OncoLife Survivorship Care Plan

Survivors who have had breast conserving therapy (lumpectomy) or single mastectomy should have a mammogram annually. In addition, breast MRI may be considered for survivors at high risk for cancer in the other breast. Those who have had double mastectomy generally do not need mammograms, but should examine the chest wall for swelling or rash, and report any changes to their oncologist. Some oncologists will recommend mammograms for women who have reconstructed breast(s).

Survivors should be seen by their oncologist every 3 to 6 months for the first 3 years and then every 6-12 months for the next 2 years, and annually after 5 years. Women who are taking tamoxifen and still have an intact uterus should be seen annually by a gynecologist and be sure to report any vaginal bleeding to their physician immediately, as this can be a sign of uterine cancer. Women taking an aromatase inhibitor, which results in a decrease in estrogen levels and can lead to loss of bone strength, should have their bone health evaluated by a Dexa scan at baseline and then periodically thereafter.

Routine CT scans or bone scans to look for cancer spread (otherwise known as metastases) are notrecommended. Research has shown that if a woman does develop metastatic disease, the type of treatment, response to treatment, and overall survival are equivalent, regardless of if it is found before symptoms develop. In other words, outcomes are similar for those who are treated for metastases found on routine scans (with no symptoms present) and women who are not treated until those metastases cause symptoms. Therefore, providers do not routinely screen patients for metastatic disease unless they have developed symptoms.

Finally, research has demonstrated that leading an active lifestyle and maintaining a healthy weight, with a body mass index (BMI) of 20-25, may result in better breast cancer outcomes. Weight bearing exercise, such as walking, yoga and dancing, can also help maintain bone strength. Talk with your healthcare team about resources to get started (or back to) a healthy lifestyle!

Recommendations for patients with breast cancer include:

• Mammogram annually for those who have had a single mastectomy (the first mammogram should be six months after therapy for survivors who underwent lumpectomy and radiation therapy).
• Perform monthly self-breast exams and / or examination of the chest wall and scar line. Report any changes, lumps, swelling or skin rashes to your physician.
• Women with an intact uterus on tamoxifen should see a gynecologist annually and notify their physician of any vaginal bleeding.
• Women taking aromatase inhibitors whose menstrual cycles have stopped should have a Dexa scan as a baseline, then periodically.
• Consider referral to genetic counseling if family or personal history includes early age at diagnosis of breast cancer (<50), triple negative disease, multiple primary cancers, or a family history of breast or ovarian cancer.
• Evidence has shown that leading an active lifestyle and maintaining a healthy weight (body mass index of 20-25), may lead to improved breast cancer outcomes.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Cervical Cancer
After treatment for cervical cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care. It is important to communicate with your healthcare team and to attend all of your follow up appointments. If you are having symptoms in between appointments, call your healthcare team.

If you received radiation therapy, you will need to use a vaginal dilator regularly to prevent the vaginal tissue from losing elasticity and forming scar tissue, which can make intercourse or vaginal exams painful. This is important both for improving quality of life, and for allowing your provider to perform effective pelvic exams.

The Society for Gynecologic Oncology recommends the following follow up care:

• Physical and pelvic exams by oncologist every 3-6 months for 2 years, then every 6 months to 1 year in years 2-5, and then annually.
• Annual Pap testing of cervical/vaginal tissue.
• Report any new or unusual symptoms to your provider, including vaginal bleeding, vaginal discharge, weight loss, abdominal or pelvic pain and fatigue.
• After radiation, survivors should use of vaginal dilators regularly for the rest of their lives to prevent losing vaginal elasticity and the formation of scar tissue.

