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This PDQ cancer information summary has current information about the late effects of treatment for childhood cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board.
CONTENTS
- General Information about Late Effects
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Late effects are health problems that occur months or years after cancer treatment has ended.
Cancer treatments may harm the body's organs, tissues, or bones and cause health problems later in life. These health problems are called late effects.
Treatments that may cause late effects include the following:
Doctors are studying the late effects caused by cancer treatment. They are working to improve cancer treatments and stop or lessen late effects. While most late effects are not life-threatening, they may cause serious problems that affect health and quality of life.
Late effects in childhood cancer survivors affect the body and mind.
Late effects in childhood cancer survivors may affect the following:
There are three important factors that affect the risk of late effects.
Many childhood cancer survivors will have late effects. The risk of late effects depends on factors related to the tumor, treatment, and patient. These include the following:
The chance of having late effects increases over time.
New treatments for childhood cancer have decreased the number of deaths from the primary cancer. Because childhood cancer survivors are living longer, they are having more late effects after cancer treatment. Survivors may not live as long as people who did not have cancer. The most common causes of death in childhood cancer survivors are:
Studies of the causes of late effects have led to changes in treatment. This has improved the quality of life for cancer survivors and helps prevent illness and death from late effects.
Regular follow-up care is very important for survivors of childhood cancer.
Regular follow-up by health professionals who are trained to find and treat late effects is important for the long-term health of childhood cancer survivors. Follow-up care will be different for each person who has been treated for cancer. The type of care will depend on the type of cancer, the type of treatment, genetic factors, other medical conditions, and the person's general health and health habits. Follow-up care includes checking for signs and symptoms of late effects and health education on how to prevent or lessen late effects.
It is important that childhood cancer survivors have an exam at least once a year. The exams should be done by a health professional who knows the survivor's risk for late effects and can recognize the early signs of late effects. Blood and imaging tests may also be done.
Long-term follow-up may improve the health and quality of life for cancer survivors. It also helps doctors study the late effects of cancer treatments so that safer therapies for newly diagnosed children may be developed.
Good health habits are also important for survivors of childhood cancer.
The quality of life for cancer survivors may be improved by behaviors that promote health and well-being. These include a healthy diet, exercise, and regular medical and dental checkups. These self-care behaviors are especially important for cancer survivors because of their risk of health problems related to treatment. Healthy behaviors may make late effects less severe and lower the risk of other diseases.
Avoiding behaviors that are damaging to health is also important. Smoking, excess alcohol use, illegal drug use, being exposed to sunlight, or not being physically active may worsen organ damage related to treatment and may increase the risk of second cancers.
- Second Cancers
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Childhood cancer survivors have an increased risk of a second cancer later in life.
A different primary cancer that occurs at least two months after cancer treatment ends is called a second cancer. A second cancer may occur months or years after treatment is completed. The type of second cancer that occurs depends in part on the original type of cancer and the cancer treatment. Benign tumors (not cancer) may also occur.
Second cancers that occur after cancer treatment include the following:
Myelodysplastic syndrome and acute myeloid leukemia may appear less than 10 years after a primary cancer diagnosis of Hodgkin lymphoma, acute lymphoblastic leukemia, sarcoma, central nervous system (CNS) tumor, non-Hodgkin lymphoma, neuroblastoma, or Wilms tumor and treatment with chemotherapy that included the following:
Patients treated with radiation to the bone marrow without chemotherapy may also have an increased risk of second acute myeloid leukemia.
Solid tumors that may appear more than 10 years after a primary cancer diagnosis and treatment include the following:
Certain genetic patterns or syndromes may increase the risk of a second cancer.
Some childhood cancer survivors may have an increased risk of developing a second cancer because they have a family history of cancer, an inherited cancer syndrome such as Li-Fraumeni syndrome, or a genetic mutation such as neurofibromatosis type 1. Problems with the way DNA is repaired in cells and the way anticancer drugs are used by the body may also affect the risk of second cancers.
Patients who have been treated for cancer need regular screening tests to check for a second cancer.
It is important for patients who have been treated for cancer to be checked for a second cancer before symptoms appear. This is called screening and may help find a second cancer at an early stage. When abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread.
