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Late Effects of Treatment for Childhood Cancer (PDQ®)

Patient Version
Last Modified: 01/11/2012

Senses

Key Points for This Section


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 to the brain and certain chemotherapy drugs increase the risk of hearing loss.

The risk of hearing loss may be increased in childhood cancer survivors after treatment with 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) or received radiation therapy to the brain and chemotherapy at the same time.

Hearing loss is the most common sign of hearing late effects.

These symptoms may be caused by hearing late effects:

  • Hearing loss.
  • Ringing in the ears.
  • Feeling dizzy.
  • Too much hardened wax in the ear.

Hearing loss may occur slowly over time or may occur several months or years after treatment ends. Other conditions may cause the same symptoms. Talk to your doctor if you have any of these problems.

Certain tests and procedures are used to detect (find) and diagnose health problems in the ear and hearing problems.

These and other tests and procedures may be used to detect or diagnose hearing late effects:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Otoscopic exam: An exam of the ear. An otoscope is used to look at the ear canal and the eardrum to check for signs of infection or hearing loss. Sometimes the otoscope has a plastic bulb that is squeezed to release a small puff air into the ear canal. In a healthy ear, the eardrum will move. If there is fluid behind the eardrum, it will not move.
  • Hearing test: A hearing test can be done in different ways depending on the child's age. The test is done to check if the child can hear soft and loud sounds and low- and high-pitched sounds. Each ear is checked separately. The child may also be asked if he or she can hear the high-pitched hum of a tuning fork when it is placed behind the ear or on the forehead.

Talk to your doctor about whether you need to have tests and procedures to check for signs of hearing late effects. If you do, 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 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 any of the following:

Late effects that affect the eye may cause certain health problems.

Eye late effects include the following:

  • Having a small eye socket that affects the shape of the child’s face as it grows.
  • Loss of vision.
  • Vision problems, such as cataracts or glaucoma.
  • Not being able to make tears.
  • Damage to the optic nerve and retina.
  • Eyelid tumors.

Possible signs of eye and vision late effects include changes in vision and dry eyes.

These symptoms may be caused by eye and vision late effects:

  • Changes in vision, such as:
    • Not being able to see objects that are close.
    • Not being able to see objects that are far away.
    • Double vision.
    • Cloudy or blurred vision.
    • Colors seem faded.
    • Seeing a glare or halo around lights at night.
  • Dry eyes that may feel like they are itchy, burning, or swollen, or like there is something in the eye.
  • Eye pain.
  • Eye redness.
  • Nausea.
  • Having a growth on the eyelid.

Other conditions may cause the same symptoms. Talk to your doctor if you have any of these problems.

Certain tests and procedures are used to detect (find) and diagnose health problems in the eye and vision problems.

These and other tests and procedures may be used to detect or diagnose eye and vision late effects:

  • Eye exam with dilated pupil: An exam of the eye in which the pupil is dilated (widened) with medicated eye drops to allow the doctor to look through the lens and pupil to the retina. The inside of the eye, including the retina and the optic nerve, is checked using an instrument that makes a narrow beam of light. This is sometimes called a slit-lamp exam. The doctor may take pictures over time to keep track of changes in the size of the tumor and how fast it is growing.
  • Indirect ophthalmoscopy: An exam of the inside of the back of the eye using a small magnifying lens and a light.

Talk to your doctor about whether you need to have tests and procedures to check for signs of eye and vision late effects. If you do, find out how often they should be done.