Follow Up Care For Chronic Lymphocytic Leukemia (CLL)
After receiving treatment for CLL, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their provider. The recommendations for CLL follow up care depend on what therapies you have received and where you are in treatment. Some patients are observed over time, some have received chemotherapy and others have received a bone marrow transplant. These patients would all be monitored differently. Speak with your oncology team about their recommendations. General recommendations include:

• Physical exams will be scheduled per your provider’s recommendation. These visits may be frequent at first and become less frequent as time goes on. At these appointments you may be instructed to have blood or imaging tests completed.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

• Patients who are taking a tyrosine kinase inhibitors may be monitored for a complete cytogenetic response at 3, 6, 12 and 18 months. Once a response is detected, BCR-ABL levels are typically measured every 3-6 months.
• Patients who have undergone allogeneic transplant are typically monitored every 3 months for 2 years, then every 6 months for 3 years.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Colon Cancer
After receiving treatment for colon cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests and reporting concerning symptoms to their physician. The guidelines for follow up care vary based on stage:

Early stage:

• Survivors should undergo colonoscopy one year after surgery.
  • If advanced adenoma is present, repeat in 1 year.
  • If no advanced adenoma, repeat in 3 years, then every 5 years.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Advanced Stage:

• Be seen and examined by their physician every 3-6 months for two years, then every 6 months for a total of 5 years.
• The tumor marker CEA should be checked at these visits.
• Survivors should undergo colonoscopy one year after surgery (this should be done in 3-6 months if no colonoscopy was performed before surgery).
  • If advanced adenoma is present, repeat in 1 year.
  • If no advanced adenoma, repeat in 3 years, then every 5 years.
• Annual CT scan for up to 5 years after diagnosis for survivors at high risk for recurrence. Stage IV survivors will have more frequent CT scans; every 3-6 months for 2 years, then every 6-12 months for up to 3 more years.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Endometrial (Uterine) Cancer
After receiving treatment for uterine (endometrial) cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care. It is important to communicate with your healthcare team and to attend all of your follow up appointments. If you are having symptoms in between appointments, call your healthcare team.

If you received radiation therapy, you will need to use a vaginal dilator regularly to prevent the vaginal tissue from losing elasticity and forming scar tissue, which can make intercourse or vaginal exams painful. This is important both for improving quality of life, and for allowing your provider to perform effective pelvic exams.

The Society for Gynecologic Oncology recommends the following follow up care:

• Have a physical and pelvic exam by oncologist every 3-6 months for the first year.
• In subsequent years, physical examination should occur every 6 months until 5 years post treatment.  In patients with low risk, stage IA/grade 1 or 2 disease, this exam can occur annually in years 2-5.
• After radiation, survivors should use vaginal dilators regularly for the rest of their lives to prevent losing vaginal elasticity and the formation of scar tissue.
• Your provider will assess for symptoms of cancer returning, including vaginal bleeding, abdominal/pelvic pain, weight loss and fatigue.
• Lab tests or radiology testing may be performed for concerning symptoms.
• Consider genetic testing if you are under the age of 50, or have a significant family history of cancers associated with Lynch Syndrome (HNPCC), including colorectal, endometrial or small bowel cancer, and transitional cell carcinoma of the ureter and renal pelvis.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Esophageal Cancer
After receiving treatment for esophageal cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their physician. The recommendations for follow up testing after esophageal cancer vary based on the stage at diagnosis and the treatment received. In general, follow up will include:

• Physical exam every 3-6 months for 1-2 years, then every 6-12 months for years 3-5, then annually thereafter.
• Blood work when new symptoms arise or there are problems maintaining adequate nutrition.
• Endoscopy and imaging studies should be obtained as recommended by your oncologist, as these are based on stage, risk, and the cancer treatment received.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Fallopian Tube Cancer
After receiving treatment for fallopian tube cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests and reporting concerning symptoms to their physician. General recommendations for follow up care include:

• Oncology visits every 2-4 months for 2 years, then every 3-6 months for 3 years, then annually after 5 years. Each visit should include:
  • Physical exam with pelvic exam.
  • Ca-125 level (or other tumor marker level, if these were elevated at initial diagnosis). Other blood work if your oncologist feels it is needed.
  • Radiology testing (X-ray, MRI, CT or PET scan) may be done if there are concerning symptoms.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Gall Bladder / Cholangiocarcinoma
After receiving treatment for gallbladder cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their physician. The recommendations for gallbladder cancer follow up state that:

