Late Effects of Cancer Treatment
Some cancer treatments like surgery, chemotherapy or radiation can cause long-term side effects years later. Learn more about the potential after effects from treatment, and the CHOC specialists who are experts in those areas that can help manage your child’s health.
If you experience problems with hearing after getting cancer treatment, you will be referred to an audiologist – a specialist trained to evaluate and treat problems with hearing, balance and other auditory disorders, or an otolaryngologist – a specialist trained focused on ears, nose, and throat surgery and medicine.
Ototoxicity is when cancer treatments cause hearing or ear function problems. Chemotherapy and radiation treatments that can cause ototoxicity include carboplatin and cisplatin.
Potential late effects of treatment include: hearing loss, ringing in your ears (tinnitus), a sense that you are moving when you are not (vertigo), or hardening of the tissues in your ear (tympanosclerosis or otosclerosis).
If you experience any problems with your heart function after getting cancer treatment, you will be referred to a cardiologist – a specially trained doctor to evaluate and treat problems with how your heart works.
Cardiac toxicity is when cancer treatments causes heart problems. Chemotherapy and radiation treatments that can cause cardiac toxicity include anthracycline agents like daunorubicin, doxorubicin and mitoxantrone.
To reduce the damage that chemotherapy can cause, you may have been given a “cardio-protectant” like dexrazoxane (also known as Zinecard®). Even if you were given this drug, your heart may have still been damaged.
- Potential late effects of treatment include:
- Enlarged heart (cardiomyopathy)
- Abnormal rhythm of your heart beat (arrhythmias)
- Changes in how your heart pumps blood to your body (left ventricular dysfunction)
- Changes to how your body is able to move blood through your body (carotid artery disease, subclavian artery disease, congestive heart failure)
- Painful heart movement (pericarditis)
- Changes to how blood flows through your heart (pericardial fibrosis, valvular disease, atherosclerotic heart disease).
In rare cases, your heart may have been damaged to such an extent that you are at higher risk than others for heart attack (myocardial infarction).
Other conditions, such as a high lipid level in your blood (dyslipidemia) and high blood pressure (hypertension), can affect how well your heart works. If you are overweight, your heart can also have problems with normal function.
Your heart function can also be influenced by how your kidneys work. Therefore, if you are receiving treatment for your kidneys then you may also receive treatment for your heart.
If you experience any problems with your endocrine system after getting cancer treatment, you will be referred to an endocrinologist – a specialist trained to evaluate and treat problems with the endocrine system.
The endocrine system is made up of a lot of different glands in your body that communicate through special chemicals called “hormones.” Potential late effects of treatment are quite varied given the big role that the endocrine system plays in your body. Some problems you can experience include:
- Difficulties with having babies in the future (infertility)
- Changes in how you grow
- Reduced bone mineral density, putting you at risk of having bone fractures
- Challenges in maintaining a healthy weight
- Changes in your period
- Feelings of extreme tiredness
- Problems feeling too cold or too hot
- Dry skin or brittle hair
- Changes in your sexual development and function
- Problems with blood sugar (diabetes) or blood lipid levels (dyslipidemia)
- Changes to the rhythm and speed of your heartbeat
- Problems with eye or other motor movement
If you experience any problems with your gastrointestinal (GI) tract after getting treatment for cancer, you will be referred to a gastroenterologist – a specialist trained to evaluate and treat problems with the stomach, intestines, esophagus, liver, pancreas, colon and rectum.
Some treatments can cause problems with your gastrointestinal (GI) tract or liver. Chemotherapy treatments that can cause problems with your liver include mercaptopurine (6MP), thioguanine (6TG), and methotrexate. Radiation therapy and bone marrow/stem cell transplantation can also change how your liver works.
Radiation therapy can also change how your esophagus (the tube from your mouth to your stomach) and intestines or bowel works.
Potential late effects of treatment include changes in how your liver or gallbladder works, difficulty swallowing (dysphagia) or narrowing of your GI tract, development of heartburn, or problems with constipation or diarrhea.
Depending on your treatment and family history, you may be at higher risk of developing colon or colorectal cancer in the future. If you are told that you are at increased risk, screening for these cancers will start sooner for you than for others your same age.
Gynecology – Female Reproduction and Sexual Health
If you experience any problems with your reproductive tract after getting treatment for cancer, you will be referred to a gynecologist – a specialist trained to evaluate and treat problems with female reproduction and sexual function.
Chemotherapy treatments that can interfere with normal ovarian function include alkylating agents (busulfan, cyclophosphamide, ifosfamide and lomustine), heavy metal agents (carboplatin and cisplatin) and other drugs like dacarbazine and temozolomide.
Radiation therapy can also change how your ovaries may work in the future. It can also cause hardening of the tissues of your reproductive system.
Potential late effects of treatment include changes in how you grow and mature, fluctuations to the cycle of your period, sexual dysfunction, pelvic pain and difficulties having children in the future.
Depending on your treatment and family history, you may be at higher risk of developing cervical cancer in the future. If you are told that you are at increased risk, screening for this cancer may start sooner for you than for others your same age.
Male Reproduction and Sexual Health
Some treatments can cause problems with the urinary and reproductive tract in boys and young men. If you experience these problems, you will be referred to a urologist – a specialist trained to evaluate and treat problems with male reproduction and sexual function.
Chemotherapy treatments that can interfere with normal testicular function include alkylating agents (busulfan, cyclophosphamide, ifosfamide and lomustine), heavy metal agents (carboplatin and cisplatin) and other drugs like dacarbazine and temozolomide.
Radiation therapy can also change how your testicles may work in the future.
Potential late effects of treatment include changes in how you grow and mature, sexual dysfunction and difficulties having children in the future.
Depending on your treatment and family history, you may be at higher risk of developing testicular or prostate cancer in the future. If you are told that you are at increased risk, screening for these cancers may start sooner for you than for others your same age.
Some treatments can cause problems with vision and how your eyes should work. If you experience any problems with your sight after getting treatment for cancer, you will be referred to an ophthalmologist – a specialist trained to evaluate and treat problems with your eyes and your vision care.
Chemotherapy treatments that can cause changes to your eye function include the use of busulfan and steroids like dexamethasone and prednisone. Radiation therapy can also change how your eyes function if your eyes were part of the treated area. If you had eye or brain surgery as part of your treatment, it is also possible that you will experience vision deficits.
Potential late effects of treatment include clouding of the lens in your eye (cataracts), changes to your vision, dry eye, chronic eye irritation or pain, excessive tearing, light sensitivity and poor night vision.
Pain Management
Cancer treatment can result in chronic pain as a result of chemotherapy, radiation, other cancer treatments or surgery that you had. If you experience any problems with pain after getting treatment for cancer, you will be referred to a pain management specialist who is trained to evaluate, treat and manage your pain. Rehabilitation, neurology or psychology specialists can also help manage your pain.
Chemotherapy treatments that can cause changes to how your nerves work include carboplatin, cisplatin, vinblastine and vincristine. Steroid treatments, such as dexamethasone and prednisone can change the structure and function of your joints making it more painful to move.
Radiation therapy can change the structure of your bones, making it more painful to move or putting you at higher risk of having a bone fracture in the future.
Bone marrow/stem cell transplantation can cause future joint or bone pain.
