Cancer Updates GI and Breast NJ: Focus on Cancer Survivorship with Dr Louise Ligresti
Presenter:
Louise Ligresti, MD, Rutgers Cancer Institute, Cooperman Barnabas Medical Center
Conference:
Cancer Updates GI and Breast New Jersey
Introduction
At the 2025 Cancer Updates GI and Breast New Jersey conference, Dr. Louise Ligresti provided an in-depth overview of cancer survivorship, an often overlooked yet essential aspect of oncology care. She highlighted the growing population of cancer survivors, gaps in post-treatment care, and evolving strategies to optimize survivorship outcomes.
Dr Ligresti’s presentation focused on defining survivorship and the evolution of survivorship care models, highlighting the current national initiatives and efforts to standardize survivorship care, considerations for breast cancer survivorship, including screening, surveillance, and lifestyle factors, as well as survivorship considerations across the GI cancers, including recurrence risks, complications, and rehabilitation.
“Cancer survivorship is a field that’s relatively ignored in the cancer trajectory, yet there are 18 million survivors in the U.S. today, a number expected to grow to 26 million over the next 20 years.”
Defining Cancer Survivorship
Dr Ligresti noted that a cancer survivor is defined as any person diagnosed with cancer, beginning from the moment of diagnosis. She noted that historically, survivorship programs have focused on patients treated with curative intent, but with longer survival now being seen in patients living with cancer, even metastatic disease, this definition may evolve.
She noted some of the common challenges in survivorship care, which could include a lack of standardization across the continuum of follow-up care, poor coordination between oncologists, specialists, and primary care providers, and an underuse of preventive healthcare services.
“Patients often become ‘cancer survivors’ in the medical system but are not seen as general patients, leading to gaps in managing other medical conditions.”
Standardizing Survivorship Care: National Guidelines
Dr Ligresti noted that the National Cancer Institute (NCI) and Division of Cancer Control issued 2024 guidelines to improve survivorship care models. Some of the key recommendations from this guidance include:
Dedicated survivorship programs (including in-person, telehealth, or referrals)
Clear referral pathways to survivorship care
Metrics to assess the overall quality of survivorship programs
“If you ask patients about their post-treatment experience, 60% report unmet needs—physical, psychological, or informational.”
Breast Cancer Survivorship: Screening and Surveillance
Dr Ligresti reviewed the current surveillance guidelines in breast cancer, which include mammography, with annual surveillance recommended for all survivors. Some centers will also perform diagnostic mammograms every 6 months for the first-year post-treatment. MRI screening is also recommended for survivors with a >20% lifetime risk; these include individuals with BRCA mutations and a young age at diagnosis. She noted MRI may also be used selectively when mammograms are difficult to interpret: “We let the radiologists guide MRI decisions. If mammograms are difficult to read, an MRI can be helpful.”
Dr Ligresti noted that laboratory monitoring for tumor markers, such as CA 15-3 or CEA, is generally not recommended for survivors who are asymptomatic, citing a 2005 meta-analysis which showed no survival benefit from intensive lab/imaging and surveillance. She also noted an emerging potential role for circulating tumor DNA (ctDNA) to detect minimal residual disease (MRD) in breast cancer survivors, but that, at present the data in this regard is immature to guide clinical practice.
“Breast cancer recurrence is often detected by symptoms, not routine imaging or bloodwork.”
Breast Cancer Survivorship: Lifestyle and Long-Term Health
Dr Ligresti also emphasized some of the current guidance for diet and weight management among breast cancer survivors. She noted the link between post-treatment weight gain and increased mortality, such that a 5% or greater gain confers a 12% increased risk for all-cause mortality, and a 10% or greater gain is associated with a 23% increased risk. In addition, while adherence to a Mediterranean diet may reduce all-cause mortality for survivors, it may not necessarily reduce breast cancer-specific mortality. Overall, Dr Ligresti emphasized: “Weight gain after breast cancer treatment is detrimental—patients do worse.” She also noted the benefits of physical activity, which has been linked to improving breast cancer outcomes, and ongoing trials that are more specifically assessing structured exercise interventions for survivors.