• The healthcare provider may consider imaging (CT scan, MRI) every 6 months for 2 years.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Head & Neck Cancers: Tongue, Lip, Oropharynx, Nasopharynx
After receiving treatment for head and neck cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology tests, dental care and reporting concerning symptoms to their provider. There are several types of cancer that fall into the category of “head and neck cancer,” so it is important to talk with your care team about your specific follow up care needs. The following are general recommendations to discuss with your oncology team:

• Physical exam every 1-3 months for year 1, then every 2-6 months for year 2, then every 4-8 months for years 3-5, then annually thereafter.
• Post-treatment baseline scan within 6 months of completing treatment. Further imaging should be conducted when your provider feels there is a concerning symptom, but is not needed routinely.
• If your neck was in the radiation treatment field, thyroid stimulating hormone (TSH) levels should be checked every 6-12 months, as radiation can impair thyroid function.
• If you continue to smoke or use alcohol, you should be referred to a cessation or counseling program to help you quit.
• Former smokers may be recommended to have lung cancer screening.
• If your mouth was in the treatment field, you should have routine dental evaluations and perform regular oral care, including fluoride, frequent tooth brushing, avoiding sugary and acidic foods to help prevent and identify any long-term damage early.
• Follow recommendations to combat dry mouth (xerostomia) to aide in dental health and quality of life.
• Referral for speech, hearing and swallowing rehabilitation and/or nutritional counseling if needed.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Hodgkin Lymphoma
After receiving treatment for Hodgkin Lymphoma, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting any concerning symptoms to their physician.

Survivorship research in Hodgkin’s disease has been going on for a number of years and, in turn, there are a number of recommendations based on what we know about life after treatment for this disease. Follow up recommendations are broken down by time since completing treatment and can vary based on age, stage at diagnosis, treatment, and risk.

Follow up after treatment, up to 5 years:

• Physical exam every 3-6 months for 1-2yrs, then every 6-12 months until year 3, then annually.
• Annual flu vaccine.
• Annual thyroid stimulating hormone (TSH) level if you received radiation to the neck.
• Some survivors may have a CT scan within the first year after treatment. Otherwise, bloodwork and radiology studies are performed as needed, based on symptoms.

Follow up after 5 years:
As you have read in your care plan, cancer therapies put you at risk for health concerns many years after treatment. There has been a considerable amount of research done in Hodgkin’s lymphoma survivors and, as a result, guidelines for monitoring for late effects in these survivors have been developed. The American Cancer Society recommendations include:

• Physical exam annually. Continued follow up is important to monitor for late effects.
• Check blood pressure annually. Heart disease can develop at a young age, so risk factors for heart disease should be managed aggressively, including hypertension, elevated cholesterol and triglycerides.
• Annual flu vaccine.
• Patients who had a splenectomy or radiation to the spleen should be re-vaccinated with pneumococcal, meningococcal and Haemophilus influenza type b (Hib) vaccines and follow precautions for a non-functioning spleen.
• Due to the risk of heart disease, your provider may consider a stress test / echocardiogram every 10 years. If you received radiation that included the neck, you may have an ultrasound of the neck veins every 10 years.
• Laboratory studies, including complete blood count and chemistry profile annually. Annual thyroid stimulating hormone (TSH) level for survivors who received radiation therapy that included the neck. Lipid (cholesterol) levels should be checked twice a year.
• Annual chest x-ray or chest CT for patients who are at increased risk for developing lung cancer due to prior therapy, including alkylating agent chemotherapy (typically Cytoxan [cyclophosphamide]), radiation to the chest, or heavy smoking.
• Breast cancer screening is recommended for women who received radiation to the chest or axilla (armpit). This includes:
  • Annual breast exam by a healthcare professional, and monthly self-breast exam.
  • Begin annual mammograms 8-10 years post therapy, or at age 40, whichever is earlier.
  • Breast MRI, in addition to the annual mammogram, for women who had chest irradiation between the ages of 10 and 30 years.