It is important to remember that your child's doctor does not necessarily think your child has cancer if he or she suggests a screening test. Screening tests are given when your child has no cancer symptoms. If a screening test result is abnormal, your child may need to have more tests done to find out if he or she has a second cancer. These are called diagnostic tests.
The kind of test used to screen for a second cancer depends in part on the kind of cancer treatment the patient had in the past.
All patients who have been treated for cancer should have a physical exam and medical history done once a year. A physical exam of the body is done to check general signs of health, including checking for signs of disease, such as lumps, changes in the skin, or anything else that seems unusual. A medical history is taken to learn about the patient’s health habits and past illnesses and treatments.
If the patient received radiation therapy, the following tests and procedures may be used to check for skin, breast, or colorectal cancer:
- Cardiovascular System
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Heart and blood vessel late effects are more likely to occur after treatment for certain childhood cancers.
Treatment for these and other childhood cancers may cause heart and blood vessel late effects:
Radiation to the chest and certain types of chemotherapy increase the risk of heart and blood vessel late effects.
The risk of health problems involving the heart and blood vessels increases after treatment with the following:
Childhood cancer survivors who were treated with radiation therapy to the heart or blood vessels and certain types of chemotherapy are at greatest risk.
New treatments that decrease the amount of radiation given and use lower doses of chemotherapy or less harmful chemotherapy drugs may lessen the risk of heart and blood vessel late effects compared with older treatments.
The following may also increase the risk of heart and blood vessel late effects:
Late effects that affect the heart and blood vessels may cause certain health problems.
Childhood cancer survivors who received radiation or certain types of chemotherapy have an increased risk of late effects to the heart and blood vessels and related health problems. These include the following:
Childhood cancer survivors may have late effects that affect the heart during pregnancy.
Long-term survivors of childhood, adolescent, and young adult cancers who have received radiation therapy or certain types of chemotherapy are at risk of a rare type of heart failure during pregnancy called peripartum cardiomyopathy (PPCM). It may occur during late pregnancy and up to 5 months after giving birth. Patients at risk of this condition should be closely followed for weakness of the heart muscle during pregnancy.
Possible signs and symptoms of heart and blood vessel late effects include trouble breathing and chest pain.
These and other signs and symptoms may be caused by heart and blood vessel late effects or by other conditions:
Talk to your child's doctor if your child has any of these problems.
Certain tests and procedures are used to diagnose health problems in the heart and blood vessels.
In addition to asking about your child's personal and family health history and doing a physical exam, your child's doctor may perform the following tests and procedures.
Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of heart and blood vessel late effects. If tests are needed, find out how often they should be done.
Health habits that promote a healthy heart and blood vessels are important for survivors of childhood cancer.
Childhood cancer survivors may lower their risk of heart and blood vessel late effects by having a healthy lifestyle, which includes:
- Central Nervous System
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Brain and spinal cord late effects are more likely to occur after treatment for certain childhood cancers.
Treatment for these and other childhood cancers may cause brain and spinal cord late effects:
Radiation to the brain increases the risk of brain and spinal cord late effects.
The risk of health problems that affect the brain or spinal cord increases after treatment with the following:
When radiation to the brain and intrathecal chemotherapy are given at the same time, the risk of late effects is higher.
The following may also increase the risk of brain and spinal cord late effects in childhood brain tumor survivors:
Central nervous system late effects are also affected by where the tumor has formed in the brain and spinal cord.
Late effects that affect the brain and spinal cord may cause certain health problems.
Childhood cancer survivors who received radiation, certain types of chemotherapy, or surgery to the brain or spinal cord have an increased risk of late effects to the brain and spinal cord and related health problems. These include the following:
Survivors may also have late effects that affect thinking, learning, memory, emotions, and behavior.
New ways of using more targeted and lower doses of radiation to the brain may lessen the risk of brain and spinal cord late effects.
Possible signs and symptoms of brain and spinal cord late effects include headaches, loss of coordination, and seizures.
These signs and symptoms may be caused by brain and spinal cord late effects or by other conditions:
Other signs and symptoms include the following:
Talk to your child's doctor if your child has any of these problems.
Certain tests and procedures are used to diagnose health problems in the brain and spinal cord.
In addition to asking about your child's personal and family health history and doing a physical exam, your child's doctor may perform the following tests and procedures.
Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of brain and spinal cord late effects. If tests are needed, find out how often they should be done.
