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Late Effects of Treatment for Childhood Cancer (PDQ®)

Patient Version
Last Modified: 01/11/2012

Musculoskeletal System

Key Points for This Section


Bone and joint

Bone and joint late effects are more likely to occur after treatment for certain childhood cancers.

Treatment for these and other childhood cancers may cause bone and joint late effects:

Surgery, chemotherapy, radiation therapy and other treatments increase the risk of bone and joint late effects.

Radiation therapy

Radiation therapy can stop or slow the growth of bone. The type of bone and joint late effect depends on the part of the body that received radiation therapy. Radiation therapy may cause any of the following:

  • Changes in the way the face or skull form, especially when treatment is given to children before age 5 or when high-dose radiation is given.
  • Tooth or sinus problems.
  • Short stature (being shorter than normal).
  • Scoliosis (curving of the spine) or kyphosis (rounding of the spine).
  • One arm or leg is shorter than the other arm or leg.
  • Osteoporosis (weak or thin bones that can break easily).

Surgery

Amputation or limb-sparing surgery to remove the cancer and prevent it from coming back may cause late effects depending on where the tumor was, age of the patient, and type of surgery. Health problems after amputation or limb-sparing surgery may include:

Studies show no difference in quality of life in childhood cancer survivors who had amputation compared to those who had limb-sparing surgery.

Chemotherapy and other drug therapy

Risk may be increased in childhood cancer survivors who receive anticancer therapy that includes methotrexate or corticosteroids or glucocorticoids such as dexamethasone. Drug therapy may cause any of the following:

  • Osteoporosis (weak or thin bones that can break easily).
  • Osteonecrosis (one or more parts of a bone dies from a lack of blood flow), especially in the hip or knee.

Stem cell transplant

A stem cell transplant can affect the bone and joints in different ways:

Possible signs of bone and joint late effects include bone and joint pain.

These symptoms may be caused by bone and joint late effects:

  • Swelling over a bone or bony part of the body.
  • Pain in a bone or joint.
  • Redness or warmth over a bone or joint.
  • Joint stiffness or trouble moving normally.
  • A bone that breaks for no known reason or breaks easily.
  • Short stature (being shorter than normal).
  • One side of the body looks higher than the other side or the body tilts to one side.
  • Always sitting or standing in a slouching position or having the appearance of a hunched back.

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 bone and joint.

These and other tests and procedures may be used to detect or diagnose bone and joint 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, past illnesses and treatments will also be taken.
  • Bone mineral density scan: An imaging test that measures bone density (the amount of bone mineral in a certain amount of bone) by passing x-rays with two different energy levels through the bone. It is used to diagnose osteoporosis (weak or thin bones that can break easily). Also called BMD scan, DEXA, DEXA scan, dual energy x-ray absorptiometric scan, dual x-ray absorptiometry, and DXA.
  • X-ray: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body, such as bones.

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

Body weight

Obesity is a late effect that is more likely to occur after treatment for certain childhood cancers.

Treatment for these and other childhood cancers may cause obesity:

  • Acute lymphoblastic leukemia (ALL).
  • Brain tumors, especially craniopharyngiomas.
  • Cancers treated with total-body irradiation (TBI) as part of a stem cell transplant.

Obesity may be measured by weight, body mass index, percent of body fat, or size of the abdomen (belly fat).

Radiation therapy to the brain increases the risk of obesity.

The risk of obesity increases after treatment with the following:

The following may also increase the risk of obesity:

  • Being a young age at the time of treatment (the younger the child, the greater the risk).
  • Being female.
  • Not doing enough physical activity to stay at a healthy body weight.

Certain tests and procedures are used to detect (find) and diagnose obesity.

These and other tests and procedures may be used to detect or diagnose obesity:

  • 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.
  • Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances, such as glucose, released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
  • 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 obesity. If you do, find out how often they should be done.

Metabolic syndrome

Metabolic syndrome is more likely to occur after treatment for certain childhood cancers.

Metabolic syndrome is a group of medical conditions that includes having too much fat around the abdomen and two of the following:

  • High blood pressure.
  • High levels of triglycerides and low levels of high-density lipoprotein cholesterol in the blood.
  • High levels of glucose (sugar) in the blood.