Follow Up Care For Kidney Cancer
After receiving treatment for kidney cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their physician. The recommendations for kidney cancer patients state that follow-up should include:

• A physical exam and blood work (comprehensive metabolic panel) every 3-6 months for 2 years, then annually for 5 years.
• Radiologic testing may include: chest and abdominal CT scan, MRI, abdominal/renal ultrasound, and chest x-ray. The test and frequency are dependent on the treatment you received and the stage of the cancer.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Liver Cancer
After receiving treatment for liver cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their healthcare provider. Patients who have undergone a liver transplant will require different monitoring, which will be directed by your transplant team and oncologist.

• Radiologic imaging every 3-6 months for 2 years, then every 6-12 months.
• Alpha fetal protein (AFP) level (if initially elevated) every 3-6 months for 2 years, then every 6-12 months.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Lung Cancer
After receiving treatment for lung cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their physician. The general recommendations for patients with no signs of cancer remaining include:

• For Non-small cell lung cancer:
  • Physical exam and chest CT every 6-12 months for 2 years, then annually.
• For Small cell lung cancer:
  • Physical exam and chest CT about every 3 months for the first couple of years, then every 6 months for the next several years, then annually thereafter.
• If you are a smoker, you should be offered smoking cessation advice, medications to help you quit, and recommendations for a cessation program.
• Annual flu vaccine and vaccination for herpes zoster (shingles) and pneumococcal pneumonia.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Melanoma
After receiving treatment for melanoma, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting any concerning symptoms to their physician. The general recommendations for follow up of melanoma include, by stage:

• All survivors should have annual skin exam by a healthcare provider for life. Regular skin and lymph node self-exams, reporting any changes to your provider.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.
• You should receive education regarding sun safety, skin protection and performing skin self-exams.

Stages IIB-IV:

• History and physical exam by your healthcare provider every 3-6 months for 2 years, then every 3-12 months for 3 years, then annually.
• In the first 3-5 years, the physician may choose to perform chest x-ray, CT or PET scan and brain MRI to screen for metastatic disease in patients with high-risk disease. Radiologic screening is not recommended after 3-5 years.

Stages IA-IIA:

• History and physical exam by your healthcare provider every 3-12 months for 5 years, then annually.
• Radiologic testing (CT scan, US) may be performed if concerning symptoms arise.

Follow Up Care For Mesothelioma
After receiving treatment for mesothelioma, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their healthcare provider. There are no formal recommendations for follow up care; therefore, your healthcare team will determine your monitoring plan. Typical monitoring includes:

• Physical exam and chest CT scan every 3 months for 2-3 years, then every 6 months until year 5, then annually thereafter.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Multiple Myeloma
After receiving treatment for multiple myeloma, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting any concerning symptoms as they arise. The general recommendations for follow up of multiple myeloma recommend:

• Periodic physical exam; monthly during initial treatment, then every 2-3 months during maintenance and observation
• Laboratory testing:
  • Quantitative immunoglobulins & quantitation of M protein at least every 3 months.
  • Complete blood count with differential, and a complete metabolic panel to follow BUN and creatinine (to follow your kidney function), and calcium.
  • Bone marrow biopsy and a serum free light chain assay are only needed if symptoms arise.
• Radiologic testing:
  • Annual bone survey, or more often if symptoms present.
  • Other radiology tests (MRI, PET) if symptoms arise.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Myelodysplastic Syndrome (MDS)
After receiving treatment for MDS, it is important for survivors to adhere to their oncology team’s plan for follow-up care. This includes physical examinations, bone marrow biopsies, radiology studies, blood tests, and reporting concerning symptoms to their physician. There are no formal guidelines for follow up care; however, your team may monitor you with:

• Periodic complete blood count (CBC) and bone marrow biopsy / aspirate if these results are abnormal.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Non-Hodgkin Lymphoma
There are a number of different types of non-Hodgkin’s lymphoma, each with its own treatment and follow up plan recommendations. It is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, blood tests, radiology scans and reporting concerning symptoms to their physician.

