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Late Effects of Treatment for Childhood Cancer (PDQ®)

Patient Version
Last Modified: 01/11/2012

Cardiovascular System

Key Points for This Section


Heart and blood vessel late effects are more likely to occur after treatment for certain childhood cancers.

Treatment for these and other childhood cancers may cause heart and blood vessel late effects:

Radiation to the chest and certain chemotherapy drugs 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 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 are types of anthracyclines. 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 both radiation to the chest and chemotherapy using anthracyclines are at greatest risk.

The following may also increase the risk of heart and blood vessel late effects:

Late effects that affect the heart and blood vessels may cause certain health problems.

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:

Possible signs 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:

  • 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, trouble speaking or understanding speech.
  • Sudden trouble seeing with one or both eyes.
  • Sudden trouble walking, dizziness, or loss of balance or coordination.
  • Sudden severe headache with no known cause.

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 heart and blood vessels.

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 doctor about whether you need to have tests and procedures to check for signs of heart and blood vessel late effects. If you do, 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 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.


Glossary Terms

abdomen (AB-doh-men)
The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.
abnormal (ab-NOR-mul)
Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).
acute lymphoblastic leukemia (uh-KYOOT LIM-foh-BLAS-tik loo-KEE-mee-uh)
An aggressive (fast-growing) type of leukemia (blood cancer) in which too many lymphoblasts (immature white blood cells) are found in the blood and bone marrow. Also called acute lymphocytic leukemia and ALL.
acute myelogenous leukemia (uh-KYOOT MY-eh-LAH-jeh-nus loo-KEE-mee-uh)
An aggressive (fast-growing) disease in which too many myeloblasts (immature white blood cells that are not lymphoblasts) are found in the bone marrow and blood. Also called acute myeloblastic leukemia, acute myeloid leukemia, acute nonlymphocytic leukemia, AML, and ANLL.
anthracycline (AN-thruh-SY-klin)
A type of antibiotic that comes from certain types of Streptomyces bacteria. Anthracyclines are used to treat many types of cancer. Anthracyclines damage the DNA in cancer cells, causing them to die. Daunorubicin, doxorubicin, and epirubicin are anthracyclines.
artery (AR-tuh-ree)
A blood vessel that carries blood from the heart to tissues and organs in the body.
biological therapy (BY-oh-LAH-jih-kul THAYR-uh-pee)
Treatment to boost or restore the ability of the immune system to fight cancer, infections, and other diseases. Also used to lessen certain side effects that may be caused by some cancer treatments. Agents used in biological therapy include monoclonal antibodies, growth factors, and vaccines. These agents may also have a direct antitumor effect. Also called biological response modifier therapy, biotherapy, BRM therapy, and immunotherapy.
blood (blud)
A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
blood clot (blud klot)
A mass of blood that forms when blood platelets, proteins, and cells stick together. When a blood clot is attached to the wall of a blood vessel, it is called a thrombus. When it moves through the bloodstream and blocks the flow of blood in another part of the body, it is called an embolus.
blood vessel (blud VEH-sel)
A tube through which the blood circulates in the body. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins.
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).
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.
carotid artery (kuh-RAH-tid AR-tuh-ree)
A major artery that carries blood from the heart to the head. There is a carotid artery on each side of the neck, and each one splits into two branches. The interior branch carries blood to the brain and eyes, and the exterior branch carries blood to the face, tongue, and outside parts of the head.
chemotherapy (KEE-moh-THAYR-uh-pee)
Treatment with drugs that kill cancer cells.
cholesterol (koh-LES-teh-rol)
A waxy, fat-like substance made in the liver, and found in the blood and in all cells of the body. Cholesterol is important for good health and is needed for making cell walls, tissues, hormones, vitamin D, and bile acid. Cholesterol also comes from eating foods taken from animals such as egg yolks, meat, and whole-milk dairy products. Too much cholesterol in the blood may build up in blood vessel walls, block blood flow to tissues and organs, and increase the risk of developing heart disease and stroke.
