What Are Late Effects of Cancer and Cancer Treatment?
If your child has cancer,
you're probably familiar with the short-term effects of the disease and its treatment:
pain, nausea, tiredness, skin rashes, and more.
But even when the disease is in
and your child has been cancer-free for years, long-term side
effects may happen. These problems are called "late effects."
About 2 out of 3 cancer survivors will develop at least one late effect at some
point. With early diagnosis and proper follow-up care, most late effects can be treated
What Causes Late Effects?
The cancer itself is not what usually causes the late effects — rather, it's the
and radiation both
work by killing fast-growing cells. Cancer cells are among those, but unfortunately
so are lots of other healthy cells.
More research needs to be done to fully understand how late effects happen. Researchers
think it is likely that damage to the cells at critical points in a child's development
leads to late effects.
Doctors have learned that the types of effects a childhood cancer survivor might
have later can depend on:
the type of cancer the child had
where the cancer was in the body
the type and dose of chemotherapy and radiation
the age and general health of the child at the time of treatment
What Are the Common Late Effects of Cancer Treatment?
Late side effects include:
Learning problems. Some chemotherapy drugs and/or radiation to
the brain may interfere with learning. The problems can range from mild to severe,
and may show up during treatment, soon after treatment, or several years later. Common
learning problems include problems with memory, processing speed, and multi-tasking.
Abnormal bone growth. Sometimes kids do not grow in the usual
timeframe and/or stop growing much earlier than normal. This may be due to radiation
treatment, chemotherapy, or a brain
tumor or its treatment.
Kids may also be at risk for developing osteoporosis (bone thinning) or scoliosis
(a curved spine).
Thyroid problems. The thyroid is a gland of the endocrine system
(chemical reactions in the body's cells). It may be damaged by radiation
to the head or neck. The result is typically hypothyroidism
(when the thyroid doesn't make enough thyroid hormone), leading to tiredness, weight
gain, thinning hair, and dry skin.
Hearing loss. Chemotherapy, radiation to the brain, and even some
antibiotics can lead to high-frequency hearing loss (when a person cannot hear high-pitched
sounds), tinnitus (ringing in the ears), or dizziness.
Vision problems. Blurred or double vision, glaucoma, or cataracts
are more likely in kids who were treated for tumors near the eye or received radiation
to the brain.
Dental problems. Short dental roots, delayed teeth, or missing
teeth are more common in very young children who've had radiation to the brain and/or
chemotherapy with a drug called vincristine. All kids who have had chemo are at risk
for tooth decay and gum disease.
Lung, liver, or kidney problems. Childhood cancer treatments have
been linked to several types of body organ damage later in life. How serious the organ
damage is depends on the type of cancer and treatment.
Heart problems. Kids who had chest radiation and/or chemo with
a class of drugs called anthracycline are at higher risk for heart problems up to
20 years or longer after treatment. The severity of the problem depends on how much
chemo and/or chest radiation they got and the child's age during treatment. Family
weight, and cholesterol level also play a role in in getting heart problems.
Delayed sexual development and fertility issues. Both chemotherapy
and radiation can cause fertility
problems. These late effects may be from damage to the endocrine
system (which starts the onset of puberty) or to the sexual organs themselves.
Because of the risk, special measures may be taken before or during treatment to
protect the reproductive organs. For example, doctors may shield the ovaries
during radiation treatment. Teen boys and girls may be able to bank their sperm and
eggs before cancer treatment. The good news is that despite these risks, many childhood
cancer survivors can go on to have healthy children of their own.
Increased risk of future cancers. Childhood cancer survivors have
a slightly higher risk of developing a second cancer at some point — even if the original
cancer doesn't come back. Many things affect this risk, such as the type of the first
cancer, the treatments given, and any genetic risks.
What Can We Expect During Remission?
When your child is considered cancer-free and in remission,
you may be tempted to stay as far away from doctors and hospitals as you can. But
your child needs to be carefully monitored for years to come, even into adulthood.
As with any disease, the sooner any possible late effects are caught, the quicker
they can be managed.
After treatment ends, ask the doctor for what's called an "off-treatment summary."
This includes all of the information related to your child's cancer diagnosis, treatment,
and follow-up care. Follow-up appointments may include regular screenings like blood
tests, hearing tests, vision tests, and heart tests (echocardiograms,
It's important that your child follow this schedule. The hospital may have a cancer
survivorship clinic to help with this process. Survivorship clinics provide long-term
medical services and follow-up care for cancer survivors. The focus is on educating
you and your child about the cancer that's now in remission; long-term follow-up recommendations;
and ways to live a healthy, happy, long life.
Keep all medical records in a safe place, and help your child begin taking responsibility
for managing his or her own health
As your child grows, emphasize the importance of regular follow-up care and also
a healthy lifestyle that includes a balanced diet and regular exercise. Both can increase
your child's chances of staying well in the future.
How Can Parents Help?
Knowing that the cancer might come back can be hard for any childhood cancer survivor.
Some kids might not tell their parents about any new symptoms for fear of being sick
Reassure your child that no one knows what tomorrow holds and that even if a late
effect should appear, it's best to pay attention to symptoms right away. Many late
effects are treatable with routine medical care.