Learning from Cancer Survivors

"Here we go again."
- Anonymous

Long-term cancer survivors are among my favorite people, and one particular patient is always a welcome sight in the office. His throat cancer was treated successfully fifteen years ago, and he returns for follow-up each year. He has taught me much about the qualities and challenges of cancer survivorship.

I watched as the late effects of radiation therapy and surgical treatment - the scars, the tissue tightness, and the discomfort - evolved. Despite the challenges, he has remained positive. He takes impeccable care of himself, faithfully watching his diet and health habits. He is among the most positive people I have ever met.

Therefore, I was alarmed when he returned early for an appointment. "I think there is something new growing in my throat. It feels a lot like my cancer did years ago." Sure enough, he had developed a mass and a biopsy confirmed a new cancer. He was soon scheduled for more surgery and treatment was underway again.

A second cancer occurring in a survivor is all too common. A recent paper (Travis LB, et al., Journal of the National Cancer Institute 2006; 98:15-25) discusses the problem of survivors who develop additional cancers. Among the U.S. population, only 3.5% are cancer survivors; however, 16% of new cancers will occur in these survivors. And when new cancers develop, they are particularly difficult to control. How can we develop better ways to identify survivors who are at risk and find their cancers as early as possible?

The authors point out that identifying some of the survivors at the highest risk is relatively easy. For example, some familial syndromes put many of the relatives in danger. In addition, higher rates of second cancers are seen in survivors with one tobacco-related cancer who continue to smoke. However, we have a long way to go to understand why many other survivors will develop new cancers.

Much of the risk for both the second cancer and for the development of complications is likely related to genetic susceptibility in ways that are largely unexplored. It is an area ripe for research.

My dad owned a dime store when I was growing up, and he did everything he could to generate repeat business. In cancer care, however, repeat business is not so welcome. As more and more people are cured, more and more of the survivors will face the ominous prospect of additional cancer and its treatment.

I recently saw a woman who had nine siblings; each had developed cancer. What do we tell her children? Future research must tell us how best to follow these types of at-risk families, both before and after cancer treatment.

Bruce H. Campbell, MD, FACS
Professor of Otolaryngology and Communication Sciences
Chief, Division of Head and Neck Oncology
Interim Director, The Medical College of Wisconsin Cancer Center

"Reflections" is a collection of essays by the health professionals of the Medical College of Wisconsin.