Treatment for these and other childhood cancers may cause metabolic syndrome to occur later in life:

  • Acute lymphoblastic leukemia (ALL).
  • Cancers treated with a stem cell transplant.

Radiation therapy to the brain and total-body irradiation (TBI) as part of a stem cell transplant increase the risk of metabolic syndrome.

Metabolic syndrome may cause the survivor to have a shorter adult height.

Childhood cancer survivors who received radiation to the brain or had a stem cell transplant are at risk for metabolic syndrome. Metabolic syndrome may cause low levels of growth hormone, which helps promote growth and control metabolism. This may cause the survivor to be shorter than normal.



Glossary Terms

abdomen (AB-doh-men)
The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.
activities of daily living (ak-TIH-vih-teez…DAY-lee LIH-ving)
The tasks of everyday life. These activities include eating, dressing, getting into or out of a bed or chair, taking a bath or shower, and using the toilet. Instrumental activities of daily living are activities related to independent living and include preparing meals, managing money, shopping, doing housework, and using a telephone. Also called ADL.
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.
amputation (am-pyoo-TAY-shun)
Surgery to remove part or all of a limb or appendage.
anticancer therapy (AN-tee-KAN-ser THAYR-uh-pee)
Treatment to stop or prevent cancer.
benign tumor (beh-NINE TOO-mer)
A growth that is not cancer. It does not invade nearby tissue or spread to other parts of the body.
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 chemistry study (blud KEH-mih-stree STUH-dee)
A procedure in which a sample of blood is examined to measure the amounts of certain substances made in the body. An abnormal amount of a substance can be a sign of disease in the organ or tissue that produces it.
body mass index (BAH-dee mas IN-dex)
A measure that relates body weight to height. BMI is sometimes used to measure total body fat and whether a person is a healthy weight. Excess body fat is linked to an increased risk of some diseases including heart disease and some cancers. Also called BMI.
bone cancer (bone KAN-ser)
Primary bone cancer is cancer that forms in cells of the bone. Some types of primary bone cancer are osteosarcoma, Ewing sarcoma, malignant fibrous histiocytoma, and chondrosarcoma. Secondary bone cancer is cancer that spreads to the bone from another part of the body (such as the prostate, breast, or lung).
bone density (...DEN-sih-tee)
A measure of the amount of minerals (mostly calcium and phosphorous) contained in a certain volume of bone. Bone density measurements are used to diagnose osteoporosis (a condition marked by decreased bone mass), to see how well osteoporosis treatments are working, and to predict how likely the bones are to break. Low bone density can occur in patients treated for cancer. Also called BMD, bone mass, and bone mineral density.
bone mineral density scan (... MIH-neh-rul DEN-sih-tee skan)
An imaging test that measures bone density (the amount of bone mineral contained in a certain volume of bone) by passing x-rays with two different energy levels through the bone. It is used to diagnose osteoporosis (decrease in bone mass and density). Also called BMD scan, DEXA, DEXA scan, dual energy x-ray absorptiometric scan, dual x-ray absorptiometry, and DXA.
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.
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.
chronic (KRAH-nik)
A disease or condition that persists or progresses over a long period of time.
chronic pain (KRAH-nik payn)
Pain that can range from mild to severe, and persists or progresses over a long period of time.
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.
craniopharyngioma (KRAY-nee-oh-fuh-RIN-jee-OH-muh)
A benign brain tumor that may be considered malignant because it can damage the hypothalamus, the area of the brain that controls body temperature, hunger, and thirst.
dexamethasone (DEK-suh-MEH-thuh-sone)
A synthetic steroid (similar to steroid hormones produced naturally in the adrenal gland). Dexamethasone is used to treat leukemia and lymphoma and may be used to treat some of the problems caused by other cancers and their treatment.
diagnosis (DY-ug-NOH-sis)
The process of identifying a disease, such as cancer, from its signs and symptoms.
drug therapy (… THAYR-uh-pee)
Treatment with any substance, other than food, that is used to prevent, diagnose, treat, or relieve symptoms of a disease or abnormal condition.
glucocorticoid (GLOO-koh-KOR-tih-koyd)
A compound that belongs to the family of compounds called corticosteroids (steroids). Glucocorticoids affect metabolism and have anti-inflammatory and immunosuppressive effects. They may be naturally produced (hormones) or synthetic (drugs).
glucose (GLOO-kose)
A type of sugar; the chief source of energy for living organisms.
