Living with hereditary cancer risk: what you and your family need to know

Part 1. Understanding cancer and inherited risk 1. The link between genetics and cancer The basics of genetics Gene wear and tear and repair How cancers develop and grow Most cancers aren't caused by inherited mutations 2. What's swimming in your gene pool? Hidden risk in the family tree Plotting your genetic pedigree 3. Signs of hereditary cancer The value of genetic counseling Making decisions about testing Insurance coverage Privacy and protection 4. What your test results tell you Positive, negative, maybe Making sense of statistics You have a mutation ; now what?

Part 2. Inherited gene mutations and the cancers they cause 5. Introducing BRCA1 and BRCA2 Who inherits a BRCA mutation? Signs of a BRCA mutation Levels of risk 6. Lynch syndrome : five genes, one hereditary syndrome Signs of Lynch syndrome in families Levels of risk 7. Other genes that are linked to inherited cancer risk Less known, less studied genes 8. Breast cancer basics Signs and symptoms What affects breast cancer risk? Types of breast cancer 9. Gynecologic cancers Ovarian, fallopian tube, and primary peritoneal cancers Endometrial cancers 10. Gastrointestinal cancers Colorectal cancer Small bowel cancer Pancreatic cancer Stomach cancer Anal cancer 11. Genitourinary cancers Prostate cancer Bladder, ureter, and renal Pelvis cancers 12. Melanoma Melanoma of the skin Ocular melanoma

Part 3. Strategies for risk reduction and early detection 13. Risk management guidelines Guidelines for BRCA1 or BRCA2 Gene mutations Guidelines for Lynch syndrome Gene mutations Guidelines for mutations in other genes 14. Early detection strategies for high-risk people The vocabulary of screening Surveillance for breast cancer Surveillance for gynecologic cancers Surveillance for gastrointestinal cancers Surveillance for prostate and other genitourinary cancers Surveillance for melanoma screening for other hereditary cancers 15. Medications that reduce cancer risk Risk-reducing medications for breast cancer Risk-reducing medications for gynecologic cancers Risk-reducing medications for colorectal cancers 16. Surgeries that reduce breast cancer risk Mastectomy procedures Breast reconstruction choices Side effects, risks, and recovery 17. Surgeries that reduce the risk of gynecologic cancers Salpingo-oophorectomy to reduce the risk of ovarian cancer Hysterectomy to reduce the risk of endometrial cancer 18. Surgeries that reduce the risk of gastrointestinal cancers Total and segmental colectomy to reduce the risk of colon cancer Total gastrectomy to reduce the risk of stomach cancer 19. Factors that affect cancer risk Nutrition, weight, and physical activity Alcohol : an unwise choice Smoking and tobacco products Other lifestyle and behavioral risk factors

Part 4. Treatment choices for hereditary cancers 20. Identifying tumor characteristics that inform treatment choices Staging and grading cancer Targeted approaches to treatment DNA damage repair genes 21. Treating breast cancer Cancer yype, subtype, and stage Biomarker testing Genetic testing Options for treatment Follow-up care 22. Treating gynecologic cancers Options for ovarian, fallopian tube, and primary peritoneal cancers Options for endometrial cancer 23. Treating gastrointestinal cancers Options for colorectal cancer Options for pancreatic cancer Options for gastric cancer 24. Treating genitourinary cancers Options for prostate cancer Options for bladder, renal pelvis, and ureter cancers 25. Treating melanoma Options for melanoma in the skin Options for ocular melanoma

Part 5. Living with inherited high risk

26. Regaining sexual health and intimacy

Body image

Coping with pain

Reduced sexual desire

Erectile dysfunction

Rebuilding intimacy

27. Effects of prevention and treatment on fertility

Preserving fertility in women

Preserving fertility in men

Other parenting alternatives

28. Managing menopause

Symptoms of early menopause

Replacement hormones

Long-term side effects

29. Side effects and other quality-of-life issues

Summarizing side effects by treatment

Managing immediate side effects

Long-term effects of prevention and treatment

Previvorship, survivorship, and follow-up care

End-of-life issues

30. Making difficult decisions

Start at the beginning : should you be tested?

Decisions about your cancer risk

Decisions about treatment

Prevention and treatment

Clinical trials

Decision-making in 15 steps

31. You are not alone

Create a support system

Find emotional strength

Pursue financial resources

Look to the horizon.