Survivors of childhood cancer may have anxiety and depression related to their cancer.
Survivors of childhood cancer may have anxiety and depression related to physical changes, having pain, the way they look, or the fear of cancer coming back. These and other factors may cause problems with personal relationships, education, employment, and health, and cause thoughts of suicide. Survivors with these problems may be less likely to live on their own as adults.
Follow-up exams for childhood cancer survivors should include screening and treatment for possible psychological distress, such as anxiety, depression, and thoughts of suicide.
For more information about psychological distress and coping skills for cancer patients, see the following PDQ summaries:
Some childhood cancer survivors have post-traumatic stress disorder.
Being diagnosed and treated for a life-threatening disease may be traumatic. This trauma may cause post-traumatic stress disorder (PTSD). PTSD is defined as having certain behaviors following a stressful event that involved death or the threat of death, serious injury, or a threat to oneself or others.
PTSD can affect cancer survivors in the following ways:
In general, childhood cancer survivors show low levels of PTSD, depending in part on the coping style of patients and their parents. Survivors who received radiation therapy to the head when younger than 4 years or survivors who received intensive treatment may be at higher risk of PTSD. Family problems, little or no social support from family or friends, and stress not related to the cancer may increase the chances of having PTSD.
Because avoiding places and persons connected to the cancer may be part of PTSD, survivors with PTSD may not get the medical treatment they need.
Adolescents who are diagnosed with cancer may have social problems later in life.
Adolescents who are diagnosed with cancer may reach fewer social milestones or reach them later in life than adolescents not diagnosed with cancer. Social milestones include having a first boyfriend or girlfriend, getting married, and having a child. They may also have trouble getting along with other people or feel like they are not liked by others their age.
Cancer survivors in this age group have reported being less satisfied with their health and their lives in general compared with others of the same age who did not have cancer. Adolescents and young adults who survived cancer need special programs that give psychological, educational, and job support.
- Digestive System
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Teeth and jaws
Problems with the teeth and jaws are late effects that are more likely to occur after treatment for certain childhood cancers.
Treatment for these and other childhood cancers may cause the late effect of problems with teeth and jaws:
Radiation to the head and neck and certain types of chemotherapy increase the risk of late effects to the teeth and jaws.
The risk of health problems that affect the teeth and jaws increases after treatment with the following:
Risk is also increased in survivors who were younger than 5 years at the time of treatment because their permanent teeth had not fully formed.
Late effects that affect the teeth and jaws may cause certain health problems.
Teeth and jaws late effects and related health problems include the following:
Possible signs and symptoms of late effects of the teeth and jaws include tooth decay (cavities) and jaw pain.
These and other signs and symptoms may be caused by late effects of the teeth and jaws or by other conditions:
Talk to your child's doctor if your child has any of these problems.
Certain tests and procedures are used to diagnose health problems in the mouth and jaws.
In addition to asking about your child's personal and family health history and doing a physical exam, your child's doctor may perform the following tests and procedures.
Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of teeth and jaw late effects. If tests are needed, find out how often they should be done.
Regular dental care is very important for survivors of childhood cancer.
Doctors suggest that survivors of childhood cancer have a dental check-up and a cleaning and fluoride treatment every 6 months. Children who had radiation therapy to the oral cavity may also see an orthodontist or an otolaryngologist. If lesions are present in the mouth, a biopsy may be needed.
Digestive tract
Digestive tract late effects are more likely to occur after treatment for certain childhood cancers.
Treatment for these and other childhood cancers may cause late effects of the digestive tract (esophagus, stomach, small and large intestines, rectum and anus):
Radiation to the bladder, prostate, or testicles and certain types of chemotherapy increase the risk of digestive tract late effects.
The risk of health problems that affect the digestive tract increases after treatment with the following:
The following may also increase the risk of digestive tract late effects:
Late effects that affect the digestive tract may cause certain health problems.
Digestive tract late effects and related health problems include the following:
Possible signs and symptoms of digestive tract late effects include abdominal pain and diarrhea.
These and other signs and symptoms may be caused by digestive tract late effects or by other conditions:
Talk to your child's doctor if your child has any of these problems.
Certain tests and procedures are used to diagnose health problems in the digestive tract.
In addition to asking about your child's personal and family health history and doing a physical exam, your child's doctor may perform the following tests and procedures.
Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of digestive tract late effects. If tests are needed, find out how often they should be done.
Liver and bile ducts
Liver and bile duct late effects are more likely to occur after treatment for certain childhood cancers.
Treatment for these and other childhood cancers may cause liver or bile duct late effects:
Certain types of chemotherapy and radiation to the liver or bile ducts increase the risk of late effects.
The risk of liver or bile duct late effects may be increased in childhood cancer survivors treated with one of the following:
The following may also increase the risk of liver and bile duct late effects:
Late effects that affect the liver and bile ducts may cause certain health problems.
Liver and bile duct late effects and related health problems include the following:
Possible signs and symptoms of liver and bile duct late effects include abdominal pain and jaundice.
These and other signs and symptoms may be caused by liver and bile duct late effects or by other conditions:
Talk to your child's doctor if your child has any of these problems.
Sometimes there are no signs or symptoms of liver or bile duct late effects and treatment may not be needed.
Certain tests and procedures are used to diagnose health problems in the liver and bile duct.
In addition to asking about your child's personal and family health history and doing a physical exam, your child's doctor may perform the following tests and procedures.
Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of liver or bile duct late effects. If tests are needed, find out how often they should be done.
Health habits that promote a healthy liver are important for survivors of childhood cancer.
Childhood cancer survivors with liver late effects should take care to protect their health, including:
Pancreas
Radiation therapy increases the risk of pancreatic late effects.
The risk of pancreatic late effects may be increased in childhood cancer survivors after treatment with one of the following:
Late effects that affect the pancreas may cause certain health problems.
Pancreatic late effects and related health problems include the following:
Possible signs and symptoms of pancreatic late effects include frequent urination and being thirsty.
These and other signs and symptoms may be caused by pancreatic late effects or by other conditions:
Talk to your child's doctor if your child has any of these problems.
Certain tests and procedures are used to diagnose health problems in the pancreas.
In addition to asking about your child’s personal and family health history and doing a physical exam, your child’s doctor may perform the following tests and procedures.
- Endocrine System
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Thyroid gland
Thyroid late effects are more likely to occur after treatment for certain childhood cancers.
Treatment for these and other childhood cancers may cause thyroid late effects:
Radiation therapy to the head and neck increases the risk of thyroid late effects.
The risk of thyroid late effects may be increased in childhood cancer survivors after treatment with any of the following:
The risk also is increased in females, in survivors who were a young age at the time of treatment, in survivors who had a higher radiation dose, and as the time since diagnosis and treatment gets longer.
Late effects that affect the thyroid may cause certain health problems.
Thyroid late effects and related health problems include the following:
Signs and symptoms of thyroid late effects depend on whether there is too little or too much thyroid hormone in the body.
These and other signs and symptoms may be caused by thyroid late effects or by other conditions:
Rarely, hypothyroidism does not cause any symptoms.
Talk to your child's doctor if your child has any of these problems.
Certain tests and procedures are used to diagnose health problems in the thyroid.
In addition to asking about your child’s personal and family health history and doing a physical exam, your child’s doctor may perform the following tests and procedures.
Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of thyroid late effects. If tests are needed, find out how often they should be done.
Hypothalamus and pituitary gland
Neuroendocrine late effects may be caused after treatment for certain childhood cancers.
The neuroendocrine system is the nervous system and the endocrine system working together.
Treatment for these and other childhood cancers may cause neuroendocrine late effects:
Treatment that affects the hypothalamus or pituitary gland increases the risk of neuroendocrine system late effects.
Childhood cancer survivors have an increased risk for neuroendocrine late effects. These effects are caused by radiation therapy to the brain in the area of the hypothalamus. The hypothalamus controls the way hormones are made and released into the bloodstream by the pituitary gland. Radiation therapy may be given to treat cancer near the hypothalamus or as total-body irradiation before a stem cell transplant. These effects are also caused by surgery in the area of the hypothalamus, pituitary gland, or optic pathways.
Childhood cancer survivors who have neuroendocrine late effects may have low levels of any of the following hormones made in the pituitary gland and released into the blood:
Late effects that affect the hypothalamus may cause certain health problems.
Neuroendocrine late effects and related health problems include the following:
Certain tests and procedures are used to diagnose health problems in the neuroendocrine system.
