People with A-T have an increased incidence (at least a 25% lifetime risk) of cancers.
People with A-T have an increased incidence (at least a 25% lifetime risk) of cancers, particularly lymphomas and leukemia, but other cancers can occur. There is currently no way to predict which individuals will develop cancer. Routine screening blood tests for leukemia and lymphoma are generally not considered helpful because there is no clear advantage in outcome from an early diagnosis. It is worthwhile, however, to consider cancer as a diagnostic possibility whenever possible symptoms of cancer arise.
In adults with A-T, very different types of cancers are seen that include cancers of the breast, esophagus, liver, colon and skin. Researchers and clinicians are still trying to determine guidelines for when breast MRI, colonoscopies or other screening tests for these types of cancers should be performed. In the meantime, every doctor caring for a person with A-T needs to be aware that all kinds of cancers can occur in people with A-T.
Treatment should avoid the use of radiation therapy, and chemotherapy drugs that work in a way that is similar to radiation therapy, as these are particularly toxic for people with A-T. The special problems of managing cancer are sufficiently complicated that treatment should be managed only in academic oncology centers after consulting with physicians who have specific expertise in A-T. (See A-T Cancer Consultations.)
Common Warning Signs of Lymphoma and Leukemia
- Recurrent or persistent fevers without explanation
- Pale appearance
- Swollen lymph nodes in neck, armpits, groin and abdomen
- Body aches and bone pains
Exposure to Radiation
People with A-T have an increased sensitivity to ionizing radiation (x-rays and gamma rays). Therefore, x-rays should be done only when they are medically necessary, because exposing a person with A-T to ionizing radiation can damage cells in such a way that the body cannot repair them. The body can cope normally with other forms of radiation, such as ultraviolet light, so there is no need for special precautions from exposure to sunlight.
Guidelines for Diagnostic X-Rays in A-T
- X-rays should be performed only when the result will affect medical management.
- If a person with A-T has fever, cough, and abnormal breath sounds characteristic of pneumonia, a diagnosis of pneumonia can be made clinically and antibiotics can be prescribed without x-ray confirmation. If symptoms persist despite antibiotics, a follow-up chest x-ray may be useful.
- Routine screening dental x-rays should be avoided, but an x-ray to evaluate tooth pain is reasonable.
- In order to keep radiation to a minimum, a person with A-T should receive frontal view chest radiographs or radiation-sparing techniques for CT (e.g., fewer CT images per scan).
- There is no contradiction to MRI and ultrasound exams.