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

Immune System

KEY POINTS

Surgery to remove the spleen increases the risk of immune system late effects.
Late effects that affect the immune system may cause infection.
Children who have had their spleen removed may need antibiotics to lessen the risk of infection.

Surgery to remove the spleen increases the risk of immune system late effects.

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

Surgery to remove the spleen.
High-dose radiation therapy to the spleen which causes the spleen to stop working.
Stem cell transplant followed by graft-versus-host disease which causes the spleen to stop working.

Late effects that affect the immune system may cause infection.

Late effects that affect the immune system may increase the risk of very serious bacterial infections. This risk is higher in younger children than in older children and may be greater in the early years after the spleen stops working or is removed by surgery. These signs and symptoms may be caused by infection:

Redness, swelling, or warmth of a part of the body.
Pain that is in one part of the body, such as the eye, ear, or throat.
Fever.

An infection may cause other symptoms that depend on the part of the body affected. For example, a lung infection may cause a cough and trouble breathing.

Children who have had their spleen removed may need antibiotics to lessen the risk of infection.

Daily antibiotics may be prescribed for children younger than 5 years of age whose spleen is no longer working or for at least 1 year after surgery to remove the spleen. For certain high-risk patients, daily antibiotics may be prescribed throughout childhood and into adulthood.

In addition, children with an increased risk of infection should be vaccinated on a schedulethrough adolescence against the following:

Pneumococcal disease.
Meningococcal disease.
Haemophilus influenzae type b (Hib) disease.
Diphtheria-tetanus-pertussis (DTaP).
Hepatitis B.

Talk to your child's doctor about whether other childhood vaccinations given before cancer treatment need to be repeated.

Musculoskeletal System

KEY POINTS

Bone and joint late effects are more likely to occur after treatment for certain childhood cancers.
Surgery, chemotherapy, radiation therapy, and other treatments increase the risk of bone and joint late effects.
- Radiation therapy
- Surgery
- Chemotherapy and other drug therapy
- Stem cell transplant
Possible signs and symptoms of bone and joint late effects include swelling over a bone or bone and joint pain.
Certain tests and procedures are used to detect (find) and diagnose health problems in the bone and joint.

Bone and joint late effects are more likely to occur after treatment for certain childhood cancers.

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

Acute lymphoblastic leukemia (ALL).
Bone cancer.
Brain and spinal cord tumors.
Ewing sarcoma.
Head and neck cancers.
Neuroblastoma.
Non-Hodgkin lymphoma.
Osteosarcoma.
Retinoblastoma.
Soft tissue sarcoma.
Wilms tumor.
Cancers treated with a stem cell transplant.

Poor nutrition and not enough exercise may also cause bone late effects.

Surgery, chemotherapy, radiation therapy, and other treatments increase the risk of bone and joint late effects.

Radiation therapy

Radiation therapy can stop or slow the growth of bone. The type of bone and joint late effect depends on the part of the body that received radiation therapy. Radiation therapy may cause any of the following:

Changes in the way the face or skull form, especially when high-dose radiation with or without chemotherapy is given to children before age 5.
Short stature (being shorter than normal).
Scoliosis (curving of the spine) or kyphosis (rounding of the spine).
One arm or leg is shorter than the other arm or leg.
Osteoporosis (weak or thin bones that can break easily).
Osteoradionecrosis (parts of the jaw bone die from a lack of blood flow).
Osteochondroma (a benign tumor of the bone).

Surgery

Amputation or limb-sparing surgery to remove the cancer and prevent it from coming back may cause late effects depending on where the tumor was, age of the patient, and type of surgery. Health problems after amputation or limb-sparing surgery may include:

Having problems with activities of daily living.
Not being able to be as active as normal.
Chronic pain or infection.
Problems with the way prosthetics fit or work.
Broken bone.
The bone may not heal well after surgery.
One arm or leg is shorter than the other.

Studies show no difference in quality of life in childhood cancer survivors who had amputation compared to those who had limb-sparing surgery.

Chemotherapy and other drug therapy

Risk may be increased in childhood cancer survivors who receive anticancer therapy that includes methotrexate or corticosteroids or glucocorticoids such as dexamethasone. Drug therapy may cause any of the following:

Osteoporosis (weak or thin bones that can break easily).
Osteonecrosis (one or more parts of a bone die from a lack of blood flow), especially in the hip or knee.

Stem cell transplant

A stem cell transplant can affect the bone and joints in different ways:

Total-body irradiation (TBI) given as part of a stem cell transplant may affect the body's ability to make growth hormone and cause short stature (being shorter than normal). It may also cause osteoporosis (weak or thin bones that can break easily).
Osteochondroma (a benign tumor of the long bones, such as the arm or leg bones) may form.
Chronic graft-versus-host disease may occur after a stem cell transplant and cause joint contractures (tightening of the muscles that causes the joint to shorten and become very stiff). It may also cause osteonecrosis (one or more parts of a bone die from a lack of blood flow).

Possible signs and symptoms of bone and joint late effects include swelling over a bone or bone and joint pain.

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

Swelling over a bone or bony part of the body.
Pain in a bone or joint.
Redness or warmth over a bone or joint.
Joint stiffness or trouble moving normally.
A bone that breaks for no known reason or breaks easily.
Short stature (being shorter than normal).
One side of the body looks higher than the other side or the body tilts to one side.
Always sitting or standing in a slouching position or having the appearance of a hunched back.

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 bone and joint.

These and other tests and procedures may be used to detect or diagnose bone and joint 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, past illnesses and treatments will also be taken. An exam of the bones and muscles by a specialist may also be done.
Bone mineral density scan : An imaging test that measures bone density (the amount of bone mineral in a certain amount of bone) by passing x-rays with two different energy levels through the bone. It is used to diagnose osteoporosis (weak or thin bones that can break easily). Also called BMD scan, DEXA, DEXA scan, dual energy x-ray absorptiometric scan, dual x-ray absorptiometry, and DXA.
X-ray: 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, such as bones.

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