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.
growth hormone (grothe HOR-mone)
A protein made by the pituitary gland that helps control body growth and the use of glucose and fat in the body. Also called somatotropin.
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.
high-dose radiation (hy-dose RAY-dee-AY-shun)
An amount of radiation that is greater than that given in typical radiation therapy. High-dose radiation is precisely directed at the tumor to avoid damaging healthy tissue, and may kill more cancer cells in fewer treatments. Also called HDR.
hypothalamus (HY-poh-THA-luh-mus)
The area of the brain that controls body temperature, hunger, and thirst.
imaging test (IH-muh-jing …)
A type of test that makes pictures of areas inside the body. Some examples of imaging tests are CT scans and MRIs. Also called imaging procedure.
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.
joint (joynt)
In medicine, the place where two or more bones are connected. Examples include the shoulder, elbow, knee, and jaw.
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.
limb-sparing surgery (LIM spayr-ing SER-juh-ree)
Surgery to remove a tumor in a limb (arm or leg) without removing all of the limb. Also called limb-salvage surgery.
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.
metabolic syndrome (MEH-tuh-BAH-lik SIN-drome)
A condition is marked by extra fat around the abdomen, high levels of blood glucose (sugar) when not eating, high levels of triglycerides (a type of fat) in the blood, low levels of high-density lipoproteins (a type of protein that carries fats) in the blood, and high blood pressure. People with metabolic syndrome are at increased risk of diabetes mellitus and diseases of the heart and blood vessels. Also called metabolic syndrome X.
metabolism (meh-TA-buh-lih-zum)
The chemical changes that take place in a cell or an organism. These changes make energy and the materials cells and organisms need to grow, reproduce, and stay healthy. Metabolism also helps get rid of toxic substances.
methotrexate (meh-thuh-TREK-sayt)
A drug used to treat some types of cancer, rheumatoid arthritis, and severe skin conditions, such as psoriasis. Methotrexate stops cells from making DNA and may kill cancer cells. It is a type of antimetabolite. Also called amethopterin, MTX, and Rheumatrex.
mineral (MIH-neh-rul)
In medicine, a mineral is a nutrient that is needed in small amounts to keep the body healthy. Mineral nutrients include the elements calcium, magnesium, and iron.
obesity (oh-BEE-sih-tee)
A condition marked by an abnormally high, unhealthy amount of body fat.
organ (OR-gun)
A part of the body that performs a specific function. For example, the heart is an organ.
osteoporosis (OS-tee-oh-puh-ROH-sis)
A condition that is marked by a decrease in bone mass and density, causing bones to become fragile.
osteosarcoma (OS-tee-oh-sar-KOH-muh)
A cancer of the bone that usually affects the large bones of the arm or leg. It occurs most commonly in young people and affects more males than females. Also called osteogenic sarcoma.
physical examination (FIH-zih-kul eg-ZA-mih-NAY-shun)
An exam of the body to check for general signs of disease.
pituitary gland (pih-TOO-ih-TAYR-ee...)
A pea-sized organ attached to the part of the brain called the hypothalamus. It lies at the base of the brain above the back of the nose. The hypothalamus sends signals to the pituitary gland, which then makes hormones that control other glands and many of the body’s functions, including growth.
prosthesis (pros-THEE-sis)
A device, such as an artificial leg, that replaces a part of the body.
quality of life (KWAH-lih-tee ... life)
The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.
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.
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).
sinus (SY-nus)
A cavity, space, or channel in the body. Examples include hollow spaces in the bones at the front of the skull, and channels for blood and lymph. Sinuses may also be found in the heart, brain, and other organs.
soft tissue sarcoma (…TIH-shoo sar-KOH-muh)
A cancer that begins in the muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body.
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.
spine (spine)
The bones, muscles, tendons, and other tissues that reach from the base of the skull to the tailbone. The spine encloses the spinal cord and the fluid surrounding the spinal cord. Also called backbone, spinal column, and vertebral column.
stature (STA-cher)
The height of a person while standing.
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.
tissue (TIH-shoo)
A group or layer of cells that work together to perform a specific function.
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.
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.
x-ray (EX-ray)
A type of radiation used in the diagnosis and treatment of cancer and other diseases. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.