Late effects are treatment-related health problems that appear months or years after treatment has ended.
The treatment of cancer may damage healthy cells at the same time it destroys cancer cells. Some cancer treatments, such as chemotherapy, radiation therapy, and bone marrow or stem cell transplant, stop the growth of rapidly dividing cells, such as cancer cells. Since bones, tissues, and organs that are growing with the child have cells that are also dividing rapidly, cancer treatment can prevent them from developing normally. Other cancer treatments include surgery to remove all or part of certain organs that have cancer in them. The damage from these cancer treatments can be mild or serious, and the effects may be seen during treatment or months to years later.
Side effects that continue or appear after cancer treatment has ended are called late effects. It is important for the parents and the patient to know that children treated for cancer (childhood cancer survivors) may develop late effects from their treatment.
Late effects of cancer treatment may affect the following in childhood cancer survivors:
The risk of developing late effects is related to the type of cancer or type of treatment.
The risk that a cancer treatment will cause late effects depends on many things, including the following:
Regular follow-up by health professionals who are expert in finding and treating late effects is important for the long-term health of childhood cancer survivors. Records about the cancer diagnosis and treatment, including all test results, should be kept by childhood cancer survivors (or their caregivers). This information may be used to help find and treat late effects.
Doctors are studying the late effects that cancer treatments cause in childhood cancer survivors. They are trying to find out if changing treatment can help prevent or lessen late effects in childhood cancer survivors.
Cancer treatments to the central nervous system (CNS) may affect the child's brain.
Childhood cancer survivors who received radiation therapy to the head, brain surgery, or intrathecal chemotherapy are at risk of having problems in the following areas:
Survivors may have learning disabilities or a lower IQ.
Certain factors increase the risk that CNS late effects will occur.
The following factors may increase the risk of CNS late effects:
CNS late effects may be caused by treatment for certain childhood cancers.
Treatment for these and other childhood cancers may cause CNS late effects:
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, appearance, or the fear of cancer coming back. These problems may prevent survivors from returning to their normal routines and activities. They may also cause problems with personal relationships, education, employment, and health.
Some cancer survivors have post-traumatic stress disorder.
Being diagnosed with a life-threatening disease and receiving treatment for it is often traumatic. This trauma may cause a group of symptoms called post-traumatic stress disorder (PTSD). PTSD is defined as having certain symptoms following a stressful event that involved death or the threat of death, serious injury, or a threat to oneself or others. People who have survived very stressful situations, such as military combat or natural disasters, may also have PTSD.
PTSD can affect cancer survivors in the following ways:
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 is part of PTSD, survivors with PTSD may not try to get the medical treatment they need.
Ears
Childhood cancer survivors may have late effects that affect hearing.
Certain factors increase the risk that hearing loss will occur.
The risk of hearing loss may be increased in childhood cancer survivors who received either of the following:
Risk may also be increased in childhood cancer survivors who were young at the time of treatment (the younger the child, the greater the risk).
Hearing late effects may be caused by treatment for certain childhood cancers.
Treatment for these and other childhood cancers may cause hearing late effects:
Eyes
Childhood cancer survivors may have late effects that affect the eyes.
Eye late effects may include the following:
Certain factors increase the risk that damage to the eye or eye socket will occur.
The following may increase the risk of damage to the eye or eye socket:
The risk may also be increased in childhood cancer survivors who had either of the following:
Eye late effects may be caused by radiation treatments for certain childhood cancers.
Radiation therapy for these and other childhood cancers may cause eye late effects:
Teeth and jaw
Childhood cancer survivors may have late effects that affect the teeth and jaw.
Teeth and jaw late effects may include the following:
Certain factors increase the risk that teeth and jaw late effects will occur.
The risk of teeth and jaw late effects may be increased in childhood cancer survivors who received any of the following:
Risk may also be increased in survivors who were younger than 3 years at the time of treatment.
It is important that childhood cancer survivors have regular dental checkups to help prevent or detect infection or decay.
Teeth and jaw late effects may be caused by treatment for certain childhood cancers.
Treatment for these and other childhood cancers may cause teeth and jaw late effects:
Liver
Childhood cancer survivors may have late effects that affect the liver.
