Long-Term Side Effects of Cancer Treatment

Approved by the Cancer.Net Editorial Board, 07/2015

A late effect is a side effect that occurs months or years after cancer treatment. Many people who have received treatment for cancer have a risk of developing long-term side effects. In fact, evaluating and treatment of late effects is an important part of survivorship care.

Types of late effects

Nearly any type of treatment can cause late effects, and these are specific to the treatment you received. Some of the more common late effects are described below. If you are concerned about a particular late effect, please talk with your doctor.

Problems from surgery.

  • Survivors of Hodgkin lymphoma, especially those diagnosed before 1988, often had their spleens removed. These people have a higher risk of serious infections because of the spleen’s role in the body’s immune system.

  • Survivors of cancers of the bone and soft tissue may experience physical and psychological effects from losing all or part of a limb, such as phantom limb pain. This is feeling pain in the area of the limb that was removed. Learn more about rehabilitation, which can help people cope with physical changes from surgery.

  • People who had surgery to remove lymph nodes or radiation therapy to lymph nodes may develop lymphedema. Lymph nodes are the tiny, bean-shaped organs that help fight infection. When lymph fluid builds up and causes swelling and pain, it is called lymphedema.

  • Men and women who had lymph nodes removed in the pelvis or abdomen may not be able to have children. This is called infertility. Learn more about fertility concerns and preserving fertility in men and in women.

Heart problems. Both chemotherapy and radiation therapy to the chest can cause heart problems. Survivors who may have a higher risk include:

  • Anyone who received treatment for Hodgkin lymphoma as a child

  • Anyone 65 and older

  • Those who received higher doses of chemotherapy

  • Those who have were treated with both trastuzumab (Herceptin) and doxorubicin (Adriamycin, Doxil)

Common heart conditions are listed here. Talk with your doctor right away if you experience any of these symptoms:

  • Congestive heart failure (CHF)—weakening of the heart muscle. People with CHF may experience shortness of breath, dizziness, and swollen hands or feet.

  • Coronary artery disease—heart disease. This condition is more common in those who had high doses of radiation therapy to the chest. People who have heart disease may experience chest pain or shortness of breath.

  • Arrhythmia—irregular heartbeat. People who have an arrhythmia may experience lightheadedness, chest pain, and shortness of breath.

These drugs tend to cause more heart problems in people treated for cancer:

  • Trastuzumab

  • Doxorubicin

  • Daunorubicin (Cerubidine)

  • Epirubicin (Ellence)

  • Cyclophosphamide (Neosar)

People taking trastuzumab should be monitored during and after treatment for heart function and possible heart damage. This may be done with a test called echocardiography, also called an echo, which measures LVEF, or left ventricular ejection fraction. Other tests include a physical examination, an electrocardiogram (EKG or ECG), and a multigated acquisition scan, or MUGA scan.

Hypertension—high blood pressure. This may occur along with CHF (see above) or be a separate symptom. If you have high blood pressure, talk with your doctor about whether you need to have your blood pressure monitored more closely because of your cancer treatment. A more serious condition, called accelerated hypertension, is when a person’s blood pressure suddenly and rapidly rises. Because this condition often causes organ damage, it is important to get medical help right away.

Drugs that target the vascular endothelial growth factor (VEGF) are a common cause of high blood pressure. They include:

  • Bevacizumab (Avastin)

  • Sorafenib (Nexavar)

  • Sunitinib (Sutent)

Although the risk of hypertension decreases once a person stops taking these drugs, the long-term effects are not known. Survivors at higher risk for hypertension should work with their doctor to lower this risk. It may involve monitoring your blood pressure, eating less salt, taking medications, and being physically active.

Lung problems. Chemotherapy and radiation therapy to the chest may damage the lungs. Cancer survivors who received both chemotherapy and radiation therapy may have a higher risk of lung damage. Some of the drugs that are more likely to cause lung damage include:

  • Bleomycin (Blenoxane)

  • Carmustine (BiCNU)

  • Prednisone (multiple brand names)

  • Dexamethasone (multiple brand names)

  • Methotrexate (multiple brand names)

The late effects may include the following:

  • A change in how well the lungs work

  • Thickening of the lining of the lungs

  • Inflammation of the lungs

  • Difficulty breathing

People with a history of lung disease and older adults may have additional lung problems.

Endocrine (hormone) system problems. Some types of cancer treatments may affect the endocrine system, which includes the glands and other organs that are responsible for making hormones and producing eggs or sperm.

For example, surgical removal of a woman’s ovaries (oophorectomy), chemotherapy, hormone therapy, and radiation therapy to the pelvic area may cause a woman to stop menstruating (menopause) or menopausal symptoms. The symptoms of menopause caused by cancer treatment may be worse than the symptoms of natural menopause because the decrease in hormones happens quickly. Learn about managing menopausal symptoms.