In addition to asking about your child’s personal and family health history and doing a physical exam, your child’s doctor may perform the following tests and procedures.
Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of neuroendocrine late effects. If tests are needed, find out how often they should be done.
Testicles and ovaries
For information about late effects in the testicles and ovaries, see the Reproductive System section.
Metabolic syndrome
Metabolic syndrome is more likely to occur after treatment for certain childhood cancers.
Metabolic syndrome is a group of medical conditions that includes having too much fat around the abdomen and at least two of the following:
Treatment for these and other childhood cancers may cause metabolic syndrome to occur later in life:
Radiation therapy increases the risk of metabolic syndrome.
The risk of metabolic syndrome may be increased in childhood cancer survivors after treatment with any of the following:
Certain tests and procedures are used to diagnose metabolic syndrome.
In addition to asking about your child’s personal and family health history and doing a physical exam, your child’s doctor may perform the following tests and procedures.
Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of metabolic syndrome. If tests are needed, find out how often they should be done.
Metabolic syndrome may cause heart and blood vessel disease and diabetes.
Metabolic syndrome is linked to an increased risk of heart and blood vessel disease and diabetes. Health habits that decrease these risks include:
Weight
Being underweight, being overweight, or having obesity is a late effect that is more likely to occur after treatment for certain childhood cancers.
Treatment for these and other childhood cancers may cause a change in weight:
Graft-versus-host disease may also cause a change in weight for patients treated with a stem cell transplant.
Radiation therapy increases the risk of being underweight, being overweight, or having obesity.
The risk of being underweight increases after treatment with the following:
The risk of being overweight or having obesity increases after treatment with the following:
The following may also increase the risk of obesity:
Childhood cancer survivors who get enough exercise and have a normal amount of anxiety have a lower risk of obesity.
Certain tests and procedures are used to diagnose a change in weight.
In addition to asking about your child’s personal and family health history and doing a physical exam, your child’s doctor may perform the following tests and procedures.
Being underweight, being overweight, or having obesity may be measured by weight, body mass index, percent of body fat, or size of the abdomen (belly fat).
Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of a change in weight. If tests are needed, find out how often they should be done.
- Immune System
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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:
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:
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 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 schedule through adolescence against the following:
Talk to your child's doctor about whether other childhood vaccinations given before cancer treatment need to be repeated.
- Musculoskeletal System
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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:
Poor nutrition and not enough exercise may also cause bone late effects.
Radiation therapy, surgery, chemotherapy, and other treatments increase the risk of bone and joint late effects.
Radiation therapy
Radiation therapy can stop or slow the growth of bone and muscle. 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:
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:
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:
Stem cell transplant
A stem cell transplant can affect the bone and joints in different ways:
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:
Talk to your child's doctor if your child has any of these problems.
Certain tests and procedures are used to diagnose health problems in the bone and joint.
In addition to asking about your child’s personal and family health history and doing a physical exam, your child’s doctor may perform the following tests and procedures.
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.
- Reproductive System
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Testicles
Testicular late effects are more likely to occur after treatment for certain childhood cancers.
Treatment for these and other childhood cancers may cause testicular late effects:
Surgery, radiation therapy, and certain types of chemotherapy increase the risk of late effects that affect the testicles.
The risk of health problems that affect the testicles increases after treatment with one or more of the following:
Late effects that affect the testicles may cause certain health problems.
Late effects of the testicles and related health problems include the following:
After treatment with chemotherapy or radiation, the body’s ability to make sperm may come back over time.
Certain tests and procedures are used to diagnose health problems in the testicles.
In addition to asking about your child’s personal and family health history and doing a physical exam, your child’s doctor may perform the following test.
Ovaries
Ovarian late effects are more likely to occur after treatment for certain childhood cancers.
Treatment for these and other childhood cancers may cause ovarian late effects:
Radiation therapy to the abdomen and certain types of chemotherapy increase the risk of ovarian late effects.
The risk of ovarian late effects may be increased after treatment with any of the following:
Late effects that affect the ovaries may cause certain health problems.
Ovarian late effects and other health related problems include the following:
Possible signs and symptoms of ovarian late effects include irregular or absent menstrual periods and hot flashes.
These and other signs and symptoms may be caused by ovarian late effects or by other conditions:
Talk to your child's doctor if your child has any of these problems.
