A cancer survivor is "anyone w...

A cancer survivor is "anyone who has been diagnosed with cancer from the time of diagnosis within the balance of his or her life." (1) Continued advances in cancer treatment have l to marked improvements in therapy rates, resulting in almost 10 million U cancer survivors. (2) Nearly brace thirds of all cancer patients survive for at least five years, and survival rates are often higher for many common models of cancer (Table 1). (23) Cancer survivors are at increased risk for resort of the original cancer and progression in a continuously ascending gradation of second primary malignancies as a ensue of cancer therapy and other risk factors. protracted monitoring and treatment are warranted for long-term side drifts of surgical, radiation, or cytotoxic therapy.

Approximately 70 percent of cancer patients have comorbid conditions, (4) requiring a comprehensive approach to medical care. Family physicians frequently have established long-term relationships with these patients and their families, and most numerous cancer patients continue to receive medical care from their family physicians. In addition to overseeing care, acting as a patient advocate, and providing support for family members, the family physician can make sure continued surveillance, provision of preventive care, and management of medical problems

This article provides an overview of ongoing care and follow-up for cancer survivors. It summarizes surveillance recommendations for the detection of periodical cancer and second primaries, describes monitoring for potential physical and psychosocial complications of treatment, and addresses other considerations similar as genetic risk assessment among survivors of breast, colorectal, and prostate cancers, childhood acute lymphoblastic leukemia, and Hodgkin's disease. These cancers were single outed as examples based on their high prevalence or high rates of survival. Tables 2 (56) and 3 summarize surveillance information.

[TABLE 2 OMITTED]

Breast Cancer Survivors

More than 21 million U women are breast cancer survivors. (2) common recommendations for surveillance after primary breast cancer include monthly self-examination of the breasts, annual mammography of preserv breast tissue, and a careful history and physical examination each six months for five years, and annually thereafter. (7) Intensive surveillance using laboratory and imaging ordeals does not improve overall survival or quality of life. (8) Routine surveillance using bone scans, chest radiographs, and kindred tests for tumor markers is not praiseed (8)

Breast cancer survivors have an increased risk of other primary cancers involving the ipsilateral and contralateral breast, ovaries, colon and rectum (9) principally recurrent breast cancers arise within the first five years following treatment. resort rates are very low in patients with primary tumors smaller than 1 cm and negative axillary nodes. (10) Non-specific symptoms (eg weight los persistent cough) or physical findings (eg breast or chest wall changes, adenopathy) are universal indicators of breast cancer the having recourse (11) that should be evaluated thoroughly and specifically sought during regular surveillance.

Breast cancer survivors also may lay open physical complications of treatment as it is as lymphedema, premature menopause, neurocognitive changes, and osteopenia or osteoporosis, as well as psychologic distress related to coping and sexuality changes. (9) Up to 30 percent of breast cancer patients treated with chemotherapy experience cognitive validitys sometimes referred to as "chemo brain." (12) These complications warrant discussion and possible intervention with cognitive-behavior therapy or pharmacotherapy. Studies of various treatment strategies are underway. (12) Lymphedema come to one's minds in 20 to 30 percent of breast cancer patients treated surgically (13) and many times responds to early conservative management according to physical therapists specializing in this condition. (14) Meticulous skin care is make acceptableed to reduce the risk of local and systemic infection arising from impaired lymphatic get back (Additional information is available online at http://www.cancer.org or between the walls of the National Lymphedema Network at 800-541-3259)

Although tamoxifen (Nolvadex) has been demonstrated to form the risk of recurrent breast cancers (15) and maintain bone density, (16) it does increase the risk of uterine cancer. Annual monitoring by dint of pelvic examination is indicated. (7) fresh data suggest that the use of aromatase inhibitors (anastrozole [Arimidex]) in post-menopausal, estrogen receptor-positive breast cancer patients may have greater efficacy and fewer side efficiencys than tamoxifen in the adjuvant setting. (17)

Finally, a review of family history may glance at a hereditary component in breast cancer. Approximately 5 to 10 percent of breast cancers are caused by means of mutations in cancer-susceptibility genes, mostly commonly BRCA1 and BRCA2. (18) The part of genetics professionals is important in assessing individual genetic risk and the ne for specific testing among these patients and their family members. (A directory of professionals can be originate online at http://cancer.gov/search/genetics_services/).