Women undergoing hormone therapy who have not been through menopause may have lighter and fewer regular menstrual periods, or their menstrual periods may stop completely. Menstrual periods may return for some younger women after treatment, but women older than 40 are less likely to have their menstrual periods return. And, in some cases, although cancer treatment does not immediately cause menopause, it may still cause menopause to start sooner than normal.

In addition, men with prostate cancer who receive hormone therapy or who have their testicles removed may experience symptoms similar to menopause. Learn more about managing hormone deprivation symptoms in men.

Men and women who receive radiation therapy to the head and neck area may have lower levels of hormones or changes to the thyroid gland. Both men and women who undergo treatment that affects the endocrine system are at risk of temporary or permanent infertility from cancer treatment. Learn more about fertility concerns and preserving fertility in men and in women.

Cancer survivors who have a risk of hormone changes from treatment should have regular blood tests to measure hormone levels.

Bone, joint, and soft tissue problems. Chemotherapy, steroid medications, or hormonal therapy may cause osteoporosis, which is thinning of the bones, or joint pain. Some people may have a great risk of these conditions if they are not physically active.

Cancer survivors can lower their risk of osteoporosis in these ways:

Learn more about managing osteoporosis.

Brain, spinal cord, and nerve problems. Chemotherapy and radiation therapy can cause long-term side effects to the brain, spinal cord, and nerves. These late effects include:

  • Hearing loss from high doses of chemotherapy, especially drugs like cisplatin (Platinol)

  • Increased risk of stroke for those who had high doses of radiation treatment to the head, usually to treat a brain tumor

  • Nervous system side effects, such as damage to the nerves outside the brain and spinal cord (peripheral neuropathy)

Cancer survivors should undergo regular physical examinations, hearing tests, and x-rays after chemotherapy or radiation therapy ends to check for these late effects.

Learning, memory, and attention difficulties. Chemotherapy and high doses of radiation therapy to the head may cause these problems for both adults and children. Cancer survivors who experience any of these problems should talk with their doctor. Learn more about cognitive problems.

Dental and oral health and vision problems. Cancer survivors may have the following dental and oral health and vision problems, depending on the treatments they received:

  • Chemotherapy may affect tooth enamel and increase the risk of long-term dental problems.

  • High-dose radiation therapy given to the head and neck area may change tooth development, cause gum disease, and lower saliva production, causing a dry mouth.

  • Steroid medications may increase the risk of eye problems such as a clouding of the eye that affects vision (cataracts).

To watch for future problems, survivors should schedule regular appointments with a dentist and an ophthalmologist, which is doctor who specializes in treating eye conditions.

Digestion problems. Chemotherapy, radiation therapy, and surgery may affect how well a person digests food. In addition, surgery or radiation therapy to the abdominal area can lead to tissue scarring, long-term pain, and intestinal problems that affect digestion. Moreover, some survivors may have chronic diarrhea that reduces the body’s ability to absorb nutrients. A nutritionist or dietitian may help treat people who are not getting enough nutrients or who are underweight because of poor digestion.

Emotional difficulties. Cancer survivors often experience a variety of positive and negative emotions, including:

Cancer survivors, caregivers, family, and friends may also experience post-traumatic stress disorder. This is an anxiety disorder. It may develop after experiencing an extremely frightening or life-threatening situation, such as cancer diagnosis and treatment.

Each person’s post-treatment experience is different. For example, some survivors struggle with negative emotional effects of the cancer. Others say that they have a renewed, positive outlook on life because of the cancer.

Secondary Cancers. A secondary cancer is either a new primary cancer or cancer that has spread to other parts of the body from the place where it started. It may develop as a late effect of previous cancer treatments, such as chemotherapy and radiation therapy.

Chemotherapy and radiation therapy can also damage bone marrow stem cells. This increases the risk of either myelodysplasia, a blood cancer where the normal parts of the blood are either not made or are abnormal, or acute leukemia. Talk with your doctor about ways to lower the risk of a secondary cancer and common signs or symptoms.

Fatigue. Fatigue is a persistent feeling of physical, emotional, or mental tiredness or exhaustion. It is the most common side effect of cancer treatment, and some cancer survivors experience fatigue for months and sometimes years after finishing treatment. Learn more about cancer-related fatigue.

Questions to ask the doctor

Learn as much as you can about the potential long-term effects of your cancer treatment from your oncologist. In fact, you may want to schedule a special appointment to review your treatment summary, which should include information about your cancer, cancer treatment, and follow-up care. ASCO offers cancer treatment summary forms to store this information.

Consider asking your doctor the following questions:

  • Would you or someone in your office write down which treatment(s) I received?

  • Am I at risk for specific late effects?

  • What other specialists (such as a cardiologist or endocrinologist) should I see to monitor potential late effects?

  • Should I watch for any signs or symptoms of late effects?

More Information

Survivorship

Late Effects of Childhood Cancer

Fear of Treatment-Related Side Effects

Side Effects

Additional Resource

LIVESTRONG: Late Effects of Cancer Treatment