GI Cancer Survivorship: Recurrence and Long-Term Effects
For colorectal cancer survivors, Dr Ligresti stressed the need for more aggressive follow up as compared with breast cancer, given that metastasectomy can be a potentially curative intervention for patients. Routine follow up for survivors will therefore include both CEA monitoring and CT scans, as well as colonoscopy surveillance.
“Less than 7% of [colorectal cancer] patients with symptomatic recurrence have curable metastatic disease. That’s why aggressive surveillance is necessary.”
In the case of colorectal cancer, Dr Ligresti noted that ctDNA has been shown to be predictive for recurrence risk, however, the role of ctDNA monitoring in surveillance remains under evaluation. Because there can be up to an 8- to 12-month lead time for ctDNA detection ahead of a detectable recurrence by imaging, Dr Ligresti noted that this may be meaningful, allowing for early, potentially curative interventions for survivors.
“In colorectal cancer, ctDNA may help detect recurrence early enough for curative intervention.”
Long-Term Complications in GI Cancer Survivorship
Dr Ligresti then outlined some of the key complications relevant for GI cancer survivors, including neuropathy, which is seen in up to 90% of oxaliplatin-treated patients. While up to a 25% improvement in this symptom can be observed per year, many patients can experience residual symptoms. Recommended treatment for neuropathy includes antidepressants such as duloxetine, although anticonvulsant medications (gabapentin and pregabalin) are commonly used off-label.
“Neuropathy is a persistent issue in GI cancer survivors, especially with oxaliplatin exposure.”
Bowel dysfunction is also commonly seen in rectal and anal cancer survivors due to surgery and radiation. Symptoms can include diarrhea, incontinence, urgency, and cramping. Management strategies include dietary changes, fiber, probiotics, as well as pelvic floor therapy.
“Many rectal cancer survivors struggle with bowel urgency and clustering—pelvic floor rehab can be helpful.”
Dr Ligresti also noted the frequent occurrence of sexual dysfunction in rectal and gastric cancer survivors. For women, symptoms can include dyspareunia, vaginal dryness, and stenosis, while men may experience symptoms of erectile dysfunction and incontinence. Due to their potential impact on overall quality of life for survivors, she noted the importance of early screening and appropriate referral to sexual health specialists.
“Sexual health is rarely discussed in oncology… but should be an integral part of survivorship care.”
Dr Ligresti noted the potential for nutritional deficiencies in gastric cancer survivors, including dumping syndrome (rapid gastric emptying), weight loss, and vitamin deficiencies which can be common. As such, regular monitoring for key nutrients such a Vitamin B12, iron and folate is required for survivors.
Lastly, Dr Ligresti stressed the frequent occurrence of psychosocial morbidity in cancer survivors, with colorectal cancer survivors especially having high rates of depression. Patients with ostomies, in particular, may face significant self-image challenges. Survivors can also be profoundly impacted by the economic burden of cancer survivorship, with many patients experiencing unemployment because of their treatment and associated financial distress.
“GI cancer survivors, especially those with ostomies, often struggle with body image, travel concerns, and interpersonal relationships.”
Conclusions & Key Takeaways
Summarizing her presentation, Dr Ligresti emphasized a need for a standardized, multidisciplinary survivorship care plan to help address long-term effects, recurrence risks, and quality-of-life concerns among cancer survivors.
It is essential that survivorship care be standardized and integrated into oncology practice.
Breast cancer survivors need appropriately structured surveillance, but not excessive testing.
GI cancer survivors require a more aggressive follow-up, due to the curative potential of metastasectomy.
Lifestyle modifications (diet, exercise) play a critical role in survivorship outcomes.
Quality of life issues including neuropathy, bowel dysfunction, and sexual health issues must be actively managed.
“Survivorship care is complex and multifaceted, but suboptimal survivorship care leaves patients with persistent symptoms and unmet needs.”
Speaker Disclosure Information: Dr Ligresti reported no relevant disclosures for this presentation.