Late Effects of Treatment for Childhood Cancer (PDQ®)—Patient Version - National Cancer Institute 6/7

Late Effects of Treatment for Childhood Cancer (PDQ®)—Patient Version - National Cancer Institute

Late Effects of Treatment for Childhood Cancer (PDQ®)–Patient Version

Respiratory System

KEY POINTS

• Lung late effects are more likely to occur after treatment for certain childhood cancers.
• Certain types of chemotherapy and radiation to the lungs increase the risk of lung late effects.
• Late effects that affect the lungs may cause certain health problems.
• Possible signs and symptoms of lung late effects include trouble breathing and cough.
• Certain tests and procedures are used to detect (find) and diagnose health problems in the lung.
• Health habits that promote healthy lungs are important for survivors of childhood cancer.

Lung late effects are more likely to occur after treatment for certain childhood cancers.

Treatment for these and other childhood cancers may cause lung late effects:

• Hodgkin lymphoma.
• Wilms tumor.
• Cancers treated with a stem cell transplant.

Certain types of chemotherapy and radiation to the lungs increase the risk of lung late effects.

The risk of health problems that affect the lungs increases after treatment with the following:

• Surgery to remove all or part of the lung or chest wall.
• Chemotherapy. In survivors treated with chemotherapy, such as bleomycin, busulfan, carmustine, or lomustine, and radiation therapy to the chest, there is a high risk of lung damage.
• Radiation therapy to the chest. In survivors who had radiation to the chest, the damage to the lungs and chest wall depends on the radiation dose, whether all or part of the lungs and chest wall received radiation, whether the radiation was given in small, divided daily doses, and the child's age at treatment.
• Total-body irradiation (TBI) or certain types of chemotherapy before a stem cell transplant.

The risk of lung late effects is greater in childhood cancer survivors who are treated with a combination of surgery, chemotherapy, and/or radiation therapy. The risk is also increased in survivors who have a history of the following:

• Infections or graft-versus-host disease after a stem cell transplant.
• Lung or airway disease, such as asthma, before cancer treatment.
• An abnormal chest wall.
• Smoking cigarettes or other substances.

Late effects that affect the lungs may cause certain health problems.

Lung late effects and related health problems include the following:

• Radiation pneumonitis (inflamed lung caused by radiation therapy).
• Pulmonary fibrosis (the build-up of scar tissue in the lung).
• Other lung and airway problems such as chronic obstructive pulmonary disease(COPD), pneumonia, cough that does not go away, and asthma.

Possible signs and symptoms of lung late effects include trouble breathing and cough.

These and other signs and symptoms may be caused by lung late effects or by other conditions:

• Dyspnea (shortness of breath), especially when being active.
• Wheezing.
• Fever.
• Chronic cough.
• Congestion (a feeling of fullness in the lungs from extra mucus).
• Chronic lung infections.
• Feeling tired.

Talk to your child's doctor if your child has any of these problems.

Lung late effects in childhood cancer survivors may occur slowly over time or there may be no symptoms. Sometimes lung damage can be detected only by imaging or pulmonary function testing. Lung late effects may improve over time.

Certain tests and procedures are used to detect (find) and diagnose health problems in the lung.

These and other tests and procedures may be used to detect or diagnose lung late effects:

• Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• Chest x-ray : An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• Pulmonary function test (PFT): A test to see how well the lungs are working. It measures how much air the lungs can hold and how quickly air moves into and out of the lungs. It also measures how much oxygen is used and how much carbon dioxide is given off during breathing. This is also called lung function test.

Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of lung late effects. If tests are needed, find out how often they should be done.

Health habits that promote healthy lungs are important for survivors of childhood cancer.

Childhood cancer survivors with lung late effects should take care to protect their health, including:

• Not smoking.
• Getting vaccines for flu and pneumococcus.

Senses

KEY POINTS

• Hearing
  • Hearing problems are a late effect that is more likely to occur after treatment for certain childhood cancers.
  • Radiation therapy to the brain and certain types of chemotherapy increase the risk of hearing loss.
  • Hearing loss is the most common sign of hearing late effects.
  • Certain tests and procedures are used to detect (find) and diagnose health problems in the ear and hearing problems.
• Seeing
  • Eye and vision problems are a late effect that is more likely to occur after treatment for certain childhood cancers.
  • Radiation therapy to the brain or head increases the risk of eye problems or vision loss.
  • Late effects that affect the eye may cause certain health problems.
  • Possible signs and symptoms of eye and vision late effects include changes in vision and dry eyes.
  • Certain tests and procedures are used to detect (find) and diagnose health problems in the eye and vision problems.

Hearing

Hearing problems are a late effect that is more likely to occur after treatment for certain childhood cancers.

Treatment for these and other childhood cancers may cause hearing late effects:

• Brain tumors.
• Head and neck cancers.
• Neuroblastoma.
• Retinoblastoma.
• Liver cancer.
• Germ cell tumors.
• Bone cancer.
• Soft tissue sarcoma.

Radiation therapy to the brain and certain types of chemotherapy increase the risk of hearing loss.

