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Types

There are three different types of transplant related cancers that may affect transplant recipients:

Donor related cancers

Although very rare, cancer can be transmitted through deceased and living donor organ, cell and tissue transplantation.

Treatment of donor related tumors consists of changing, reducing or stopping immunosuppressive drug therapy, returning to chronic hemodialysis (for renal recipients) and possible re-transplantation.

Recipient past history of cancer

Transplant recipients with a history of pre-existing malignancies have a very low incidence of recurrence post-transplant. Recurrence rates are obviously affected by the specific type of cancer, the extent of the disease at treatment, the time elapsed since the treatment and the natural history of the malignancy in the normal population.

Cancer due to suppression of the immune system

Transplant recipients have an increased risk of developing new cancers in general (one to two percent per year) and a 15-20 percent higher incidence of certain types of cancer.

Skin cancer and lymphomas (cancers of the lymph glands) are the most prevalent types of cancer seen post transplantation. The risk of cervical, breast cancer and colorectal cancer are also increased.

When it comes to skin cancer, post-transplant patients, in particular, have a significantly increased risk of developing squamous cell carcinomas, as well as increased risk for other types of skin cancers, such as melanoma.

A smaller number of transplant recipients develop lymphoma within a year of the operation. This cancer is the growth of white blood cells in the body's immune system. There are several treatment options that will require careful assessment by your specialists. Some lymphomas will go away if your anti-rejection drugs are reduced or stopped, while some will respond to drugs (chemotherapy) or X-ray treatment (radiotherapy).

A small number of patients develop non-skin, non-lymphoma solid cancers. When this occurs, standard cancer treatment options, including surgery, radiotherapy and chemotherapy must be individualized to the patient, and coordinated by the oncologist and transplant surgeon/physician. A thorough consideration of the patient’s tumor risk, treatment risk and risk of graft loss must also be made.

For renal recipients, immunosuppression may be reduced or stopped even to the point of graft loss and return to hemodialysis. For liver recipients with malignancy confined to the transplanted liver, retransplantation is an option. Switching immunosuppression from a calcineurin inhibitor (Cyclosporine, Tacrolimus) to a Target-of-Rapamycin (TOR) inhibitor (Sirolimus) should be considered as the incidence of malignancies associated with TOR inhibitors is less than the malignancy incidence associated with calcineurin inhibitors. Additionally, there have been reports of malignancy regression when immunosuppression was switched from a calcineurin inhibitor to a TOR inhibitor.




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