What Are Late Effects of Childhood Cancer?

Approved by the Cancer.Net Editorial Board, 10/2022

There are more than 18 million cancer survivors living in the United States, over 500,000 of which are survivors of childhood cancer.

In the last 30 years, cancer treatment and supportive care have improved significantly. As a result, more than 80% of children treated for cancer live 5 years or more after treatment. At the same time, because cancer treatments are powerful, these survivors are at risk for side effects that can occur over the long term, called "late effects," that are related to their prior cancer treatment.

This type of side effects can develop during treatment and continue well after treatment is completed. Or, late effects can develop many years after a cancer diagnosis. It is important to know what late effects you or your child are at risk for. Screening may be recommended to help find conditions earlier, when they are the most treatable.

Talk with your health care team about how to screen for, prevent, or manage late effects. This is an important part of your follow-up care after cancer treatment.

This article explains the different types of late effects that are common after childhood cancers. Learn more in another article on this website about how to manage the long-term effects of childhood cancer.

What are the causes of late effects of childhood cancer?

Any cancer treatment can cause late effects. A child's risk of developing late effects depends on many factors, including:

  • The type of cancer and its location in the body

  • The part of the body that was treated

  • The type and dose of treatment

  • Age when treated for cancer

  • Genetics and family history

  • General health

  • Any other health problems that existed before the cancer diagnosis

What are common types of late effects of childhood cancer?

Some possible late effects of childhood cancer include the following, with more information on each below:

Emotional effects after childhood cancer

The long-term emotional effects of childhood cancer can include anxiety, depression, and fear of the cancer coming back. Some survivors avoid getting health care because of difficult memories and emotions. However, this can harm their health as an adult.

Sadness, fear, and worry are normal emotions, especially after an experience with cancer. But if those feelings are long-lasting and impact your day-to-day life, it is important to seek help. Counseling from a licensed therapist or psychiatrist can help. Sometimes, treatment with medication is helpful for both depression and anxiety. Support groups with other people who have experienced childhood cancer can also help.

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Second cancers after childhood cancer

Some survivors have a higher risk for developing a second, or additional, cancer. This is a different type of cancer that happens after the first cancer diagnosis.

Common second cancers include skin cancer, breast cancer, and thyroid cancer. Radiation therapy and some types of chemotherapy have the strongest links to second cancers. Medications with links to second cancers include:

  • Cyclophosphamide (Neosar)

  • Ifosfamide (Ifex)

  • Etoposide (Toposar, VePesid)

  • Daunorubicin (Cerubidine)

  • Doxorubicin (Adriamycin)

It is important to keep a record of the cancer treatment, including a list of specific chemotherapy drugs or other medications, you or your child received. Ask your health care team for this record, which may be given as part of a "survivorship care plan" after treatment is finished. Also, talk with them to find out if any of the treatments that were part of your or your child's treatment plan carry a risk of a second cancer.

Learn more about secondary cancers.

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Reproductive, sexual development, and sexual function problems after childhood cancer

There is a higher risk of developing reproductive, sexual development, and sexual function problems after certain cancer treatments.

Infertility is one possible side effect of certain treatments. Infertility is the inability to become pregnant, stay pregnant, or make someone else pregnant. Treatments that can cause infertility, affect sexual development or puberty, and sexual functioning include:

  • Radiation therapy to the lower abdomen, pelvis, lower spine, or groin

  • Radiation therapy to the brain, which can affect the pituitary gland and cause hormone changes that cause fertility problems

  • Chemotherapy drugs called alkylating agents, which commonly include cyclophosphamide and ifosfamide

Learn more about fertility concerns and sexual health after cancer treatment.

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Growth, development, and hormone problems after childhood cancer

Cancer treatments can affect the body's glands that make hormones. These glands are a part of the endocrine system and control many body functions, such as growth, metabolism, and puberty. Treatments that can cause side effects related to the endocrine system include:

Radiation therapy near the brain, eyes, or ears. This can affect the pituitary gland. Children who have had radiation therapy to these areas before reaching their adult height may have problems with their body's growth.

They may also reach puberty earlier or later than usual. Children who have had radiation therapy to the pituitary gland also have a higher chance of being overweight or obese. A doctor who specializes in treating hormone problems is called an endocrinologist. They can test for these conditions and provide hormone treatments if necessary.

Radiation therapy to the muscles, bones, and soft tissues. This can lead to reduced or uneven growth of body parts. For example, it can lead to a curved spine, called scoliosis.

Treatment with steroid drugs such as prednisone, dexamethasone, or methotrexate (multiple brand names are available for all 3 drugs). These drugs have direct effects on bone formation and can lead to low bone mineral density. When severe, it can cause osteoporosis. This is a disease that causes weak bones and increases the risk of broken bones. However, most children regain their bone density after stopping these medicines.

Children should receive regular checkups to check for any growth problems through puberty. Adults who had childhood cancer should also be checked for osteoporosis. Some children may receive x-rays to measure bone mineral density. If necessary, dietary supplements, special foods, and exercise can help improve bone density.

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Learning and memory problems after childhood cancer

The following treatments may increase the risk of learning and memory problems for childhood cancer survivors:

  • Radiation therapy to the brain

  • High doses of certain medications, such as methotrexate

There are resources available for survivors who have these challenges. Ask your health care team for referrals to:

  • School programs

  • State or county social services

  • Other educational and career services

These types of programs can provide survivors with tools and techniques to do well at school and work.