Talk with your oncology team about your plan for follow up care, including what testing you should have, at what intervals, and who is responsible for ordering these tests and reviewing the results. Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Non-Melanoma Skin Cancers
After receiving treatment for non-melanoma skin cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to your physician. The general recommendations for follow up of non-melanoma skin cancer include:

• Basal cell cancers:
  • Skin examination every 6-12 months for life.
  • You should receive education regarding sun safety, skin protection and performing skin self-exams.
  • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.
• Squamous cell cancers:
  • Local, resected tumor: physical exam every 3-12 months for 2 years, then every 6-12 months for 3 years, than annually.
  • Tumor with spread to lymph node: physical exam every 1-3 months for year 1, every 2-4 months for year 2, every 4-6 months for 3 years, then every 6-12 months for life.
  • You should receive education regarding sun safety, skin protection and performing skin self-exams.
  • Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Ovarian Cancer / Primary Peritoneal Cancer
After treatment for ovarian cancer, your oncology team will monitor you closely for an extended period of time. It is important to communicate regularly with your healthcare team and to attend all of your follow up appointments.  If you are having symptoms in between appointments, call your healthcare team. The Society for Gynecologic Oncology recommends the following follow up care after treatment:

• Oncology visit every 2-4 months for 2 years, then every 3-6 months for 3 years, then annually after 5 years. Each visit should include:

• • Physical exam with pelvic exam.
  • Ca-125 level (or other tumor marker level, if these were elevated at initial diagnosis). Other blood work if your oncologist feels it is needed.
  • Radiology testing (X-ray, MRI, CT or PET scan) may be done if there are concerning symptoms.
  • Your physician may consider referral to genetic counseling if your family or personal history includes early age at diagnosis (<50) of breast or ovarian cancer, triple negative breast cancer, multiple primary cancers, or a family history of breast or ovarian cancer.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Pancreatic Cancer
After receiving treatment for pancreatic cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their healthcare provider. The guidelines for pancreatic cancer follow up recommend:

• Physical examination every 3-6 months for 2 years, then annually.
• Based on your oncologist’s recommendations, a CA19-9 blood test (tumor marker test) and CT scan may also be done every 3-6 months for 2 years and then annually.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Penile Cancer
After receiving treatment for penile cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care. This includes physical examinations, radiology studies, blood tests, and reporting concerning symptoms to their healthcare provider. The recommendations for penile cancer follow-up care depend on the stage at diagnosis and the treatment received. In general survivors will have:

• Exams every 3-6 months for the first 2 years, then every 6-12 months thereafter. These should include a thorough examination of the penis and groin area.
• You should examine your penis and groin area routinely and report any changes to your provider.
• In general, CT scans and chest x-rays are done periodically in men who had lymph node involvement, or if symptoms arise in any survivor.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Prostate Cancer
After receiving treatment for prostate cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their healthcare provider. The recommendations for prostate cancer follow up care are as follows:

• Men who have not yet received treatment (also called “active surveillance,” “observation,” or “watchful waiting”) should have:
  • PSA (prostate specific antigen) every 6 months.
  • Digital rectal exam (DRE) every 12 months, which should be performed after the PSA blood test, as DRE can affect the PSA result.
  • May have periodic repeat biopsies to evaluate whether the tumor’s aggressiveness is changing. For men on active surveillance, this is usually performed one year after the initial prostate needle biopsy, and then annually.
• For men who have been treated with surgery and/or radiation therapy, post-treatment surveillance includes:
  • PSA every 6-12 months for the first 5 years, then annually.
  • Digital rectal exam (DRE) every year, which should be taken after the PSA blood specimen, as DRE can affect the PSA result.
• Survivors who have locally advanced or metastatic disease should have a physical exam and PSA every 3-6 months.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Rectal Cancer
After receiving treatment for rectal cancer, it is important for survivors to adhere to their physician’s plan for follow up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their healthcare provider. The general recommendations for follow up care for rectal cancer survivors include:

