Our Health Library information does not replace the advice of a doctor. Please be advised that this information is made available to assist our patients to learn more about their health. Our providers may not see and/or treat all topics found herein. This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER. 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. They may include physical, mental, and social problems and second cancers. These health problems are called late effects. Treatments that may cause late effects include: 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: 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 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 care plan the cancer survivor receives will depend on their general health and health habits, the type of cancer, the type of treatment, genetic factors, and other medical conditions. Follow-up care includes checking for 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 check-ups. 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, not following good sun protection measures, or not being physically active may worsen organ damage related to treatment and may increase the risk of second cancers. 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 may occur after cancer treatment include: 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: Children 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: 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. People who have been treated for cancer need regular screening tests to check for a second cancer. It is important for people 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 when it is smaller and has not spread. 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 the doctor does not necessarily think a childhood cancer survivor has cancer if he or she suggests a screening test. Screening tests are given when the cancer survivor has no cancer symptoms. If a screening test result is abnormal, more tests may be done to find out if there is 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 survivors had in the past. Childhood cancer survivors should have a physical exam and medical history done once a year. A physical exam of the body is done to see how healthy the person is and to check 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 cancer survivor's health habits and past illnesses and treatments. Childhood cancer survivors who received radiation therapy may have the following tests and procedures to check for skin, breast, or colorectal cancer: Heart and blood vessel late effects are more likely to occur after treatment for certain childhood cancers. Cardiovascular disease occurs at a younger age in childhood cancer survivors. 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: Childhood cancer survivors who were treated with both radiation therapy to the heart or blood vessels and certain types of chemotherapy are at greatest risk. Other factors that may also increase the risk of heart and blood vessel late effects include: New treatments that decrease the amount of radiation given, use lower doses of chemotherapy or less harmful chemotherapy drugs, and incorporate dexrazoxane may be leading to a lower risk of heart and blood vessel late effects in childhood cancer survivors. 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: Possible symptoms of heart and blood vessel late effects include trouble breathing and chest pain. These and other symptoms may be caused by heart and blood vessel late effects or by other problems: The only way to know if these symptoms are caused by heart and blood vessel late effects is to see a doctor. Certain tests and procedures are used to diagnose health problems in the heart and blood vessels. In addition to asking the childhood cancer survivor about their personal and family health history and doing a physical exam, the doctor may perform the following tests and procedures: Talk to the doctor about whether tests and procedures are needed 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: Brain and spinal cord late effects are more likely to occur after treatment of brain tumors and acute lymphoblastic leukemia. 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: 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: 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. A child may develop these problems soon after treatment or years later in adulthood. Brain and spinal cord late effects include: 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 symptoms of brain and spinal cord late effects include headaches, loss of coordination, and seizures. These symptoms may be caused by brain and spinal cord late effects or by other problems: Other symptoms include: The only way to know if these symptoms are caused by brain and spinal cord late effects is to see a doctor. Certain tests and procedures are used to diagnose health problems in the brain and spinal cord. In addition to asking the childhood cancer survivor about their personal and family health history and doing a physical exam, the doctor may perform the following tests and procedures: Talk to the doctor about whether tests and procedures are needed 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 have an increased risk of mental health disorders. Survivors of childhood cancer are more likely to be diagnosed with mental health disorders than their peers who have not had cancer. These disorders include: Having a mental health disorder may cause problems with personal relationships, education, employment, and health, and cause thoughts of suicide. As a result, survivors may be less likely to live on their own as adults. Follow-up care for childhood cancer survivors should include screening and treatment for possible psychological distress or mental health disorders. For more information about psychological distress and coping skills for people with cancer, see: 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 their coping style and the coping style of 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 people 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. Treatment with chemotherapy, radiation therapy, or surgery may cause problems throughout the digestive system, which starts at the mouth and ends at the rectum. Teeth and jaws Problems with the teeth and jaws are more likely to occur after treatment for certain childhood cancers. Treatment for these and other childhood cancers may cause late effects of the 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: 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: Possible symptoms of late effects of the teeth and jaws include tooth decay (cavities) and jaw pain. These and other symptoms may be caused by late effects of the teeth and jaws or by other problems: The only way to know if these symptoms