Liver late effects may include the following:
Hepatic fibrosis, hepatitis C infection, and veno-occlusive disease can cause long-term problems.
Certain factors increase the risk that liver late effects will occur.
The risk of liver late effects may be increased in childhood cancer survivors who received any of the following:
Risk may also be increased in survivors who had liver disease before treatment or developed veno-occlusive disease during treatment.
Liver late effects may be caused by treatment for certain childhood cancers.
Treatment for these and other childhood cancers may cause liver late effects:
Digestive tract
Childhood cancer survivors may have late effects that affect the digestive tract.
Digestive tract late effects may include the following:
These effects may be caused by damage to the blood vessels, which may lead to long-term problems.
Radiation therapy to the abdomen may damage blood vessels and increase the risk of digestive tract late effects.
Digestive tract late effects may be caused by treatment for certain childhood cancers.
Treatment for these and other childhood cancers may cause digestive tract late effects:
Childhood cancer survivors may have late effects that affect the spleen.
Spleen late effects may increase the risk of life-threatening bacterial infections.
Certain factors increase the risk that spleen late effects will occur.
The risk of spleen late effects may be increased in childhood cancer survivors who received either of the following:
It is very important that childhood cancer survivors who received either of these treatments keep immunizations up-to-date and receive antibiotics before having any dental work.
Spleen late effects may be caused by treatment for childhood Hodgkin lymphoma and other childhood cancers.
Childhood cancer survivors may have late effects that affect the heart.
Heart late effects may include the following:
Certain factors may increase the risk that heart late effects will occur.
The following may increase the risk of heart late effects:
This risk may also increase as the amounts of anthracycline drugs and radiation used increase and as the time since treatment gets longer.
Heart late effects may be caused by treatment for certain childhood cancers.
Treatment for these and other childhood cancers may cause heart late effects:
Childhood cancer survivors may have late effects that affect the lungs.
Lung late effects may include the following:
Certain factors increase the risk that lung problems will occur.
The risk of lung late effects may be increased in childhood cancer survivors who had either of the following:
Risk may also be increased in survivors who received any of the following:
Lung late effects may be caused by treatment for certain childhood cancers.
Treatment for these and other childhood cancers may cause lung late effects:
Childhood cancer survivors may have late effects that affect the kidneys.
Kidney late effects may include the following:
Certain factors increase the risk that kidney problems will occur.
The following may increase the risk of kidney late effects:
Risk may also be increased in childhood cancer survivors who received any of the following:
Kidney late effects may be caused by treatment for Wilms’ tumor and other childhood cancers.
Childhood cancer survivors may have late effects that affect the thyroid.
Thyroid late effects may include the following:
Certain factors increase the risk that thyroid problems will occur.
The risk of thyroid late effects may be increased in childhood cancer survivors who received either of the following:
The risk may also be greater in females and may increase as the amount of time since diagnosis gets longer.
Thyroid late effects may be caused by treatment for certain childhood cancers.
Treatment for these and other childhood cancers may cause thyroid late effects:
Childhood cancer survivors may have late effects that affect the neuroendocrine system.
Neuroendocrine late effects may include the following:
Childhood cancer survivors who received a stem cell transplant with total-body irradiation (TBI) have an increased risk of growth disorders.
Their risk is affected as follows:
Neuroendocrine late effects may be caused by treatment for certain childhood cancers.
Treatment for these and other childhood cancers may cause neuroendocrine late effects:
Bone
Childhood cancer survivors may have late effects that affect the bones.
Bone late effects may include the following:
Certain factors increase the risk that bone late effects will occur.
The following may increase the risk of bone late effects:
Risk may also be increased in childhood cancer survivors who received either of the following:
Bone late effects may be caused by treatment for certain childhood cancers.
Treatment for these and other childhood cancers may cause bone late effects:
Body weight
Childhood cancer survivors may have late effects that affect body weight and cause obesity.
The following may increase the risk of obesity:
Obesity may be caused by treatment for certain childhood cancers.
Treatment for these and other childhood cancers may cause obesity:
Testicles
Childhood cancer survivors may have late effects that affect the testicles.
