Treatment for childhood cancer - long-term risks

Today's cancer treatments help cure many children of cancer. These treatments also may cause health problems later on. These are called "late effects."

Late effects are treatment side effects that appear several months or years after treatment for cancer. Late effects can impact one or more areas of the body. Effects can be mild to severe. Examples include learning, vision, joint, or teeth problems.

Whether your child will have late effects depend on the type of cancer and the treatments your child has. Being aware of your child's risk of long-term health problems can help you follow-up with health care providers and detect any problems early.

What Causes Late Effects

Some cancer treatments damage healthy cells. The damage is not seen during treatment, but as the child's body grows, changes in cell growth or function appear.

The medicines used for chemotherapy and the high-energy rays used in radiation therapy can harm healthy cells. This damage can change or delay the way cells grow. Radiation therapy has a more direct effect on long-term growth than chemotherapy.

When cancer surgery is performed, it may cause changes in the growth or function of an organ.

Your child's health care team will come up with a treatment plan to avoid harming healthy cells as much as possible.

Risk Factors

Every child is unique. The risk of getting a late effect depends on many factors such as:

• Child's overall health before cancer
• Child's age at the time of treatment
• Dose of radiation therapy and what body organs received radiation
• Chemotherapy type and total dose
• How long the treatment was needed
• Type of cancer being treated and area of body involved
• Child's genetic background (some children are more sensitive to treatments)

Types of Late Effects

There are many types of late effects depending on where the cancer was and what types of treatments were done. Many of the effects can be managed. The following are examples of some late effects based on body parts affected.

Brain:

• Learning
• Memory
• Attention
• Language
• Behavior and emotional problems
• Seizures, headaches

Ears:

• Hearing loss
• Ringing in the ears
• Dizziness

Eyes:

• Vision problems
• Dry or watery eyes
• Sensitivity to light
• Irritation
• Drooping eyelid
• Eyelid tumors

Lungs:

• Infections
• Shortness of breath
• Persistent cough
• Trouble breathing
• Lung cancer

Mouth:

• Small or missing teeth
• Risk for cavities
• Sensitive teeth
• Delayed tooth development
• Gum disease
• Dry mouth

Other late effects may include:

• Muscle or bone can be affected in any area of the body where treatments were needed. It may impact how a child walks or runs or cause bone or muscle pain, weakness, or stiffness.
• Glands and organs that make hormones may be exposed to treatments. These include the thyroid gland in the neck and pituitary gland in the brain. This can have an effect on later growth, metabolism, puberty, fertility, and other functions.
• The heart's rhythm or function may be affected by certain treatments.
• A small increase in risk of getting another cancer later in life.

Most of the effects above are physical. There may be long-term emotional effects as well. Coping with health problems, extra medical visits, or the worries that come with cancer can be a lifelong challenge.

Preventing Health Problems

Many late effects cannot be prevented, but others can be managed or treated.

There are some things your child can do to help prevent other health problems and detect problems early such as:

• Eat healthy foods
• DO NOT smoke
• Exercise regularly
• Maintain a healthy weight
• Have regular screenings and tests, including the heart and lungs

Follow-Up

Watching for late effects will be a key part of your child's care for many years. The Children's Oncology Group (COG) creates guidelines for long-term follow up in children and adolescents who have had cancer. Ask your child's provider about the guidelines. Follow these general steps:

• Make regular appointments for physical exams and tests.
• Keep detailed records of your child's treatments.
• Get copies of all medical reports.
• Keep a contact list of your child's health care team.
• Ask your child's provider what late effects your child may want to look out for based on the treatments.
• Share information about the cancer with future providers.

Regular follow-up and care gives your child the best chance of recovery and good health.