condition (kun-DIH-shun)
In medicine, a health problem with certain characteristics or symptoms.
confusion (kun-FYOO-zhun)
A mental state in which one is not thinking clearly.
congestive heart failure (kun-JES-tiv hart FAYL-yer)
Weakness of the heart muscle that leads to a buildup of fluid in body tissues.
coronary artery disease (KOR-uh-NAYR-ee AR-tuh-ree dih-ZEEZ)
A disease in which there is a narrowing or blockage of the coronary arteries (blood vessels that carry blood and oxygen to the heart). Coronary artery disease is usually caused by atherosclerosis (a build up of fatty material and plaque inside the coronary arteries). The disease may cause chest pain, shortness of breath during exercise, and heart attacks. The risk of coronary artery disease is increased by having a family history of coronary artery disease before age 50, older age, smoking tobacco, high blood pressure, high cholesterol, diabetes, lack of exercise, and obesity. Also called CAD and coronary heart disease.
daunorubicin (DAW-noh-ROO-bih-sin)
The active ingredient in a drug used to treat acute leukemias and some other types of cancer. It blocks a certain enzyme needed for cell division and DNA repair, and it may kill cancer cells. It is a type of anthracycline antibiotic and a type of topoisomerase inhibitor. Also called daunomycin.
dexrazoxane (DEX-ruh-ZOK-sane)
The active ingredient in a drug used to treat severe side effects caused by certain anticancer drugs. Under the brand name Totect it is used to treat the toxic effects of an anticancer drug that leaks from a vein into surrounding tissue and causes tissue damage. Under the brand name Zinecard it is used to reduce heart damage in women given doxorubicin for breast cancer that has spread. Dexrazoxane is also being studied in the treatment of cancer. It is a type of cardioprotective agent, a type of chemoprotective agent, and a type of topoisomerase inhibitor.
diabetes (dy-uh-BEE-teez)
Any of several diseases in which the kidneys make a large amount of urine. Diabetes usually refers to diabetes mellitus in which there is also a high level of glucose (a type of sugar) in the blood because the body does not make enough insulin or use it the way it should.
diagnosis (DY-ug-NOH-sis)
The process of identifying a disease, such as cancer, from its signs and symptoms.
diet (DY-et)
The things a person eats and drinks.
dose (dose)
The amount of medicine taken, or radiation given, at one time.
doxorubicin (DOK-soh-ROO-bih-sin)
A drug that is used to treat many types of cancer and is being studied in the treatment of other types of cancer. Doxorubicin comes from the bacterium Streptomyces peucetius. It damages DNA and may kill cancer cells. It is a type of anthracycline antitumor antibiotic. Also called Adriamycin PFS, Adriamycin RDF, doxorubicin hydrochloride, hydroxydaunorubicin, and Rubex.
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.
echocardiography (EH-koh-KAR-dee-AH-gruh-fee)
A procedure that uses ultrasonic waves directed over the chest wall to obtain a graphic record of the heart's position, motion of the walls, or internal parts such as the valves.
electrocardiogram (ee-LEK-troh-KAR-dee-oh-gram)
A line graph that shows changes in the electrical activity of the heart over time. It is made by an instrument called an electrocardiograph. The graph can show that there are abnormal conditions, such as blocked arteries, changes in electrolytes (particles with electrical charges), and changes in the way electrical currents pass through the heart tissue. Also called ECG and EKG.
epirubicin (EH-pih-ROO-bih-sin)
A drug used together with other drugs to treat early breast cancer that has spread to lymph nodes. It is also being studied in the treatment of other types of cancer. Epirubicin is a type of anthracycline antibiotic. Also called Ellence and epirubicin hydrochloride.
family history (FA-mih-lee HIH-stuh-ree)
A record of the relationships among family members along with their medical histories. This includes current and past illnesses. A family history may show a pattern of certain diseases in a family. Also called family medical history.
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]).
high blood pressure (hy blud PREH-sher)
A blood pressure of 140/90 or higher. High blood pressure usually has no symptoms. It can harm the arteries and cause an increase in the risk of stroke, heart attack, kidney failure, and blindness. Also called hypertension.
Hodgkin lymphoma (HOJ-kin lim-FOH-muh)