are caused by late effects of the teeth and jaws is to see a doctor. Certain tests and procedures are used to diagnose health problems in the mouth and jaws. In addition to asking the childhood cancer survivor about their personal and family health history and doing a physical exam, the doctor may perform the following tests and procedures: Talk to the doctor about whether tests and procedures are needed 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 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: Possible symptoms of digestive tract late effects include abdominal pain and diarrhea. These and other symptoms may be caused by digestive tract late effects or by other problems: The only way to know if these symptoms are caused by digestive late effects is to see a doctor. Certain tests and procedures are used to diagnose health problems in the digestive tract. In addition to asking the childhood cancer survivor about their personal and family health history and doing a physical exam, the doctor may perform the following tests and procedures: Talk to the doctor about whether tests and procedures are needed 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: 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: Possible symptoms of liver and bile duct late effects include abdominal pain and jaundice. These and other symptoms may be caused by liver and bile duct late effects or by other problems: The only way to know if these symptoms are caused by liver and bile duct late effects is to see a doctor. 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 the childhood cancer survivor about their personal and family health history and doing a physical exam, the doctor may perform the following tests and procedures: This test is used to check the amount of platelets in the body. Talk to the doctor about whether tests and procedures are needed 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: Late effects that affect the pancreas may cause certain health problems. Pancreatic late effects and related health problems include: Possible symptoms of pancreatic late effects include frequent urination and being thirsty. These and other symptoms may be caused by pancreatic late effects or by other problems: The only way to know if these symptoms are caused by pancreatic late effects is to see a doctor. Certain tests and procedures are used to diagnose health problems in the pancreas. In addition to asking the childhood cancer survivor about their personal and family health history and doing a physical exam, the doctor may perform the following tests and procedures: 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: 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. Risk for endocrine problems also depends on the location of the tumor. Late effects that affect the thyroid may cause certain health problems. Thyroid late effects and related health problems include: Symptoms of thyroid late effects depend on whether there is too little or too much thyroid hormone in the body. These and other symptoms may be caused by thyroid late effects or by other problems: Hypothyroidism (too little thyroid hormone) Rarely, hypothyroidism does not cause any symptoms. Hyperthyroidism (too much thyroid hormone) The only way to know if these symptoms are caused by thyroid late effects is to see a doctor. Certain tests and procedures are used to diagnose health problems in the thyroid. In addition to asking the childhood cancer survivor about their personal and family health history and doing a physical exam, the doctor may perform the following tests and procedures: Talk to the doctor about whether tests and procedures are needed 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 treat cancer in the brain near the hypothalamus or used as total-body irradiation before a stem cell transplant. The hypothalamus controls the way hormones are made and released into the bloodstream by the pituitary gland. These effects are also caused by surgery in the area of the hypothalamus, pituitary gland, or optic pathways. Late effects that affect the hypothalamus may cause certain health problems. Childhood cancer survivors who have neuroendocrine late effects may have abnormal levels of hormones made in the pituitary gland and released into the blood. Neuroendocrine late effects and related health problems include: A low level of growth hormone in childhood results in adult height that is shorter than normal. If the child's bones have not fully developed, low growth hormone levels may be treated with growth hormone replacement therapy beginning one year after the end of treatment. Symptoms of adrenocorticotropin deficiency may not be severe and may not be noticed. Symptoms include: Low levels of adrenocorticotropin may be treated with hydrocortisone therapy. Sometimes there are no signs and symptoms. Treatment is rarely needed. Sometimes the symptoms of thyroid-stimulating hormone deficiency are not noticed. Low thyroid hormone levels may cause slow growth and delayed puberty, as well as other symptoms. Learn more about the symptoms of hypothyroidism. A low level of thyroid hormone may be treated with thyroid hormone replacement therapy. Childhood cancer survivors who had brain tumors near the hypothalamus or pituitary gland, who were treated with lower doses of radiation to the brain, or who have hydrocephalus may develop central precocious puberty (a condition that causes puberty to start before age 8 in girls and 9 in boys). Central precocious puberty happens when the brain releases luteinizing and follicle-stimulating hormones too soon in the child's development. This condition may be treated with gonadotropin-releasing hormone (GnRH) agonist therapy to delay puberty and help the child's growth. Childhood cancer survivors who were treated with higher doses of radiation to the brain may have low levels of luteinizing hormone or follicle-stimulating hormone. This condition may be treated with sex hormone replacement therapy. The dose will depend on the child's age and whether the child has reached puberty. Symptoms of central diabetes insipidus in infants may include: Certain tests and procedures are used to diagnose health problems in the neuroendocrine system. In addition to asking the childhood cancer survivor about their personal and family health history and doing a physical exam, the doctor may perform the following tests and procedures: Talk to the doctor about whether tests and procedures are needed to check for signs of neuroendocrine late effects. If tests are needed, find out how often they should be done. 