Treatment for childhood cancer - long-term risks

Some cancer treatments damage healthy cells. Part of 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.

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

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 given
• Type of cancer being treated and the area of body involved
• Child's genetic background (some children are more sensitive to treatments)

There are many types of late effects that may occur depending on where the cancer was and what types of treatments were done. Late effects are generally predictable based on a child's specific treatments. Many of the effects can be managed. The following are examples of some late effects based on body parts affected. Note that this is a complete list and not all effects will apply to a child depending on the specific treatments.

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

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.

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:

• Eating healthy foods
• Not smoking or using tobacco
• Exercising regularly
• Maintaining a healthy weight
• Seeing their provider regularly to have regular screenings and tests, including the heart and lungs

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.
• Follow up with an oncologist or member of the survivorship or late-effects 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 give your child the best chance of recovery and good health.

Childhood cancer - late effects

American Cancer Society website. Late effects of childhood cancer treatment. www.cancer.org/cancer/survivorship/children-with-cancer/late-effects-of-cancer-treatment.html. Updated September 18, 2017. Accessed August 21, 2024.

Joffe L, Levine J. Survivorship and late effects. In: Weiner M, Yamashiro DJ, Satwani P, Bhatia M, Neunert C, eds. Pediatric Hematology & Oncology Secrets. 2nd ed. Philadelphia, PA: Elsevier; 2024:chap 24.

National Cancer Institute website. Children with cancer: A guide for parents. www.cancer.gov/publications/patient-education/guide-for-parents. Updated September 2015. Accessed August 21, 2024.

National Cancer Institute website. Late effects of treatment for childhood cancer (PDQ) - health professional version. www.cancer.gov/types/childhood-cancers/late-effects-hp-pdq#section/all. Updated June 24, 2024. Accessed August 21, 2024.

Updated by: Rachel Offenbacher, MD, Pediatric Hematology & Oncology, The Children's Hospital at Montefiore, Bronx, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.