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Heart problems after childhood cancer

Heart problems are a serious side effect of some cancer treatments. Doctors and researchers call heart problems caused by cancer treatment "cardiac toxicity." Some common treatments that are more likely to cause heart problems include:

Chemotherapy. A type of chemotherapy treatment called anthracyclines are an effective treatment for many different types of childhood cancers. Anthracyclines include doxorubicin (available as a generic drug), daunorubicin (Cerubidine), idarubicin (Idamycin), mitoxantrone (available as a generic drug).

Anthracyclines can cause heart problems such as:

  • Abnormal heart rhythms

  • Weakness of the heart muscle

  • Heart failure

Other chemotherapy drugs such as mitoxantrone (Novatrone) and cisplatin (Platinol) can cause heart problems.

Radiation therapy. Radiation therapy to the chest, spine, or upper abdomen can increase the risk of late heart effects. Possible radiation therapy-related late heart effects include:

  • Leaky heart valves

  • Problems with the heart's blood vessels, such as coronary artery disease

  • Weakness of the heart muscle

  • Abnormal heart rhythms

Targeted therapy. Some targeted therapy treatments used for childhood cancers can cause heart problems or high blood pressure, which can lead to heart problems in the future.

  • Bevacizumab (Avastin)

  • Dasatinib (Sprycel)

  • Pazopanib (Votrient)

  • Sorafenib (Nexavar)

  • Sunitinib (Sutent)

Childhood cancer survivors who received anthracyclines or other treatments that can cause heart problems should have regular follow-up care specifically for heart health. These heart conditions may not cause symptoms early on.

Your doctor may ask you to get an electrocardiogram (ECG or EKG), echocardiogram, or similar imaging tests. Learn more about heart problems caused by cancer treatment.

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Lung problems after childhood cancer

These treatments may cause lung damage:

  • Certain types of chemotherapy, including bleomycin (Blenoxane), carmustine (BiCNU), lomustine (CeeNU), or busulfan (Busulfex, Myleran)

  • Radiation therapy to the chest

  • Surgery to the chest

  • Bone marrow/stem cell transplantation

Children who receive cancer treatment at a younger age have a greater risk of lung and breathing problems.

Survivors should have a lung test called a pulmonary function test. Talk with your doctor about any breathing problems, how often to repeat this test, and how it can be addressed.

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Dental problems after childhood cancer

The teeth and mouth can be affected by cancer treatment, affecting your dental health. These treatments may cause dental problems:

Radiation therapy to the mouth, head or neck. Radiation therapy to these areas can cause dry mouth, gum disease, and cavities.

Chemotherapy. When chemotherapy is given to a child whose adult teeth have not formed, it can cause tooth development problems.

Childhood cancer survivors should have dental visits every 6 months. Talk with your child's dentist before and after treatment so they can help you lower potential late effects.

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Digestive system problems after childhood cancer

Abdominal or pelvic surgery and radiation therapy to the neck, chest, abdomen, or pelvis can cause problems with digesting food, also called gastrointestinal system problems.

Childhood cancer survivors should talk with a doctor if they have difficulty swallowing or these chronic symptoms:

  • Heartburn

  • Stomach pain

  • Constipation

  • Diarrhea

  • Nausea and vomiting

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Hearing problems after childhood cancer

These treatments may cause hearing problems:

  • Radiation therapy to the head or brain

  • Certain types of chemotherapy, such as cisplatin (Platinol) or carboplatin (Paraplatin)

Younger children have a higher risk of these problems. Children who receive cisplatin-based chemotherapy may be given sodium thiosulfate at the time of cancer treatment to reduce the risk of hearing loss.

All childhood cancer survivors who receive any of the above treatments should visit an audiologist at least once after treatment. An audiologist is a specialist who diagnoses and treats hearing problems. Survivors with hearing loss should receive testing every year or as needed. Learn more about hearing problems due to treatment.

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Vision and eye problems after childhood cancer

Drugs called steroids, bone marrow/stem cell transplantation, and high-dose radiation therapy to the eye, eye socket, or brain may cause these problems:

  • Cataracts, or clouding of the eyes

  • Dry eyes

  • Other problems that can affect vision

Radioactive iodine treatment (called RAI or I-131) for thyroid cancer may cause the eye to make more tears.

Childhood cancer survivors who have had one of these treatments should see an ophthalmologist, which is a physician who treats eye diseases.

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Where to find survivorship care after childhood cancer

After childhood cancer, it is important to continue with the plan of follow-up care, including exams and tests, that your oncologist recommended after cancer treatment is complete. This is called survivorship care. It is important to monitor your or your child's ongoing recovery and long-term health.

As mentioned above, talk with your health care team about getting a survivorship care plan. This includes a summary of the treatment given and the specific follow-up care recommendations. The American Society of Clinical Oncology also offers survivorship care plan forms that you can download and fill out with the help of your health care providers.

During survivorship care, you may continue to see an oncologist or you may get your care through a combination of other specialists and a primary care doctor. There are also medical centers that offer a survivorship care center, many of which are located at National Cancer Institute Comprehensive Cancer Centers. You can also find long-term follow-up care clinics listed on the National Children's Cancer Society website.

Questions to ask the health care team

Consider asking your health care team these questions about late effects of childhood cancer:

  • What late effects are common after this cancer treatment?

  • What can be done to prevent or relieve long-term or late effects?

  • What other specialists should I or my child see to watch for potential late effects?

  • What signs or symptoms of late effects should I watch for?

  • How can I get a survivorship care plan?

Related Resources

Managing Late Effects of Childhood Cancer

Life After Cancer

What It’s Like Being a Childhood Cancer Survivor

More Information

Children’s Oncology Group: Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers

National Cancer Institute: Late Effects of Treatment for Childhood Cancer