After a child finishes treatment for cancer, regular follow-up screening is needed to diagnose potential late effects — treatment-related side effects that occur several years after a cancer diagnosis. Long-term follow-up care, which should continue throughout adulthood, helps ensure that survivors of childhood cancer stay healthy.

Types of late effects

Late effects can be physical or emotional. Below is a listing of specific late effects of childhood cancer. If you're concerned about a particular one, talk with your doctor. Many of the recommendations listed here are based on guidelines from the Children's Oncology Group (COG).

Bone problems. Radiation therapy, especially to the head and spine, can affect bone formation and cause bone problems such as osteoporosis (a disease that causes weak bones). Treatment for acute lymphoblastic leukemia (ALL), central nervous system tumors, bone cancer, Wilms tumor, and other cancers may cause late effects of the bone. Children under age six, or those undergoing a growth spurt, are at increased risk for these problems. Regular physical examinations and x-rays may help detect these late effects early.

Brain problems. Radiation therapy to the head can cause late effects, such as stroke and learning disabilities. Chemotherapy delivered into the spine (intrathecal therapy) may also cause learning disabilities. Children who were under age five during treatment may be at higher risk for learning disabilities and should be evaluated after treatment and later if they're having problems in school or at work.

Dental and jaw problems. Radiation therapy to the mouth, head, or neck may cause problems, such as xerostomia (dry mouth) and cavities. Chemotherapy, especially when given to a child whose adult teeth haven't formed, or who was under age five, may cause tooth development problems. Childhood cancer survivors should visit their dentist every six months for check-ups and tell the dentist about the cancer treatment they received. Talk with your child's dentist before and after treatment for guidance on reducing these potential late effects.

Digestive system. The gastrointestinal system, which helps digest and absorb food, can be affected by abdominal or pelvic surgery, and radiation therapy to the neck, chest, abdomen, or pelvis. Talk with your doctor if you experience abdominal pain, or chronic (long-term) constipation, diarrhea, heartburn, or nausea and vomiting.

Emotional problems. No matter what age a child is during treatment, potentially long-lasting emotional effects, such as anxiety, depression, and fear of recurrence, may occur. The Cancer.Net Coping and Survivorship sections provide information on coping with cancer-related distress.

Endocrine problems. Cancer treatments can affect the endocrine system, a group of hormone-producing glands that control body functions, such as growth, energy, and puberty. For example, radiation therapy near the brain, eyes, or ears can affect the pituitary gland, which helps control growth. Children who haven't reached adult height may be at increased risk for growth problems. An endocrinologist (a doctor who specializes in endocrine glands and hormones) can test for problems and provide hormone treatments.

Hearing problems. Radiation therapy to the head or brain may cause hearing loss. Some chemotherapy, such as cisplatin (Platinol) or carboplatin (Paraplatin) may also affect hearing. Younger children are at greater risk for these problems. A child's hearing should be tested annually by an audiologist, a medical professional who identifies, treats, and manages hearing problems.

Heart problems. A class of chemotherapy called anthracyclines — including doxorubicin (Adriamycin, Rubex), daunorubicin (Daunomycin, Cerubidine), and idarubicin (Idamycin) — may cause heart problems, such as abnormal heart beat, disease of the heart muscle, and congestive heart failure. Radiation therapy to the chest, spine, or upper abdomen may increase the risk of heart late effects, as does having a stem cell transplant. Women are at increased risk of heart late effects, in addition to younger children (the younger the child at the time of treatment, the greater the risk). Survivors of childhood cancer should visit their doctor yearly for follow-up care since heart conditions often have no symptoms. An electrocardiogram (ECG or EKG), and an echocardiogram or multiple gated acquisition (MUGA) scan — noninvasive tests that check how the heart is functioning — should be done approximately two years after treatment is finished. COG provides clinical guidelines on how frequently a patient should continue to have these tests.

Lung problems. Certain chemotherapy may cause lung damage, including bleomycin (Blenoxane), carmustine (BCNU), and lomustine (CeeNU). Chest radiation and surgery to the chest or lungs may also cause lung problems. Younger age at the time of treatment increases risk. Childhood cancer survivors should have a chest x-ray and lung function tests done at least two years after treatment has ended. Talk with your doctor about how often these tests need to be repeated.

Reproductive problems and sexual development. In boys, radiation therapy to the brain, head, testicles, or abdomen may cause infertility (the inability to father a child), as can cyclophosphamide (Cytoxan, Neosar) and ifosfamide (Ifex) chemotherapy. Treatments may also alter levels of testosterone (a male hormone), which can affect progression through puberty. In girls, particularly those who have begun menstruation, chemotherapy, as well as radiation therapy to the whole abdomen, pelvis, lower spine, or head, can affect the ovaries, causing infertility (inability to conceive a child or maintain a pregnancy), irregular menstruation, and premature menopause.

Second cancers. Survivors of childhood cancer have a slightly increased risk of developing a second cancer (a different type of cancer that appears after the original cancer diagnosis). Radiation therapy may increase the risk of developing solid tumors and leukemia. Some chemotherapy, including cyclophosphamide and doxorubicin, may also cause leukemia. Children and adolescents treated for Hodgkin lymphoma have the highest risk for second cancers, particularly breast and thyroid cancers.

Vision problems. High doses of radiation to the eye, eye socket, or brain may cause eye problems such as cataracts (a clouding of the eye lens). Radioiodine treatment for thyroid cancer may result in increased tearing, and bone marrow and stem cell transplants increase risk for dry eyes. An ophthalmologist, a doctor who specializes in diseases of the eye, should evaluate childhood cancer survivors.

Additional Resources

Cancer Care: Post-Treatment Survivors

Candlelighters Childhood Cancer Foundation

More Information

Cancer. Net Guide to Childhood Cancer

Late Effects of Childhood Cancer (Part I)

Childhood Cancer Survivorship