Key Points for This Section
- Heart and blood vessel late effects are more likely to occur after treatment for certain childhood cancers.
- Radiation to the chest and certain chemotherapy drugs increase the risk of heart and blood vessel late effects.
- Late effects that affect the heart and blood vessels may cause certain health problems.
- Possible signs and symptoms of heart and blood vessel late effects include trouble breathing and chest pain.
- Certain tests and procedures are used to detect (find) and diagnose health problems in the heart and blood vessels.
- Health habits that promote a healthy heart and blood vessels are important for survivors of childhood cancer.
- Acute lymphoblastic leukemia (ALL).
- Acute myelogenous leukemia (AML).
- Brain and spinal cord tumors.
- Head and neck cancer.
- Hodgkin lymphoma.
- Non-Hodgkin lymphoma.
- Wilms tumor.
- Cancers treated with a stem cell transplant.
The risk of health problems involving the heart and blood vessels increases after treatment with the following:
- Radiation to the chest or spine: The risk of problems depends on the part of the heart that was exposed to radiation, the amount of radiation given, and whether the radiation was given in small or large doses.
- Radiation to the brain or neck: The risk of problems depends on the part of the brain or neck that was treated with radiation and the amount of radiation given.
- Chemotherapy : Chemotherapy with anthracyclines such as doxorubicin, daunorubicin, idarubicin, epirubicin, and mitoxantrone. The risk of problems depends on the total dose of anthracycline given. It also depends on whether a drug called dexrazoxane was given during treatment with anthracyclines to lessen heart and blood vessel damage.
- Stem cell transplant.
- Biologic therapy .
Childhood cancer survivors who were treated with radiation to the chest or chemotherapy using anthracyclines are at greatest risk. New treatments that decrease the amount of radiation given and use lower doses of chemotherapy may decrease the risk of heart and blood vessel late effects.
The following may also increase the risk of heart and blood vessel late effects:
- Being female.
- Being young at the time of treatment (the younger the child, the greater the risk).
- Having high blood pressure or other risk factors for heart disease, such as a family history of heart disease, being overweight, smoking, high cholesterol, or diabetes. When these risk factors are combined, the risk of late effects is even higher.
Childhood cancer survivors who received radiation or certain chemotherapy drugs are at risk of late effects to the heart and blood vessels. These include the following:
- Abnormal heartbeat.
- Weakened heart muscle.
- Inflamed heart or sac around the heart.
- Damage to the heart valves.
- Coronary artery disease (hardening of the heart arteries).
- Congestive heart failure.
- Chest pain or heart attack.
- Blood clots or one or more strokes.
- Carotid artery disease.
- Trouble breathing, especially when you are lying down.
- Heartbeat that is too slow, too fast, or different from the heart's normal rhythm.
- Chest pain.
- Swelling of the feet, ankles, legs, or abdomen.
- When exposed to cold or having strong emotions, the fingers, toes, ears, or nose become white and then turn blue. When this happens to the fingers, there may also be pain and tingling.
- Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body).
- Sudden confusion or trouble speaking or understanding speech.
- Sudden trouble seeing with one or both eyes.
- Sudden trouble walking or feeling dizzy.
- Sudden loss of balance or coordination.
- Sudden severe headache for no known reason.
Talk to your child's doctor if your child has any of these problems.
These and other tests and procedures may be used to detect or diagnose heart and blood vessel late effects:
- Physical exam and history : An exam of the body to check general signs of health, including checking the heart for signs of disease, such as abnormal heart beat or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Electrocardiogram (EKG): A recording of the heart's electrical activity to evaluate its rate and rhythm. A number of small pads (electrodes) are placed on the patient’s chest, arms, and legs, and are connected by wires to the EKG machine. Heart activity is then recorded as a line graph on paper. Electrical activity that is faster or slower than normal may be a sign of heart disease or damage.
- Echocardiogram : A procedure in which high-energy sound waves (ultrasound) are bounced off the heart and nearby tissues or organs and make echoes. A moving picture is made of the heart and heart valves as blood is pumped through the heart.
- Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs such as the heart and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
- Lipid profile studies: A procedure in which a blood sample is checked to measure the amounts of triglycerides, cholesterol, and low- and high-density lipoprotein cholesterol in the blood.
Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of heart and blood vessel late effects. If tests are needed, find out how often they should be done.
Childhood cancer survivors with heart and blood vessel late effects should take care to protect their health, including:
- Having a healthy weight.
- Eating a heart-healthy diet.
- Having regular exercise.
- Talking to their doctor before starting an intense exercise program.
- Not smoking.