Glossary Terms

brain tumor (brayn TOO-mer)
The growth of abnormal cells in the tissues of the brain. Brain tumors can be benign (not cancer) or malignant (cancer).
busulfan (byoo-SUL-fan)
An anticancer drug that belongs to the family of drugs called alkylating agents.
cancer (KAN-ser)
A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
carboplatin (KAR-boh-pla-tin)
A drug that is used to treat advanced ovarian cancer that has never been treated or symptoms of ovarian cancer that has come back after treatment with other anticancer drugs. It is also used with other drugs to treat advanced, metastatic, or recurrent non-small cell lung cancer and is being studied in the treatment of other types of cancer. Carboplatin is a form of the anticancer drug cisplatin and causes fewer side effects in patients. It attaches to DNA in cells and may kill cancer cells. It is a type of platinum compound. Also called Paraplatin.
cataract (KA-tuh-RAKT)
A condition in which the lens of the eye becomes cloudy. Symptoms include blurred, cloudy, or double vision; sensitivity to light; and difficulty seeing at night. Without treatment, cataracts can cause blindness. There are many different types and causes of cataracts. They may occur in people of all ages, but are most common in the elderly.
chemotherapy (KEE-moh-THAYR-uh-pee)
Treatment with drugs that kill cancer cells.
chronic (KRAH-nik)
A disease or condition that persists or progresses over a long period of time.
cisplatin (sis-PLA-tin)
A drug used to treat many types of cancer. Cisplatin contains the metal platinum. It kills cancer cells by damaging their DNA and stopping them from dividing. Cisplatin is a type of alkylating agent.
condition (kun-DIH-shun)
In medicine, a health problem with certain characteristics or symptoms.
corticosteroid (KOR-tih-koh-STAYR-oyd)
Any steroid hormone made in the adrenal cortex (the outer part of the adrenal gland). They are also made in the laboratory. Corticosteroids have many different effects in the body, and are used to treat many different conditions. They may be used as hormone replacement, to suppress the immune system, and to treat some side effects of cancer and its treatment. Corticosteroids are also used to treat certain lymphomas and lymphoid leukemias.
diagnosis (DY-ug-NOH-sis)
The process of identifying a disease, such as cancer, from its signs and symptoms.
dilate (DY-layt)
To widen or enlarge an opening or hollow structure beyond its usual size, such as the pupil of the eye or a blood vessel.
dose (dose)
The amount of medicine taken, or radiation given, at one time.
drug (drug)
Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.
fluid (FLOO-id)
A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.
glaucoma (glaw-KOH-muh)
A condition in which there is a build-up of fluid in the eye, which presses on the retina and the optic nerve. The retina is the layer of nerve tissue inside the eye that senses light and sends images along the optic nerve to the brain. Glaucoma can damage the optic nerve and cause loss of vision or blindness.
graft-versus-host disease (... dih-ZEEZ)
A disease caused when cells from a donated stem cell graft attack the normal tissue of the transplant patient. Symptoms include jaundice, skin rash or blisters, a dry mouth, or dry eyes. Also called GVHD.
head and neck cancer (... KAN-ser)
Cancer that arises in the head or neck region (in the nasal cavity, sinuses, lips, mouth, salivary glands, throat, or larynx [voice box]).
indirect ophthalmoscopy (IN-duh-REKT OF-thul-MOS-koh-pee)
An exam of the inside of the back of the eye using a beam of light and a hand-held lens. Indirect ophthalmoscopy gives a wider view inside the eye than an exam using an ophthalmoscope does.
infection (in-FEK-shun)
Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.
late effects (layt eh-FEKTS)
Side effects of cancer treatment that appear months or years after treatment has ended. Late effects include physical and mental problems and second cancers.
lens (lenz)
A clear disk that focuses light, as in a camera or microscope. In the eye, the lens is a clear, curved structure at the front of the eye behind the pupil. It focuses light rays that enter the eye through the pupil, making an image on the retina (light-sensitive layers of nerve tissue at the back of the eye).
medical history (MEH-dih-kul HIH-stuh-ree)
A record of information about a person’s health. A personal medical history may include information about allergies, illnesses, surgeries, immunizations, and results of physical exams and tests. It may also include information about medicines taken and health habits, such as diet and exercise. A family medical history includes health information about a person’s close family members (parents, grandparents, children, brothers, and sisters). This includes their current and past illnesses. A family medical history may show a pattern of certain diseases in a family.
nausea (NAW-zee-uh)
A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.
neuroblastoma (NOOR-oh-blas-TOH-muh)
Cancer that arises in immature nerve cells and affects mostly infants and children.
optic nerve (OP-tik nerv)
The nerve that carries messages from the retina to the brain.
physical examination (FIH-zih-kul eg-ZA-mih-NAY-shun)
An exam of the body to check for general signs of disease.
pupil (PYOO-pul)
The round opening in the center of the iris (the colored tissue that makes the "eye color" at the front of the eye). The pupil changes size to let light into the eye. It gets smaller in bright light and larger as the amount of light decreases.
radiation therapy (RAY-dee-AY-shun THAYR-uh-pee)
The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.
retina (REH-tih-nuh)
The light-sensitive layers of nerve tissue at the back of the eye that receive images and sends them as electric signals through the optic nerve to the brain.
retinoblastoma (REH-tih-noh-blas-TOH-muh)
Cancer that forms in the tissues of the retina (the light-sensitive layers of nerve tissue at the back of the eye). Retinoblastoma usually occurs in children younger than 5 years. It may be hereditary or nonhereditary (sporadic).
rhabdomyosarcoma (RAB-doh-MY-oh-sar-KOH-muh)
Cancer that forms in the soft tissues in a type of muscle called striated muscle. Rhabdomyosarcoma can occur anywhere in the body.
stem cell transplant (stem sel tranz-plant)
A method of replacing immature blood-forming cells in the bone marrow that have been destroyed by drugs, radiation, or disease. Stem cells are injected into the patient and make healthy blood cells. A stem cell transplant may be autologous (using a patient’s own stem cells that were saved before treatment), allogeneic (using stem cells donated by someone who is not an identical twin), or syngeneic (using stem cells donated by an identical twin).
surgery (SER-juh-ree)
A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.
survivor (ser-VY-ver)
One who remains alive and continues to function during and after overcoming a serious hardship or life-threatening disease. In cancer, a person is considered to be a survivor from the time of diagnosis until the end of life.
symptom (SIMP-tum)
An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.
total-body irradiation (TOH-tul-BAH-dee ih-RAY-dee-AY-shun)
Radiation therapy to the entire body. It is usually followed by bone marrow or peripheral stem cell transplantation.
tumor (TOO-mer)
An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.