Screening Recommendations for Other Cancers

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1 Department of Otolaryngology Head and Neck Surgery One Hospital Dr., MA314, DC Columbia, MO PHONE: FAX: WEB: Screening Recommendations for Other Cancers Prostate Cancer - Men between 45 and 55 years old who have a higher risk for prostate cancer may need a PSA test and/or a doctor s exam every year - Talk to your local primary care doctor before getting screened. You should understand the potential risks and benefits of prostate cancer screening. Testicular Cancer - There is no standard or routine screening test used for early detection of testicular cancer. Most often, testicular cancer are first found by men themselves, either by chance or during self-exam. Sometimes the cancer is found by a doctor during a routine physical exam - Let your primary care doctor know if you find a lump in your testicle Colon and Rectal Cancer - Men and women between 50 and 75 years old need a fecal occult blood testing, sigmoidoscopy, or colonoscopy. Testing frequency can vary depending on your colon and rectal cancer risk. - Men and women at higher risk for colorectal cancer may be screened at an earlier age and/or more frequently Lung Cancer - Men and women between 55 and 74 years old with a history of smoking (1 pack per day for 30 years) are at higher risk for lung cancer and may need a low dose chest CT or chest x-ray every year Skin Cancer - Men and women who are 65 years or older and are fair-skinned should have their whole body checked every year Breast Cancer - Women 40 years and older need a mammogram every one to two years - Women in their 20s and older may perform yearly self-breast exams - Women should know how their breasts normally look and feel and report any breast change promptly to their local doctor. Cervical Cancer - Women between 21 and 29 years old should have a Pap smear every 3 years - Women between 30 and 65 years old should have a Pap smear plus an HPV test every 5 years - Women 65 years old and over who have had regular cervical cancer testing with normal results may stop testing unless you have had an abnormal test result less than 20 years ago and/or a family history of cervical cancer - Women who have had their uterus and cervix removed may not need to be tested for cervical cancer

2 ADVICE FOR HEALTHY LIVING AND TO HELP PREVENT CANCER Don t smoke or chew tobacco Don t drink alcohol heavily or drink it every day Smoking, chewing tobacco, and/or drinking alcohol can increase the severity of treatment side effects, can increase your chances of getting a second cancer or having your head and neck cancer come back Be a healthy weight - Exercise regularly and eat a well-balanced diet - Eat four to five cups of fruits and vegetables every day - Keep your body mass index (BMI) between 18.5 and (Your current - Exercise for 30 to 60 minutes at least five days every week - Do muscle strengthening exercise for at least two days every week Use sunscreen with an SPF of 15 or higher and with UV-A and UV-B protection. Put on more sunscreen every two hours when you are in the sun LONG-TERM FOLLOW-UP CARE OF YOUR HEAD AND NECK CANCER Follow-up visits are needed with your UI head and neck surgeon or UI head and neck survivorship provider to detect new cancers, recurrence, or assessing for late effects of treatment. Have a physical exam of the head and neck with an endoscopy, using the following schedule: - Year 1 (the first year after your treatment is finished): every 1 to 3 months - Year 2: every 2 to 4 months - Year 3-5: every 4 to 6 months - After 5 years: 6 to 12 months Tests and lab studies - Your doctor may want you to have PET or CT scans done at three months and at 12 months after your treatment is finished, if clinically indicated - Have a chest x-ray every one to two years, if clinically indicated - Have your thyroid level (TSH) checked each year if you had radiation to your neck - Have your blood and blood pressure checked every year if you received chemotherapy Have a yearly physical exam with your local primary care provider that may include: - Heart and lung exam - Blood pressure check - Routine labs work, including a complete blood count (CBC), cholesterol levels, electrolytes (BMP or CMP). Have a routine dental evaluation every six to 12 months Have your vision checked every one to 5 years, if clinically indicated Have your skin checked every year by your local primary care provider or a dermatologist, if clinically indicated CHECK FOR NEW OR RETURNING CANCER Call your UI head and neck surgeon or UI head and neck survivorship provider if you have: - New pain - Weight loss - New coughing or spitting-up blood - Difficulty swallowing

3 - Difficulty opening the mouth completely - Sores in the mouth that don t heal - Earache, especially with swallowing HEAD AND NECK CANCER TREATMENT SIDE EFFECTS *Acute, late or long term effects of cancer treatment can vary greatly depending on the type of surgery, chemotherapy and the areas included in the field of radiation therapy. SURGERY - Head and neck surgery can injure nerves. This may cause pain, numbness, tingling, or weakness in your arms, fingers, legs, or toes. - Chewing, swallowing, talking, or breathing may be harder for you - You might inhale food or liquids into your lungs, which can lead to pneumonia - Movement of your neck may be limited - You may have changes in your hearing and how things taste or smell - Your voice may change RADIATION - Exposing healthy skin, muscle, and bone to radiation might cause other cancers - Follow your doctor s advice to check for any signs of cancer - EYES - Radiation therapy can cause cataracts to form - See an eye doctor (ophthalmologist) if your eyesight changes, if things look blurry, it is harder for you to see at night, if you see things in double, or if you see circles or halos around objects - Have your eyes checked every one to five years. Have your eyes checked right away if your eyesight changes. - MUSCLES, BONES, JOINTS - Radiation may cause your soft tissues and muscles to scar or shrink under the skin. This can affect how easily your body can move - Swelling in your neck can occur and may harden over time. Massaging this area may help reduce the swelling. Please tell your doctor if your face or neck swelling becomes concerning to you or discomforting. - Radiation may cause arthritis in your neck. It also can make it easier for your bones or joints to break (fracture). - Trismus or the inability to full open your jaw can occur after radiation therapy. This occurs by a combination of spasm, fibrosis and contraction of the muscles responsible for movement at your jaw joint or temporomandibular joint (TMJ). Please see your doctor if you are having trouble opening your mouth. - See your doctor if you have any new back or neck pain - Radiation to your neck and throat can cause scarring or swelling. This may make it harder for you to speak, swallow, or breathe. Please talk to your doctor if you have these symptoms. - OSTEORADIONECROSIS (oss -tee-oh-ray -dee-oh-neh-kro -sis) - Radiation treatment can cause a wound of your jaw or bone that won t heal. This is called osteoradionecrosis. - This can cause pain, swelling, and your jaw may be hard to move. See your doctor right away if you have any of these symptoms.

