Central Nervous System
Key Points for This Section
- Brain and spinal cord late effects are more likely to occur after treatment for certain childhood cancers.
- Radiation to the brain increases the risk of brain and spinal cord late effects.
- Late effects that affect the brain and spinal cord may cause certain health problems.
- Possible signs and symptoms of brain and spinal cord late effects include headaches, loss of coordination, and seizures.
- Certain tests and procedures are used to detect (find) and diagnose health problems in the brain and spinal cord.
- Survivors of childhood cancer may have anxiety and depression related to their cancer.
- Some childhood cancer survivors have post-traumatic stress disorder.
- Teenagers who are diagnosed with cancer may have social problems later in life.
The risk of health problems that affect the brain or spinal cord increases after treatment with the following:
- Radiation to the brain or spinal cord, especially high doses of radiation. This includes total-body irradiation given as part of a stem cell transplant.
- Intrathecal or intraventricular chemotherapy.
- Chemotherapy with high-dose methotrexate or cytarabine that can cross the blood-brain barrier (protective lining around the brain). This includes high-dose chemotherapy given as part of a stem cell transplant.
- Surgery to remove a tumor on the brain or spinal cord.
When radiation to the brain and intrathecal chemotherapy are given at the same time, the risk of late effects is higher.
New ways to lower the dose of radiation to the brain are being studied to lessen the risk of brain and spinal cord late effects.
The following may also increase the risk of brain and spinal cord late effects:
- Being younger than 5 years at the time of treatment.
- Being female.
- Where the tumor has formed.
- Having hydrocephalus and a shunt placed to removed the extra fluid from the ventricles.
- Having hearing loss.
- Having cerebellar mutism following surgery to remove the brain tumor. Cerebellar mutism includes not being able to speak, loss of coordination and balance, mood swings, being irritable, and having a high-pitched cry.
- Having a personal history of stroke.
Childhood cancer survivors who received radiation, intrathecal chemotherapy, or surgery to the brain or spinal cord are at risk of late effects to the brain and spinal cord. These include the following:
- Loss of coordination and balance.
- Loss of the myelin sheath that covers nerve fibers in the brain.
- Movement disorders that affect the legs and eyes or the ability to speak and swallow.
- Nerve damage in the hands or feet.
- Loss of bladder and/or bowel control.
Survivors may also have late effects that affect thinking, learning, memory, emotions, and behavior.
New ways of using more targeted and lower doses of radiation to the brain may lower the risk of brain and spinal cord late effects.
- Headache that may go away after vomiting.
- Loss of balance, lack of coordination, or trouble walking.
- Trouble speaking, swallowing or coordinating eye movements.
- Numbness, tingling, weakness in the hands or feet; being unable to bend your ankle to lift your foot up.
- Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body).
- Unusual sleepiness or change in activity level.
- Unusual changes in personality or behavior.
- A change in bowel habits or trouble urinating.
- Increase in head size (in infants).
- Sudden confusion or trouble speaking or understanding speech.
- Sudden trouble seeing with one or both eyes.
- Sudden severe headache for no known reason.
Other signs and symptoms include the following:
- Problems with memory.
- Problems with paying attention.
- Trouble with solving problems.
- Trouble with organizing thoughts and tasks.
- Slower ability to learn and use new information.
- Trouble learning to read, write, or do math.
- Trouble coordinating movement between the eyes, hands, and other muscles.
- Delays in normal development.
- Social withdrawal or trouble getting along with others.
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 brain and spinal cord 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.
- Neurological exam : A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks a person’s mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam. In some cases, a more detailed exam may be done by a neurologist or neurosurgeon.
- Neuropsychological assessment : A series of tests to examine the patient's mental processes and behavior. Areas that are checked usually include:
- Knowing who and where you are and what day it is.
- Ability to learn and remember new information.
- Ability to solve problems.
- Use of oral and written language.
- Eye-hand coordination.
- Ability to organize information and tasks.
Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of brain and spinal cord late effects. If tests are needed, find out how often they should be done.
Survivors of childhood cancer may have anxiety and depression related to physical changes, the way they look, or the fear of cancer coming back. This may cause problems with personal relationships, education, employment, and health. Survivors with these problems may be less likely to live independently as adults.
Being diagnosed and treated for a life-threatening disease may be traumatic. This trauma may cause post-traumatic stress disorder (PTSD). PTSD is defined as having certain behaviors following a stressful event that involved death or the threat of death, serious injury, or a threat to oneself or others.
PTSD can affect cancer survivors in the following ways:
- Reliving the time they were diagnosed and treated for cancer, in nightmares or flashbacks, and thinking about it all the time.
- Avoiding places, events, and people that remind them of the cancer experience.
- Being constantly overexcited, fearful, irritable, or unable to sleep, or having trouble concentrating.
In general, childhood cancer survivors show low levels of PTSD, depending in part on the coping style of patients and their parents. Survivors who received radiation therapy to the head when younger than 4 years or survivors who received intensive treatment may be at higher risk of PTSD. Family problems, little or no social support from family or friends, and stress not related to the cancer may increase the chances of having PTSD.
Because avoiding places and persons connected to the cancer may be part of PTSD, survivors with PTSD may not get the medical treatment they need.
Teenagers who are diagnosed with cancer may reach fewer social milestones or reach them later in life than teenagers not diagnosed with cancer. Social milestones include having a first boyfriend, getting married, and having a child. They may also have trouble getting along with other people or feel like they are not liked by others their age.
Cancer survivors in this age group have reported being less satisfied with their health and their lives in general compared with others of the same age who did not have cancer. Teenagers and young adults who have survived cancer need special programs that provide psychological, educational, and employment support.