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: Certain tests and procedures are used to diagnose metabolic syndrome. In addition to asking the childhood cancer survivor about their personal and family health history and doing a physical exam, the doctor may perform the following tests and procedures: Talk to the doctor about whether tests and procedures are needed 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, having excess body weight, 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, having excess body weight, or having obesity. The risk of being underweight increases after treatment with: The risk of having excess body weight or obesity increases after treatment with: 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 the childhood cancer survivor about their personal and family health history and doing a physical exam, the doctor may perform the following tests and procedures: Being underweight, having excess body weight, or having obesity may be measured by weight, body mass index, percent of body fat, or size of the abdomen (belly fat). Talk to the doctor about whether tests and procedures are needed to check for signs of a change in weight. If tests are needed, find out how often they should be done. Cancer treatments and surgery to remove the spleen increase the risk of immune system late effects. The risk of health problems that affect the immune system increases after treatment that affects the spleen, including: The risk of health problems that affect the immune system may increase after treatment with: Late effects that affect the immune system may cause infection. Late effects that affect the immune system may increase the risk of viral infections or very serious bacterial infections. This risk is higher in younger children than in older children and in children who have decreased vaccine coverage after cancer treatment. The risk may be greater in the early years after the spleen stops working or is removed by surgery. These 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 or have lost vaccine immunity may need antibiotics or booster vaccine doses to lessen the risk of infection. Daily antibiotics may be prescribed for children younger than 5 years 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: Some children may lose the protection they had from vaccines during their cancer treatments. Talk to the doctor about whether childhood vaccinations given before cancer treatment need to be repeated. 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 effects depends on the part of the body that received radiation therapy. Radiation therapy may cause: 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 for 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 received cancer treatment that included methotrexate or corticosteroids or glucocorticoids such as dexamethasone. Drug therapy may cause: Stem cell transplant A stem cell transplant can affect the bone and joints in different ways: Possible symptoms of bone and joint late effects include swelling over a bone or bone and joint pain. These and other symptoms may be caused by bone and joint late effects or by other problems: The only way to know if these symptoms are caused by bone and joint late effects is to see a doctor. Certain tests and procedures are used to diagnose health problems in the bone and joint. In addition to asking the childhood cancer survivor about their personal and family health history and doing a physical exam, the doctor may perform the following tests and procedures: Talk to the doctor about whether tests and procedures are needed to check for signs of bone and joint late effects. If tests are needed, find out how often they should be done. Reproductive system 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: Treatment for these and other childhood cancers may cause ovarian late effects: Surgery, radiation therapy, and certain types of chemotherapy increase the risk of late effects that affect the reproductive system. The risk of health problems that affect the reproductive system increases after treatment with: In female survivors who had radiation therapy to the abdomen, the damage to the ovaries depends on the radiation dose, age at the time of treatment, and whether all or part of the abdomen received radiation. Testicles Late effects that affect the testicles may cause certain health problems. Late effects of the testicles and related health problems include: 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 the childhood cancer survivor about their personal and family health history and doing a physical exam, the doctor may perform the following tests: Ovaries Late effects that affect the ovaries may cause certain health problems. Ovarian late effects and other health-related problems include: Hormone replacement therapy can be used to start puberty. Possible symptoms of ovarian late effects include irregular or absent menstrual periods and hot flashes. These and other symptoms may be caused by ovarian late effects or by other problems: The only way to know if these symptoms are caused by late effects to the ovaries is to see a doctor. Certain tests and procedures are used to diagnose health problems in the ovaries. In addition to asking the childhood cancer survivor about their personal and family health history and doing a physical exam, the doctor may perform the following test. Fertility and reproduction Childhood cancer survivors may have late effects that affect pregnancy. Late effects on pregnancy include increased risk of: 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. It may occur during late pregnancy and up to 5 months after giving birth. If cancer treatments have caused damage to the heart, these patients may also be at risk of congestive heart failure during pregnancy. Patients at risk of these conditions should be closely followed for weakness of the heart muscle during pregnancy. 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. 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: In survivors who had radiation to the chest, the damage to the lungs and chest wall depends on the radiation dose, whether all or part of the lungs and chest wall received radiation, whether the radiation was given in small, divided daily doses, and the child's age at treatment. 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: Late effects that affect the lungs may cause certain health problems. Lung late effects and related health problems include: Possible symptoms of lung late effects include trouble breathing and cough. These and other symptoms may be caused by lung late effects or by other problems: The only way to know if these symptoms are caused by lung late effects is to see a doctor. 