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Late Effects of Treatment for Childhood Cancer (PDQ®)

Patient Version
Last Modified: 01/11/2012

General Information about Late Effects

Key Points for This Section


Late effects are health problems that occur months or years after treatment has ended.

The cancer itself or the treatment of cancer may cause health problems for childhood cancer survivors months or years after successful treatment has ended. Cancer treatments may harm the body's organs, bones, or tissues and cause health problems later in life. These health problems are called late effects. Treatments that may cause late effects include surgery, chemotherapy, radiation therapy, or stem cell transplant.

Doctors are studying the late effects caused by cancer treatment. They are working to improve treatments and stop or lessen late effects. While most late effects are not life-threatening, they may cause serious problems that affect health and quality of life.

Late effects in childhood cancer survivors are both physical and emotional.

Late effects in childhood cancer survivors may affect the following:

  • Organs, tissues, and body function.
  • Growth and development.
  • Mood, feelings, and actions.
  • Thinking, learning, and memory.
  • Social and psychological adjustment.
  • Risk of second cancers.

There are three important factors that affect the risk of late effects.

Some childhood cancer survivors will not have late effects. The risk of late effects depends on factors related to the patient, tumor, and treatment. These include the following:

  • Tumor-related factors
    • Type of cancer.
    • Where the tumor is in the body.
    • How the tumor affects the way tissues and organs work.
  • Treatment-related factors
    • Type of surgery.
    • Chemotherapy type, dose, and schedule.
    • Radiation therapy type, part of the body treated, and dose.
    • Stem cell transplant.
    • Use of two or more types of treatment at the same time.
    • Blood product transfusion.
  • Patient-related factors
    • The child's gender.
    • The child’s age at diagnosis and treatment.
    • Length of time since diagnosis and treatment.
    • Certain changes in the child's genes.
    • Family history of cancer or other conditions.
    • Health problems the child had before being diagnosed with cancer.
    • Health habits.

The chance of having late effects increases over time.

New treatments for childhood cancer have decreased the number of deaths from the primary cancer. However, the number of late effects in childhood cancer survivors increases with longer time since treatment and with older age. Survivors may not live as long as people who did not have cancer. The most common causes of death in childhood cancer survivors are:

  • The primary cancer comes back.
  • A second (different) primary cancer forms.
  • Heart and lung damage.

Studies of the causes of late effects have led to changes in treatment. This has improved the quality of life for cancer survivors and helps prevent illness and death from late effects.

Regular follow-up care is very important for survivors of childhood cancer.

Regular follow-up by health professionals who are experts in finding and treating late effects is important for the long-term health of childhood cancer survivors. Follow-up care will be different for each person who has been treated for cancer. The type of care will depend on the type of cancer, the type of treatment, genetic factors, and the person's general health and health habits.

It is important that childhood cancer survivors have an exam at least once a year. The exams should be done by a health professional who is familiar with the survivor's risk for late effects and can recognize the early signs of late effects. Blood and imaging tests may also be done.

Long-term follow-up may improve the health and quality of life for cancer survivors and also helps doctors study the late effects of cancer treatments so that safer therapies for newly diagnosed children may be developed.

Good health habits are also important for survivors of childhood cancer.

The quality of life enjoyed by cancer survivors may be improved by behaviors that promote health and well-being. These include a healthy diet, exercise, and regular medical and dental checkups. These self-care behaviors are especially important for cancer survivors because of their risk of treatment-related health problems. Healthy behaviors may make late effects less severe and lower the risk of other diseases.

Avoiding behaviors that are damaging to health is also important. Smoking, excess alcohol use, illegal drug use, sun exposure, or not being physically active may worsen treatment-related organ damage and possibly increase the risk of second cancers.



Glossary Terms

alcohol (AL-kuh-hol)
A chemical substance found in beer, wine, and liquor, and some medicines, mouthwashes, household products, and essential oils (scented liquid taken from plants). Alcohol contains a carbon atom attached to a hydroxyl group (a molecule made of an oxygen atom and a hydrogen atom).
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.
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.
chemotherapy (KEE-moh-THAYR-uh-pee)
Treatment with drugs that kill cancer cells.
clinical study (KLIH-nih-kul STUH-dee)
A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical trial.
condition (kun-DIH-shun)
In medicine, a health problem with certain characteristics or symptoms.
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.
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.
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.
follow-up (FAH-loh-up)
Monitoring a person's health over time after treatment. This includes keeping track of the health of people who participate in a clinical study or clinical trial for a period of time, both during the study and after the study ends.
gene (jeen)
The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein.
genetic (jeh-NEH-tik)
Inherited; having to do with information that is passed from parents to offspring through genes in sperm and egg cells.
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.
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.
lung (lung)
One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.
organ (OR-gun)
A part of the body that performs a specific function. For example, the heart is an organ.
primary tumor (PRY-mayr-ee TOO-mer)
The original tumor.
psychological (SY-koh-LAH-jih-kul)
Having to do with how the mind works and how thoughts and feelings affect behavior.
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.
schedule (SKEH-jool)
In a clinical setting, the step-by-step plan for how patients are to be treated; for example, the drug or type of radiation therapy that is to be given, the method by which it is to be given, the amount of time between courses, and the total length of treatment.
second primary cancer (SEH-kund PRY-mayr-ee KAN-ser)
Refers to a new primary cancer in a person with a history of cancer.
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.
therapy (THAYR-uh-pee)
Treatment.
tissue (TIH-shoo)
A group or layer of cells that work together to perform a specific function.
transfusion (tranz-FYOO-zhun)
A procedure in which a person is given an infusion of whole blood or parts of blood. The blood may be donated by another person, or it may have been taken from the patient earlier and stored until needed. Also called blood transfusion.
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.