Cancer screening |
HL survivors should be advised of their increased risk of developing a malignancy following treatment, encouraged to participate in routine age-appropriate cancer surveillance, and encouraged to report any concerning symptoms to their physician. |
Breast cancer | - Starting at age 40 years (or if chest irradiated, eight years after radiation or age 25, whichever is later):
- Annual screening mammogram
- Consider annual breast magnetic resonance imaging (MRI) in addition to mammogram for women who received radiation to the chest between the age of 10 and 30 years
- Consider referral to high-risk breast clinic for discussion of chemoprevention
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Lung cancer | - Consider annual low-dose chest computed tomography (CT) scan starting five years after diagnosis for those with a significant smoking history
- Smoking cessation
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Skin cancer | - Annual complete skin examination
- Sun safety practice
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Colon cancer | - Begin colorectal cancer screening 10 years earlier than for the general population
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Cardiovascular health |
Screening and counseling techniques are similar to those used for other high-risk populations. At a minimum, patients should be instructed not to ignore persistent troubling symptoms and to bring such symptoms to the attention of their physician without delay. |
Cardiac disease | - Referral to cardiologist for baseline evaluation after treatment for patients who received an anthracycline or radiation therapy
- Resting and stress echocardiogram (frequency depending on baseline findings and existence of other cardiac risk factors)
- Traditional risk factors should be minimized (eg, smoking, obesity, hyperlipidemia, hypertension)
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Non-coronary vascular disease | - Annual examination for carotid bruits; obtain carotid ultrasound if suspicious clinical findings
- Traditional risk factors should be minimized (eg, smoking, obesity, hyperlipidemia, hypertension)
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Pulmonary assessment |
HL survivors should be advised to report respiratory symptoms, assessed for pulmonary findings, and counseled to avoid smoking. |
Respiratory function | - Baseline pulmonary function tests (PFT) with diffusing capacity for patients who underwent radiation to the chest wall, with or without bleomycin therapy
- Referral to a pulmonologist with imaging and/or PFTs for patients with chronic and/or progressive respiratory symptoms
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Endocrine assessment |
HL survivors, especially those who received radiation therapy, should be advised to report symptoms that might suggest thyroid dysfunction, diabetes mellitus, and infertility. |
Infertility | - Referral to reproductive endocrinologist as needed
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Hypothyroidism | - Annual thyroid examination and thyroid function tests (ie, thyroid-stimulating hormone [TSH]) for HL survivors whose treatment included radiation to the neck or mediastinum
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Diabetes mellitus | - Fasting glucose or hemoglobin A1c every two years in HL survivors whose treatment included radiation to the chest or abdomen
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Neurologic and psychiatric evaluation |
Annual evaluation should include a discussion of psychiatric health including an assessment of symptoms of depression. |