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 the childhood cancer survivor about their personal and family health history and doing a physical exam, the doctor may perform the following tests and procedures: Talk to the doctor about whether tests and procedures are needed 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: 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 risk of hearing loss from radiation therapy is greater in children who are diagnosed with cancer before age 5 years, and the risk increases for children of all ages with higher radiation doses. The risk of hearing loss is also greater in childhood cancer survivors who received radiation therapy to the brain and chemotherapy at the same time. The risk of hearing loss may be lower if children treated with cisplatin were also given a drug called sodium thiosulfate. Hearing loss is the most common sign of hearing late effects. These and other symptoms may be caused by hearing late effects or by other problems: The only way to know if these symptoms are caused by hearing late effects is to see a doctor. Hearing loss may occur during treatment, soon after treatment ends, or several months or years after treatment ends and worsen over time. A young child may have trouble learning, communicating, doing well in school, and interacting with others if they have hearing loss. In adulthood, hearing loss can lead to social isolation, depression, anxiety, and trouble finding stable employment. Talk to a doctor to learn about hearing aids or other ways to cope with hearing loss. Certain tests and procedures are used to diagnose health problems in the ear and hearing problems. In addition to asking the childhood cancer survivor about their personal and family health history and doing a physical exam, the doctor may perform the following tests and procedures: Talk to the doctor about whether tests and procedures are needed 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: Having a history of chronic graft-versus-host disease after a stem cell transplant can also increase the risk of eye problems and vision loss. Late effects that affect the eye may cause certain health problems. Eye late effects and related health problems include: Possible signs and symptoms of eye and vision late effects include changes in vision and dry eyes. These and other symptoms may be caused by eye and vision late effects or by other problems: The only way to know if these symptoms are caused by eye and vision late effects is to see a doctor. Certain tests and procedures are used to diagnose health problems in the eye and vision problems. In addition to asking the childhood cancer survivor about their personal and family health history and doing a physical exam, the doctor may perform the following tests and procedures: Talk to the doctor about whether tests and procedures are needed to check for signs of eye and vision late effects. If tests are needed, find out how often they should be done. 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 risk of kidney late effects is greater in childhood cancer survivors who were treated with a combination of surgery, chemotherapy, 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: Possible symptoms of kidney late effects include problems urinating and swelling of the feet or hands. These and other symptoms may be caused by kidney late effects or by other problems: Sometimes there are no signs or symptoms in the early stages. Signs or symptoms may appear as damage to the kidney continues over time. The only way to know if these symptoms are caused by kidney late effects is to see a doctor. Certain tests and procedures are used to diagnose health problems in the kidney. In addition to asking the childhood cancer survivor about their personal and family health history and doing a physical exam, the doctor may perform the following tests and procedures: Talk to the doctor about whether tests and procedures are needed to check for signs of kidney late effects. If tests are needed, find out how often they should be done. If kidney problems are found, treatment options are available, including kidney transplant. 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: 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: Late effects that affect the bladder may cause certain health problems. Bladder late effects and related health problems include: Possible symptoms of bladder late effects include changes in urination and swelling of the feet or hands. These and other symptoms may be caused by bladder late effects or by other problems: The only way to know if these symptoms are caused by bladder late effects is to see a doctor. Certain tests and procedures are used to diagnose health problems in the bladder. In addition to asking the childhood cancer survivor about their personal and family health history and doing a physical exam, the doctor may perform the following tests and procedures: Talk to the doctor about whether tests and procedures are needed to check for signs of bladder late effects. If tests are needed, find out how often they should be done. For more information about late effects of treatment for childhood cancer: For more childhood cancer information and other general cancer resources from the National Cancer Institute: 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). Permission to Use This Summary PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as "NCI's PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary]." 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] Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images. Disclaimer 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. Contact Us More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website's E-mail Us. Last Revised: 2024-10-29 If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions. This information does not replace the advice of a doctor. Ignite Healthwise, LLC disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use and Privacy Policy. Learn how we develop our content. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Ignite Healthwise, LLC.Topic Contents
Late Effects of Treatment for Childhood Cancer (PDQ®): Treatment - Patient Information [NCI]
General Information About Late Effects
Second Cancers
Cardiovascular System
Central Nervous System
Digestive System
Endocrine System
Immune System
Musculoskeletal System
Reproductive System
Respiratory System
Senses
Urinary System
To Learn More About Late Effects of Treatment for Childhood Cancer
About This PDQ Summary
Our Health Library information does not replace the advice of a doctor. Please be advised that this information is made available to assist our patients to learn more about their health. Our providers may not see and/or treat all topics found herein. This information does not replace the advice of a doctor. Ignite Healthwise, LLC disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use and Privacy Policy. Learn how we develop our content. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Ignite Healthwise, LLC.Late Effects of Treatment for Childhood Cancer (PDQ®): Treatment - Patient Information [NCI]