A cancer of the immune system that is marked by the presence of a type of cell called the Reed-Sternberg cell. The two major types of Hodgkin lymphoma are classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma. Symptoms include the painless enlargement of lymph nodes, spleen, or other immune tissue. Other symptoms include fever, weight loss, fatigue, or night sweats. Also called Hodgkin disease.
idarubicin (I-duh-ROO-bih-sin)
An anticancer drug that is a type of antitumor antibiotic. Also called 4-demethoxydaunorubicin.
inflammation (IN-fluh-MAY-shun)
Redness, swelling, pain, and/or a feeling of heat in an area of the body. This is a protective reaction to injury, disease, or irritation of the tissues.
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.
lipid (LIH-pid)
Fat.
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.
mitoxantrone (MY-toh-ZAN-trone)
A drug used to treat advanced prostate cancer that does not respond to hormones, adult acute nonlymphocytic leukemia, and advanced or chronic multiple sclerosis. It is also being studied in the treatment of other cancers. It belongs to the family of drugs called antitumor antibiotics. Also called Novantrone.
non-Hodgkin lymphoma (non-HOJ-kin lim-FOH-muh)
Any of a large group of cancers of lymphocytes (white blood cells). Non-Hodgkin lymphomas can occur at any age and are often marked by lymph nodes that are larger than normal, fever, and weight loss. There are many different types of non-Hodgkin lymphoma. These types can be divided into aggressive (fast-growing) and indolent (slow-growing) types, and they can be formed from either B-cells or T-cells. B-cell non-Hodgkin lymphomas include Burkitt lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), diffuse large B-cell lymphoma, follicular lymphoma, immunoblastic large cell lymphoma, precursor B-lymphoblastic lymphoma, and mantle cell lymphoma. T-cell non-Hodgkin lymphomas include mycosis fungoides, anaplastic large cell lymphoma, and precursor T-lymphoblastic lymphoma. Lymphomas that occur after bone marrow or stem cell transplantation are usually B-cell non-Hodgkin lymphomas. Prognosis and treatment depend on the stage and type of disease. Also called NHL.
organ (OR-gun)
A part of the body that performs a specific function. For example, the heart is an organ.
overweight (OH-ver-WAYT)
Being too heavy for one’s height. Excess body weight can come from fat, muscle, bone, and/or water retention. Being overweight does not always mean being obese.
physical examination (FIH-zih-kul eg-ZA-mih-NAY-shun)
An exam of the body to check for general signs of disease.
radiation (RAY-dee-AY-shun)
Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).
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.
risk factor (... FAK-ter)
Something that increases the chance of developing a disease. Some examples of risk factors for cancer are age, a family history of certain cancers, use of tobacco products, being exposed to radiation or certain chemicals, infection with certain viruses or bacteria, and certain genetic changes.
spinal cord (SPY-nul kord)
A column of nerve tissue that runs from the base of the skull down the back. It is surrounded by three protective membranes, and is enclosed within the vertebrae (back bones). The spinal cord and the brain make up the central nervous system, and spinal cord nerves carry most messages between the brain and the rest of 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).
stroke (stroke)
In medicine, a loss of blood flow to part of the brain, which damages brain tissue. Strokes are caused by blood clots and broken blood vessels in the brain. Symptoms include dizziness, numbness, weakness on one side of the body, and problems with talking, writing, or understanding language. The risk of stroke is increased by high blood pressure, older age, smoking, diabetes, high cholesterol, heart disease, atherosclerosis (a build-up of fatty material and plaque inside the coronary arteries), and a family history of stroke.
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.
tissue (TIH-shoo)
A group or layer of cells that work together to perform a specific function.
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.
ultrasound (UL-truh-SOWND)
A procedure in which high-energy sound waves are bounced off internal tissues or organs and make echoes. The echo patterns are shown on the screen of an ultrasound machine, forming a picture of body tissues called a sonogram. Also called ultrasonography.
Wilms tumor (wilmz TOO-mer)
A disease in which malignant (cancer) cells are found in the kidney, and may spread to the lungs, liver, or nearby lymph nodes. Wilms tumor usually occurs in children younger than 5 years old.