05. PTC: Cancer Risks for Heart Recipients

All organ transplant recipients are at heightened risk of developing cancer after transplant. This is because although life-sustaining, long-term use of immunosuppressant drugs lowers the body’s ability to fend off certain cancers. When you are taking immunosuppressant drugs, your immune response is lowered, and this is what helps to prevent your body from rejecting your new heart. It also means that your body is less able to recognize and destroy cancer cells or infections that can cause cancer.

Additionally, because immunosuppressant drugs reduce your body’s natural monitoring and disease response, you are at increased risk of developing certain viral infections that are linked to increased cancer risk. A common cancer to develop for both heart and kidney transplant recipients is Non-Hodgkin Lymphoma (NHL) in which tumors develop from a type of white blood cell called lymphocytes.

Note: For full versions of any of the INTRO video clips below, go to the full library of ONLINE resources at https://www.triowebptc.org/link/resource-library.html

With the ultimate goal of catching cancers early when they are very treatable, the heart transplant patients surviving the longest are those that closely adhere to their transplant programs' testing regimen.  Once the patient is in long-term recovery, typically by the 9 months to 1-year milestone post-surgery, annual and semi-annual testing will catch some cancers that are beyond the everyday symptoms that are obvious.  A PSA test for men, as an example, is typically part of the annual blood testing which will raise alarms for prostate cancer.  But equally important are others, like the eye exams and dermatology visits that are recommended but left to the patient to schedule and complete on their own.  Typically the clinic visit will include a verbal questioning about those 'outside' careful vigilance practices, but it is up to the patient to give honest responses and to take those actions.  Some patients, either because of the testing expense or being too busy, fail to follow the team's proactive advice and pay the price in cancer issues that come up too late for easy and effective treatment.

For all people, cancer risk increases as a natural part of the aging process. For heart transplant recipients, the risk increases with each year of immunosuppressant drug use. This means that the longer heart transplant recipients survive post-transplant, the greater the incidence of cancer. In fact, cancer is the leading cause of death for heart transplant recipients. There are also certain lifestyle choices that can raise your risk of cancer, such as not getting regular exercise, smoking, or having a poor diet. Below you can read about some of the most common cancers for heart transplant recipients like skin, lung, breast, prostate and colon cancers.  Explore the look pages to learn more about each of these types of cancer and how to manage your risk.

• Skin Cancer: Some research has found that heart recipients are at 50 times greater risk of developing skin cancer compared to the general public. Over time the risk can become greater, especially if you live in a place with lots of exposure to sunlight and have fair skin. The possibility of skin cancer increases from 7% to 45% after eleven years, and 70% after twenty years of using the medicine that suppresses your immune system. Squamous cell cancer is one of the more aggressive types of skin cancer found for people who receive a heart transplant, and tends to reoccur more than other types of skin cancers. Compared to other types of transplants people get, people who receive a heart transplant have to take more intense immunosuppression medications and are at an especially high risk for skin cancer.

• Lung, Bladder, Prostate, Breast, Cervix, Colon and Kidney: Some research has found that heart transplant recipients are at higher risk of developing solid tumors in these areas. Other reported cancers include the following: Kaposi’s sarcoma, adenocarcinoma, melanoma, and solid tumors such as prostate, lung, bladder, breast, cervix, colon, and kidney. (https://www.clinmedjournals.org/articles/ijtrm/international-journal-of-transplantation-research-and-medicine-ijtrm-2-022.php?jid=ijtrm)

• First and most important, follow your transplant team's advice and recommended precautions and healthcare screenings.
• Follow your care team’s advice when it comes to sun exposure. Transplant medications can make your skin more sensitive to sunlight leading to skin cancers.
• See a dermatologist regularly who specializes in treating transplant patients. A specialist will have a better understanding of your unique needs as a transplant recipient and can work with your transplant team to adjust medication dosages or propose different medication options to reduce the risk of skin cancers.
  • If you do develop skin cancer, your dermatologist can use a special pain-free procedure to completely remove the cancer. This is called a Mohs surgery and is a common procedure used with transplant patients.
• If you are a smoker, commit to quitting. Quitting can be daunting, but there are many resources available to help you make a plan to quit and stick to it.
• Eat a healthy balanced diet.
• If you are overweight, consider trying to lose weight. For help, take a look at these resources. [coming: a link to external resources and programs]
• Stay active. As approved by your physician, getting regular exercise has been linked to reduced cancer risk.

1. Learn the signs and symptoms for early skin cancer detection through this short description with example pictures: https://www.cancer.org/latest-news/how-to-spot-skin-cancer.html
2. Learn more by watching the longer video [click here for that video] that gives an in-depth exploration of this subject. Note there are some graphic images included, which are intended to help you know what to look for and motivate you to take action.
3. Use the closing link below to move to the LOOK section where topics addressing the more common cancer symptoms are explained.
4. After reading about the symptoms, use the LIVE section to understand how to prevent, diagnose, treat and live long in recovering from cancer.
5. Under the site's LINKS section, you can watch patient testimonials of transplant recipients living successfully with cancers of various types. There you will also find 10 Best Practices for living with the risks of post-transplant cancer, as well as an extensive list of online reading and video resources related to this important issue.

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