The risk of hearing loss is increased in childhood cancer survivors after treatment with the following:

• Certain types of chemotherapy, such as cisplatin or high-dose carboplatin.
• Radiation therapy to the brain.

The risk of hearing loss is greater in childhood cancer survivors who were young at the time of treatment (the younger the child, the greater the risk), were treated for a brain tumor, or received radiation therapy to the brain and chemotherapy at the same time.

Hearing loss is the most common sign of hearing late effects.

These and other signs and symptoms may be caused by hearing late effects or by other conditions:

• Hearing loss.
• Ringing in the ears.
• Feeling dizzy.
• Too much hardened wax in the ear.

Hearing loss may occur during treatment, soon after treatment ends, or several months or years after treatment ends and worsen over time. Talk to your child's doctor if your child has any of these problems.

Certain tests and procedures are used to detect (find) and diagnose health problems in the ear and hearing problems.

These and other tests and procedures may be used to detect or diagnose hearing late effects:

• Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• Otoscopic exam: An exam of the ear. An otoscope is used to look at the ear canal and the eardrum to check for signs of infection or hearing loss. Sometimes the otoscope has a plastic bulb that is squeezed to release a small puff air into the ear canal. In a healthy ear, the eardrum will move. If there is fluid behind the eardrum, it will not move.
• Hearing test: A hearing test can be done in different ways depending on the child's age. The test is done to check if the child can hear soft and loud sounds and low- and high-pitched sounds. Each ear is checked separately. The child may also be asked if he or she can hear the high-pitched hum of a tuning fork when it is placed behind the ear or on the forehead.

Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of hearing late effects. If tests are needed, find out how often they should be done.

Seeing

Eye and vision problems are a late effect that is more likely to occur after treatment for certain childhood cancers.

Treatment for these and other childhood cancers may cause eye and vision late effects:

• Retinoblastoma, rhabdomyosarcoma, and other tumors of the eye.
• Brain tumors.
• Head and neck cancers.
• Acute lymphoblastic leukemia (ALL).
• Cancers treated with total-body irradiation (TBI) before a stem cell transplant.

Radiation therapy to the brain or head increases the risk of eye problems or vision loss.

The risk of eye problems or vision loss may be increased in childhood cancer survivors after treatment with any of the following:

• Radiation therapy to the brain, eye, or eye socket.
• Surgery to remove the eye or a tumor near the optic nerve.
• Certain types of chemotherapy, such as cytarabine and doxorubicin or busulfan and corticosteroids as part of a stem cell transplant.
• Total-body irradiation (TBI) as part of a stem cell transplant.
• Stem cell transplant (and a history of chronic graft-versus-host disease).

Late effects that affect the eye may cause certain health problems.

Eye late effects and related health problems include the following:

• Having a small eye socket that affects the shape of the child’s face as it grows.
• Loss of vision.
• Vision problems, such as cataracts or glaucoma.
• Not being able to make tears.
• Damage to the optic nerve and retina.
• Eyelid tumors.

Possible signs and symptoms of eye and vision late effects include changes in vision and dry eyes.

These and other signs and symptoms may be caused by eye and vision late effects or by other conditions:

• Changes in vision, such as:
  • Not being able to see objects that are close.
  • Not being able to see objects that are far away.
  • Double vision.
  • Cloudy or blurred vision.
  • Colors seem faded.
  • Being sensitive to light or trouble seeing at night.
  • Seeing a glare or halo around lights at night.
• Dry eyes that may feel like they are itchy, burning, or swollen, or like there is something in the eye.
• Eye pain.
• Eye redness.
• Having a growth on the eyelid.
• Drooping of the upper eyelid.

Talk to your child's doctor if your child has any of these problems.

Certain tests and procedures are used to detect (find) and diagnose health problems in the eye and vision problems.

These and other tests and procedures may be used to detect or diagnose eye and vision late effects:

• Eye exam with dilated pupil : An exam of the eye in which the pupil is dilated (widened) with medicated eye drops to allow the doctor to look through the lens and pupil to the retina. The inside of the eye, including the retina and the optic nerve, is checked using an instrument that makes a narrow beam of light. This is sometimes called a slit-lamp exam. If there is a tumor, the doctor may take pictures over time to keep track of changes in the size of the tumor and how fast it is growing.
• Indirect ophthalmoscopy : An exam of the inside of the back of the eye using a small magnifying lens and a light.

Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of eye and vision late effects. If tests are needed, find out how often they should be done.

Urinary System

KEY POINTS

• Kidney
  • Certain types of chemotherapy increase the risk of kidney late effects.
  • Late effects that affect the kidney may cause certain health problems.
  • Possible signs and symptoms of kidney late effects include problems urinating and swelling of the feet or hands.
  • Certain tests and procedures are used to detect (find) and diagnose health problems in the kidney.
  • Health habits that promote healthy kidneys are important for survivors of childhood cancer.
• Bladder
  • Surgery to the pelvic area and certain types of chemotherapy increase the risk of bladder late effects.
  • Late effects that affect the bladder may cause certain health problems.
  • Possible signs and symptoms of bladder late effects include changes in urination and swelling of the feet or hands.
  • Certain tests and procedures are used to detect (find) and diagnose health problems in the bladder.