4 - Take good care of your teeth and mouth. See your dentist regularly. - Poor dental care may increase your risk of late complications, such as osteoradionecrosis and infections - Let your dentist know you had radiation treatment for a head and neck cancer before having any teeth pulled or any major dental procedures. - You may need to contact your Radiation Oncologist before having any teeth pulled or any major dental procedures - LYMPH NODES - Radiation to lymph nodes or having lymph nodes removed can cause swelling (lymphedema) - Massaging the swollen area can help with the pain and discomfort. - Please contact your doctor if the swelling and discomfort continue or becomes worse. - STROKE - Radiation could cause injury to your carotid artery and narrow your veins and arteries - You may be more at risk for an ischemic stroke or carotid artery stenosis (narrowing of the artery). A past history of smoking and elevated cholesterol levels can also increase your risk of a stroke. - Make lifestyle choices that are good for your heart and arteries limit the amount of fat you eat, eat a balanced diet, and exercise regularly - Have your blood pressure and cholesterol checked every year - TEETH AND SALIVA GLANDS - Radiation can make it hard for your mouth to make spit (saliva). This is called xerostomia or dry mouth. - Dry mouth can make it harder for you to eat and speak - It can cause tooth decay and cavities - Dry mouth can cause tenderness and infection of your gums - See your dentist regularly, every six to 12 months - Fluoride treatments can help protect your teeth - THYROID - Radiation treatments near your thyroid can cause thyroid disease, nodules, or thyroid cancer - Your doctor may want lab tests (thyroid-stimulating hormone or TSH) and/or an ultrasound CHEMOTHERAPY - Exposing your body to chemotherapy can damage normal cells - Chemotherapy can cause effects that can last for a short or long time, or can appear long after treatment is finished - Some chemotherapy can hurt cells in your brain, heart, bone marrow, ears, skin and nerves. - COGNITIVE or Chemo-brain - Chemotherapy can cause problems with short-term memory, trying to do more than one thing at a time, learning new things, understanding what you read, working with numbers, and having trouble concentrating - Some cognitive abilities can improve over time, but deficits can continue in many long term survivors.

5 - HEART - Chemotherapy can affect your heart, blood pressure, cholesterol, and may narrow your veins and arteries - You may be more at risk for cardiac events such as a heart attack (myocardial infarction) or angina (chest pain) - Make lifestyle choices that are good for your heart limit the amount of fat you eat, eat a balanced diet, and exercise regularly - Have your blood pressure, cholesterol, and a complete blood count with differential (CBC with diff) checked every year - BLOOD - Some chemotherapy medicine can hurt the blood cells in your bone marrow - This can cause blood cancers, leukemia or myelodysplasia, even years after you finish your treatment - Have a complete blood cell count with differential (CBC with diff) checked every year - NERVES - Chemotherapy can irritate or hurt your nerves. This is called peripheral neuropathy. - You may feel numbness, tingling, or burning - You may have a feeling of heaviness or weakness in your fingers, arms, toes, or legs - These symptoms may show up during chemotherapy treatment. Tell your UI medical oncologist or UI head and neck survivorship provider if you have any of these symptoms at any time CHEMORADIATION THERAPY - EARS - The chemotherapy medicine, Cisplatin, may cause hearing loss, ringing in your ears (tinnitus), or a feeling of spinning or losing your balance (vertigo). This can happen during or after treatment is finished - Radiation can make your ear canals dry and can cause fluid to collect in your inner ears - If you hearing changes, have it tested with a hearing test (audiogram) - SKIN - Some chemotherapy medicines and radiation treatments may cause your skin, hair, or nails to change. This can happen during or after treatment. - You may see a bronzing look in the area that received radiation treatment - The area may become red, dry, tender, and itchy - Wash your skin with water and mild soap - Use a moisturizing lotion for dry or scaly skin - Protect all open sores or wounds - Use sunscreen when you are outdoors - See a dermatologist if you have changes in your skin SURGERY and CHEMORADIATION THERAPY - FATIGUE - Fatigue may be worse during treatment but can persist in some survivors after completing treatment. - Avoid fatigue by getting enough sleep at night, incorporating physical activity into your life and eating a healthy diet may be helpful. - Let your doctor know if your fatigue is worsening

6 - DISTRESS OR EMOTIONAL CHANGES - Your quality of life can be changed because of cancer and its treatment - Depression and anxiety are common. - Please talk with your doctor if you are having trouble coping with everyday life, are more worried or upset, depressed, or having mood changes.