can be divided into those that screen for both cancer and polyps, and those that just screen for cancer. Tests that screen for cancer and polyps include flexible sigmoidoscopy, colonoscopy, double-contrast barium enema, or CT colonography (virtual colonoscopy). Tests that screen mainly for cancer include stool testing for blood, or stool DNA testing. Learn more about colorectal cancer screening options.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The “preferred screening” recommended by the American College of Gastroenterologists is a colonoscopy every 10 years. The ACS recommends screening beginning at age 50 (unless you are considered “high risk,” see below), using one of the following testing schedules:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that find polyps and cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    (Preferred over those that find cancer aloneIf any of these tests are positive, a colonoscopy should be done.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Flexible sigmoidoscopy every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Colonoscopy every 10 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Double-contrast barium enema every 5 years, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • CT colonography (virtual colonoscopy) every 5 years

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Tests that primarily test for cancer:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal occult blood test (FOBT)*, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Yearly fecal immunochemical test (FIT) *, or
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Stool DNA test (sDNA), interval uncertain*

                                                                                                                                                                                                                                                                                                                                                                                                                                                    * The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Talk with your doctor about your medical history, and what colorectal cancer screening test and schedule is best for you. For more information on colorectal cancer from the ACS, read: Colorectal Cancer: Early Detection.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Individuals at higher risk of colon cancer should have screening earlier and potentially more frequently. Individuals at higher risk of colon and rectal cancer include:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a family history of colon or rectal cancer in a relative who was diagnosed before the age of 60.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a history of polyps.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Individuals with a genetic predisposition to colon or rectal cancer, such as hereditary non-polyposis colon cancer (HNPCC) syndrome or familial adenomatous polyposis (FAP) syndrome.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For more detailed information regarding screening for individuals at higher risk for colon cancer, see the ACS guidelines for screening for high risk individuals.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Lung Cancer Screening

                                                                                                                                                                                                                                                                                                                                                                                                                                                    The American Cancer Society does not recommend tests to check for lung cancer in people who are at average risk. However, they do have screening guidelines for those who are at high risk of lung cancer due to cigarette smoking. Screening might be right for you if you meet the following:

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • 55 to 74 years of age and in fairly good health
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have at least a 30 pack-year smoking history AND are either still smoking or have quit smoking within the last 15 years (A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 15 years.)

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Screening is done with a low-dose CT scan (LDCT) of the chest. If you fit the list above, you and a doctor should talk about whether you want to start screening.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Sun Exposure and Skin Cancer Risk

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Skin cancer is the most commonly diagnosed type of cancer, and rates are on the rise. However, this is one cancer that in most cases can be prevented or detected early. While you may hear that you need the sun to make vitamin D, in reality you only need a few minutes a day to do this. Exposure to ultraviolet (UV) rays, either by natural sunlight or tanning beds, can lead to skin cancer. In addition, UV rays lead to other forms of skin damage, including wrinkles, loss of skin elasticity, dark patches (sometimes called age spots or liver spots), and pre-cancerous skin changes (such as dry, scaly, rough patches). Although dark-skinned people are less likely to develop skin cancer, they can and do develop skin cancers, most often in areas that are not exposed to sun (on the soles of the feet, under nails, and genitals).

                                                                                                                                                                                                                                                                                                                                                                                                                                                    You can do a lot to protect yourself from damaging UV rays and to detect skin cancer early. Start by practicing sun safety, including using a broad spectrum sunscreen (which protects against UVA & UVB rays) every day, avoiding peak sun times (10am-4pm, when the rays are strongest) and wearing protective clothing such as hats, sunglasses and long sleeved shirts.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Examine your skin regularly so you become familiar with any moles or birthmarks. If a mole has changed in any way, you should have a healthcare provider examine the area. This includes a change in size, shape, or color, the development of scaliness, bleeding, oozing, itchiness, or pain, or if you develop a sore that will not heal. If you have a lot of moles, it may be helpful to make note of moles using photographs or a “mole map”. The American Academy of Dermatology has a helpful guide to performing a skin exam

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Learn more about the types of skin cancer on OncoLink and the Skin Cancer Foundation.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    Healthy Lifestyle

                                                                                                                                                                                                                                                                                                                                                                                                                                                    For some cancer survivors, the experience is the impetus to making healthy lifestyle changes. It may seem insignificant, but these changes have been shown to reduce the risk of the cancer coming back or a new cancer developing. Below are some tips on adopting a healthier lifestyle.

                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Do not use tobacco in any form. If you do, learn more on OncoLink and talk to your healthcare provider about taking steps to quit.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Maintain a healthy weight. Many studies have found that excess weight plays an important role in cancer development and recurrence. While maintaining a healthy weight is important in cancer prevention, it cannot easily be separated from the importance of physical activity and eating a healthy diet. Strive to incorporate all three pieces of the puzzle: healthy weight, balanced diet and regular exercise.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Talk to your healthcare team about what a healthy weight is for you, and take steps to reach and maintain that weight.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Experts recommend at least 30 minutes of moderate to vigorous activity per day, 5 days a week.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Eat healthy, including plenty of fruits and vegetables daily. Strive to have 2/3 of your plate be vegetables, fruits, whole grains and beans, while 1/3 or less should be an animal product. Choose fish and chicken and limit red meat and processed meats.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about recommendations for diet, activity and weight in the AICR’s Guidelines for Survivors and the ACS Eat Healthy and Get Active information on their website.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn more about the benefits of physical activity from Macmillan Cancer Support.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Limit how much alcohol you drink (if you drink at all).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Have regular check-ups by a healthcare professional.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Keep up-to-date on general health screening tests, including cholesterol, blood pressure and glucose (blood sugar) levels.
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • Learn about healthy screening tests for women and men from the US Department of Health and Human Services.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get an annual influenza vaccine (flu shot).
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Get vaccinated with the pneumococcal vaccine, which prevents a type of pneumonia, and re-vaccinated as determined by your healthcare team. Learn more about adult vaccinations from the CDC.
                                                                                                                                                                                                                                                                                                                                                                                                                                                    • Don’t forget dental and eye health!
                                                                                                                                                                                                                                                                                                                                                                                                                                                      • The American Optometric Association recommend