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Malignancy

Immunosuppressant drugs reduce the body’s ability to find and destroy abnormal cells that can lead to the development of malignancies, or cancers. With people now surviving much longer after transplantation and because the transplant population is getting older, malignancies are becoming an increasingly significant complication. For this reason it is important that you take precautions to reduce the chances of developing cancers or to help early detection of malignant changes.

The most common malignancies are:

Lymphoproliferative disease
These are disorders such as such as lymphomas and leukaemia in which too many lymphocytes are produced or act abnormally. Lymphoproliferative disease is the most common malignancy arising from liver transplantation and may develop at any time.

Doctors will be on the lookout in all patients for signs of post-transplant lymphoproliferative disease (PTLD), such as swollen lymph glands and unexplained fevers.

Skin cancers
Exposure to the sun can damage your skin and increase the chances of developing skin cancer. This means avoiding the midday sun (10am to 3pm) when the ultraviolet rays are the strongest and applying a sunscreen lotion on uncovered skin (especially your face, neck and hands) when outdoors. Wear a hat, long sleeves and trousers if you are not using a sunscreen. If you notice any changing spots, blemishes or moles on your skin, report this to medical staff immediately.

Cervical cancer
The detection and treatment of cervical abnormalities through screening programmes can prevent the development of cervical cancer. All women aged between 20 and 64 years should be offered a cervical smear test every 3 years at their GP clinic. Women on immunosuppressant drugs are advised to visit their GP or local clinic for a smear once a year.

Colorectal carcinoma
Ulcerative colitis is an inflammation of the colon that produces ulcers in its lining. If your liver disease is associated with this condition it is advisable that you are screened for colon cancer by colonoscopyexamination every year. There are studies that suggest people who undergo transplantation for primary sclerosing cholangitis (PSC) should also be screened annually for this cancer.

Oropharyngeal carcinoma
Sometimes called throat cancer, this malignancy develops in the part of the throat just behind the mouth, called the oropharynx.

Immunosuppression is considered to increase the risk of oropharyngeal carcinoma and is more commonly seen in people who have transplants for alcohol related reasons.

Hepatocellular carcinoma (HCC)
Hepatocellular carcinoma (HCC) is a primary liver cancer that is becoming more common in the UK due to increased incidence of chronic hepatitis C infection. People with a background of chronic hepatitis B, haemochromatosis, autoimmune liver disorders or alcoholic cirrhosis also have an increased risk of developing this malignancy.

As with many liver diseases HCC has the potential to return after treatment. However, liver transplantation is increasingly regarded as an effective treatment to stop tumours returning. This is provided that tumours are small (no larger than 5cm in diameter) and you have no more than three (no larger than 3cm) before your transplant.