Certain tests and procedures are used to diagnose health problems in the ovaries.
In addition to asking about your child’s personal and family health history and doing a physical exam, your child’s doctor may perform the following test.
Fertility and reproduction
Treatment for cancer may cause infertility in childhood cancer survivors.
The risk of infertility increases after treatment with the following:
Childhood cancer survivors may have late effects that affect pregnancy.
Late effects on pregnancy include increased risk of the following:
Some studies have not shown an increased risk of late effects on pregnancy.
There are methods that may be used to help childhood cancer survivors have children.
The following methods may be used so that childhood cancer survivors can have children:
Children of childhood cancer survivors are not affected by the parent’s previous treatment for cancer.
The children of childhood cancer survivors do not appear to have an increased risk of birth defects, genetic disease, or cancer.
- Respiratory System
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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:
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:
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:
Late effects that affect the lungs may cause certain health problems.
Lung late effects and related health problems include the following:
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:
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 diagnose health problems in the lung.
In addition to asking about your child’s personal and family health history and doing a physical exam, your child’s doctor may perform the following tests and procedures.
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:
- Senses
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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:
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:
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 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 diagnose health problems in the ear and hearing problems.
In addition to asking about your child’s personal and family health history and doing a physical exam, your child’s doctor may perform the following tests and procedures.
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:
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:
Late effects that affect the eye may cause certain health problems.
Eye late effects and related health problems include the following:
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:
Talk to your child's doctor if your child has any of these problems.
Certain tests and procedures are used to diagnose health problems in the eye and vision problems.
In addition to asking about your child’s personal and family health history and doing a physical exam, your child’s doctor may perform the following tests and procedures.
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
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Kidney
Kidney 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 kidney late effects:
Certain types of chemotherapy increase the risk of kidney late effects.
The risk of health problems that affect the kidney increases after treatment with the following:
The risk of kidney late effects is greater in childhood cancer survivors who are treated with a combination of surgery, chemotherapy, and/or radiation therapy.
The following may also increase the risk of kidney late effects:
Late effects that affect the kidney may cause certain health problems.
Kidney late effects or related health problems include the following:
Possible signs and symptoms of kidney late effects include problems urinating and swelling of the feet or hands.
These and other signs and symptoms may be caused by kidney late effects or by other conditions:
Sometimes there are no signs or symptoms in the early stages. Signs or symptoms may appear as damage to the kidney continues over time. Talk to your child's doctor if your child has any of these problems.
Certain tests and procedures are used to diagnose health problems in the kidney.
In addition to asking about your child’s personal and family health history and doing a physical exam, your child’s doctor may perform the following tests and procedures.
Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of kidney late effects. If tests are needed, find out how often they should be done.
Health habits that promote healthy kidneys are important for survivors of childhood cancer.
Childhood cancer survivors who had all or part of their kidney removed should talk to their doctor about the following:
Bladder
Bladder 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 bladder late effects:
Surgery to the pelvic area and certain types of chemotherapy increase the risk of bladder late effects.
The risk of health problems that affect the bladder increases after treatment with the following:
Late effects that affect the bladder may cause certain health problems.
Bladder late effects and related health problems include the following:
Possible signs and symptoms of bladder late effects include changes in urination and swelling of the feet or hands.
These and other signs and symptoms may be caused by bladder late effects or by other conditions:
Talk to your child's doctor if your child has any of these problems.
Certain tests and procedures are used to diagnose health problems in the bladder.
In addition to asking about your child’s personal and family health history and doing a physical exam, your child’s doctor may perform the following tests and procedures.
Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of bladder late effects. If tests are needed, find out how often they should be done.
- To Learn More About Late Effects of Treatment for Childhood Cancer
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For more information about late effects of treatment for childhood cancer, see the following:
For more childhood cancer information and other general cancer resources from the National Cancer Institute, see the following:
- About This PDQ Summary
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About PDQ
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.
PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.
Purpose of This Summary
This PDQ cancer information summary has current information about the late effects of treatment for childhood cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
Reviewers and Updates
Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.
The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board.
Clinical Trial Information
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).
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The best way to cite this PDQ summary is:
PDQ® Pediatric Treatment Editorial Board. PDQ Late Effects of Treatment for Childhood Cancer. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/childhood-cancers/late-effects-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389365]
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The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
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