The medical late effects associated with childhood cancer and its treatment can vary greatly from person to person. The most commonly seen medical late effects at the Long-Term Follow-Up Clinic are:

Endocrine (Hormone) Problems

Some survivors of childhood cancer may experience endocrine dysfunction, or hormone imbalances. These are the most common type of late effects seen at the Long-Term Follow-Up Clinic. Thyroid problems, growth hormone deficiency, and early or late puberty fall into this category.

Radiation therapy to the head or neck and total-body irradiation as part of a blood and marrow transplant may increase the risk of thyroid problems, according to the National Cancer Institute (NCI). About 43 percent of brain tumor survivors tracked in the Childhood Cancer Survivor Study had one or more endocrine disorders, according to a 2003 study published in the journal Cancer.

Infertility

Some childhood cancer survivors also might face infertility, which is difficulty conceiving or the inability to have children. Male survivors who received chemotherapy with alkylating agents—such as cyclophosphamide, procarbazine, and ifosfamide—or abdominal radiation may be at an increased risk for infertility or low sperm count, according to the NCI.

Female survivors who received chemotherapy with alkylating agents or radiation together with alkylating agents or who were treated at an older age may be at a higher risk for infertility or early menopause, the NCI reports. About 3 in 100 childhood cancer survivors experience ovarian failure, according to a 2006 study published in the New England Journal of Medicine.

Cardiovascular Disease

Some survivors experience heart-related late effects. Just over 1 percent of childhood cancer survivors experience each congestive heart failure and coronary artery disease, for example, according to the New England Journal of Medicine study. The NCI reports that those who were treated with certain chemotherapy drugs such as anthracyclines (such as doxorubicin and daunorubicin) or radiation—as well as those who were young when they were treated, received a stem cell transplant, and had other heart disease risk factors (smoking, overweight, family history, high blood pressure, high cholesterol, or diabetes)—may face an increased risk of heart problems.

Visual or Hearing Impairment

Survivors of childhood cancer treatment might experience vision-related late effects, which can include poor vision, dry eye, cataracts, damage to the optic nerve or retina, and drooping eyelids. About 3 in 100 survivors experience severe visual late effects such as legal blindness or loss of an eye, according to the New England Journal of Medicine article. Being younger than 1 year old at the time of treatment or having received radiation to the eye or eye socket may increase the risk of damage.

About 2 in 100 survivors have some hearing loss not corrected by an aid as a result of their cancer or related treatment, according to the same study. Those who received certain drugs (cisplatin or carboplatin) or radiation to the brain as part of their therapy may be at an increased risk, the NCI reports.

Secondary Cancers

Between 3 and 5 of 100 childhood cancer survivors develop a secondary cancer within 20 to 25 years of their original diagnosis, according to a 2007 study published in the Annual Review of Public Health. Skin cancer is the most common type of secondary cancer, especially in the areas where the survivor received radiation. But if caught early through close monitoring, these cancers are generally very treatable.

Radiation therapy and bone marrow transplants may increase the risk of tumors later in life, according to the NCI. The risk of secondary cancers in those who had radiation therapy also increases if the person also was treated with alkylating agents, is female, or was young when diagnosed. Survivors of Hodgkin's lymphoma are at the highest risk for secondary cancers, especially breast or thyroid cancer.

Bone Health Concerns

Childhood cancer survivors also might experience bone-related late effects, which can include weak or thin bones, bone pain, joint stiffness, and decreased bone and tissue growth in treated areas. Those who received radiation therapy, especially to the head or spine, or steroids such as dexamethasone as part of their cancer treatment may face an increased risk, the NCI reports.

Other

Less common medical concerns may include gastrointestinal issues, geritourinary concerns, dental problems, lung disease, liver disease, autoimmune disorders, obesity, pain, infectious disease, and scoliosis.

More Web Resources

Read the Children's Oncology Group's late effects summaries (in PDF format) on:

Bone health
Cardiovascular disease
Dental problems
Gastrointestinal issues
Growth hormone deficiency
Hearing impairment
Infectious disease
Infertility: men
Infertility: women
Liver disease
Lung disease
Pain
Puberty (early or late)
Scoliosis
Secondary cancers
Thyroid problems
Visual impairment

Back to About Late Effects

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The Growing Up After Cancer section of the Masonic Cancer Center Web site was produced by University of Minnesota School of Journalism and Mass Communication graduate student Nicole Endres. The section's medical content was written under the advisement of Masonic Cancer Center member Joseph Neglia, M.D., M.P.H.