• Be seen and examined by their physician every 3-6 months for two years, then every 6 months for a total of 5 years.
• The tumor marker CEA should be checked at these visits for patients who had tumors that were at least Stage T2 at diagnosis.
• Survivors should undergo colonoscopy one year after surgery. If no colonoscopy was performed before surgery, this should be done in 3-6 months.
  • If advanced adenoma is present, repeat in 1 year.
  • If no advanced adenoma, repeat in 3 years, then every 5 years.
• Survivors at high risk of recurrence may be followed with an annual CT scan for up to 5 years after diagnosis.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.
• If the woman has received pelvic radiation therapy, she should use a vaginal dilator regularly to prevent the vaginal tissue from losing elasticity and forming scar tissue, which can make intercourse or vaginal exams painful. This is important both for improving quality of life, and for improving the ability to follow your cancer after treatment for evidence of recurrence.
• Report any concerns regarding chronic diarrhea, urinary incontinence, urgency or frequency, or sexual concerns. Your team can refer you to specialists to help manage these concerns.

Follow Up Care For Sarcoma
After receiving treatment for a sarcoma, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their healthcare provider. The recommendations for sarcoma follow up care vary slightly from one type to the next and by the grade of the lesion, but in general include:

• Frequent physical exams for 2-5 years (exact timing dependent on the sarcoma type, stage and location) and annually thereafter. Talk to your oncology team about the schedule for your follow up care plan.
• Some survivors will require chest imaging (CT scan or chest x-ray) at varying intervals or imaging of the primary tumor site.
• Other blood work and imaging tests are ordered based on the type of sarcoma or new symptoms.
• Assessment of function and referral for rehabilitative therapy when needed.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Stomach Cancer
After receiving treatment for stomach cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their healthcare provider. The general recommendations for stomach cancer follow up care include:

• Physical exam every 3-6 months for 1-2 years, then every 6-12 months for 3-5 years, then annually.
• Radiology and laboratory tests and endoscopy are done if concerning symptoms develop.
• Patients who have had surgical removal of the stomach need to be monitored and treated for vitamin B12 and iron deficiency.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care for Testicular Cancer
After receiving treatment for testicular cancer, it is important that survivors adhere to their physician’s plan for follow up care. Recommendations for follow up care are available on the Testicular Cancer Resource Center website (TCRC). Follow up care varies based on the type of testicular cancer (seminoma versus non-seminoma), the stage of the disease, and the treatment received.

Follow up care includes an examination by the physician, tumor markers, abdominal CT scan and/or chest x-ray. The frequency of these tests, and how many years after treatment they are performed, depends upon the tumor type and stage. Survivors should discuss their specific follow up plan and TCRC guidelines with their healthcare team. Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Thymoma Or Thymic Carcinoma
After receiving treatment for thymoma or thymic cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their healthcare provider. Survivors of thymoma or thymic cancer should:

• Have periodic physical exams, which should continue for at least 10 years due to the risk of late recurrence of these cancers.
• Have a chest CT scan every 6 months for 2 years, then annually for 5 years for thymic carcinoma and annually for 10 years for thymoma.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Thyroid Cancer
After receiving treatment for thyroid cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their healthcare provider. The recommendations for thyroid cancer follow up care vary slightly depending on the tumor type, stage and treatment received, but in general include:

• A physical exam (including neck examination) and TSH, thyroglobulin and antithyroglobulin antibody levels at 6 and 12 months, then annually if disease free.
• Periodic neck ultrasound.
• Some survivors will require imaging (radioiodine or non-radioiodine), depending on their initial staging and previous imaging results.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.

Follow Up Care For Vaginal And Vulvar Cancers
After receiving treatment for vaginal or vulvar cancer, it is important for survivors to adhere to their oncology team’s plan for follow-up care, including physical examinations, radiology and blood tests, and reporting concerning symptoms to their healthcare provider. There are no formal recommendations for follow up care; however, your team may monitor you with:

• Frequent exams for the first 5 years, then every 6-12 months thereafter. These should include a pelvic exam and Pap smear.
• CT scans and chest x-rays may be done periodically, or if symptoms arise.
• Any new, unusual and/or persistent symptoms should be brought to the attention of your care team.