Testicular late effects may cause infertility or a low sperm count. Low sperm counts may be temporary or permanent depending on the radiation dose and schedule, the area of the body treated, and the age when treated.
Certain factors increase the risk that testicular late effects will occur.
The risk of testicular late effects may be increased in childhood cancer survivors who received either of the following:
Testicular late effects may be caused by treatment for certain childhood cancers.
Treatment for these and other childhood cancers may cause testicular late effects:
Ovaries
Childhood cancer survivors may have late effects that affect the ovaries.
Ovarian late effects may include the following:
Certain factors increase the risk that ovarian late effects will occur.
The risk of ovarian late effects may be increased in childhood cancer survivors who received any of the following:
Uterus
Childhood cancer survivors may have late effects that affect the uterus.
The uterus may become less elastic and grow to a size that is smaller than normal. This can cause an increased risk of miscarriage and premature birth. Growth of the fetus within the uterus may also be affected.
The risk of uterine late effects may be increased in women who received radiation therapy to the abdomen.
Ovarian and uterine late effects may be caused by treatment for childhood osteosarcoma and other childhood cancers.
Reproduction
Childhood cancer survivors may have late effects that affect pregnancies.
Late effects on pregnancies include increased risk of the following:
For male survivors of childhood cancer, there is an increased risk that their children may be stillborn.
Certain stem cell and bone marrow transplants increase the risk of infertility.
Stem cell and bone marrow transplants that include total-body irradiation (TBI), cyclophosphamide, or busulfan may damage the ovaries. Problems with the ovaries, fertility, and the ability to carry a baby to term may occur.
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:
There is a risk that there may be cancer cells in the saved eggs, sperm, or embryo. This risk is highest in patients who had cancer of the blood, testicles, or ovaries.
Children of childhood cancer survivors are usually not affected by a parent’s prior cancer treatment.
Survivors of childhood cancer may wonder if their children will have birth defects, inherited diseases, or cancer. There is a small increase in the risk of birth defects in the children of females who received radiation therapy to the lower back, but most children of childhood cancer survivors are born healthy.
There may be an increased risk of birth defects in children whose embryos were created in the laboratory and an increased risk of cancer in the children of cancer survivors who had second cancers.
Childhood cancer survivors have an increased risk of developing a second cancer later in life.
Certain factors related to treatment increase the risk of second cancers. These include the following:
Childhood cancer survivors with certain genetic syndromes have an increased risk of developing a second cancer.
Some childhood cancer survivors have an increased risk of developing a second cancer because they have certain genetic syndromes that also placed them at risk of developing the primary cancer. These include the following:
Frequent and careful follow-up exams are very important for these childhood cancer survivors.
Improvements in cancer treatment have decreased the number of deaths from primary cancer. The number of late effects in childhood cancer survivors may increase with age, however, and survivors may not live as long as people who did not have cancer. The most common causes of death in childhood cancer survivors include the following:
Studies of the causes of late effects have led to changes in treatment. This has improved the quality of life for cancer survivors and helped to prevent deaths from late effects.
Regular follow-up care is very important for survivors of childhood cancer.
Follow-up care will be different for each person who has been treated for cancer, depending on the type of cancer, the type of treatment, and the person's general health. It is important that childhood cancer survivors receive regular exams by a health care provider who is familiar with their treatments and risks and who can recognize the early signs of late effects.
Childhood cancer survivors are more likely to need special education services, especially survivors of central nervous system tumors, leukemia, and Hodgkin disease.
The childhood cancer survivor's follow-up care will go on into adulthood. It ideally includes the survivor’s primary doctor and specialists; educational, vocational, and social service systems; and the family.
Long-term follow-up improves the health and quality of life for cancer survivors and also helps doctors study the late effects of cancer treatments so that safer therapies for newly diagnosed children may be developed.
Behaviors that promote health are important for survivors of childhood cancer.
The quality of life enjoyed by cancer survivors may be improved by behaviors that promote their future health and well-being, such as 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 treatment-related health problems. 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, and the use of illegal drugs increase the risk of organ damage and, possibly, of second cancers.
For more information from the National Cancer Institute 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:
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The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Changes were made to this summary to match those made to the health professional version.
2005-03-24 Last Modified: 2009-08-13
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