Long-Term Side Effects of Cancer Treatment

Approved by the Cancer.Net Editorial Board, 02/2018

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 treating late effects is an important part of survivorship care.

Types of late effects

Nearly any treatment can cause late effects, and these late effects are specific to the treatment you received. Below is a list of some of the more common late effects. Talk with your doctor about any concerns you have about a specific late effect.

Problems from surgery. Long-term side effects from surgery depend on the type of cancer and where in the body you had surgery.

  • Survivors of Hodgkin lymphoma, especially those diagnosed before 1988, often had their spleens removed. Because of the spleen’s role in the immune system, removing it is linked with a higher risk of infections.

  • Survivors of bone and soft-tissue cancers may experience physical and emotional effects from losing all or part of a limb. One example is phantom limb pain. This is feeling pain in the limb that was removed even though it is no longer there. 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. Lymphedema is when lymph fluid builds up and causes swelling and pain.

  • Men and women who had certain surgeries 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 received certain medicines, such as trastuzumab (Herceptin, Ogivri) and doxorubicin (Adriamycin, Doxil)

Below is a list of common heart conditions. 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.

Examples of drugs that tend to cause more heart problems:

  • Trastuzumab

  • Doxorubicin

  • Daunorubicin (Cerubidine)

  • Epirubicin (Ellence)

  • Cyclophosphamide (Genoxal, Mitoxan)

  • Osemertinib (Tagrisso)

Ask your doctor if the treatments you are receiving can affect heart function. He or she may recommend checking heart function and watching for heart damage during and after treatment. This may be done with a test called echocardiography, also called an echo.

Other heart tests may include a physical examination, an electrocardiogram (EKG or ECG), and a multigated acquisition scan (MUGA) scan.

Hypertension—high blood pressure. This may occur along with CHF (see above) or be a separate symptom. Talk with your doctor if you have high blood pressure. You may need to have your blood pressure watched more closely during 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. Ask your doctor if the medicine you are taking can cause high blood pressure. Examples of these drugs include:

  • Bevacizumab (Avastin, Mvasi)

  • Sorafenib (Nexavar)

  • Sunitinib (Sutent)

The risk of high blood pressure decreases once a person stops taking these drugs. But the long-term effects are not known. Survivors at higher risk for high blood pressure should work with their health care team to lower this risk. This may include steps such as testing blood pressure, losing weight, eating less salt, taking medicine, and being 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 (Blexane)

  • Carmustine (Becenum, BiCNU, Carmubris)

  • 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. The endocrine system includes the glands and other organs that make hormones and produce eggs or sperm. Cancer survivors who have a risk of hormone changes from treatment should have regular blood tests to measure hormone levels.

  • Menopause. Many cancer treatments may cause a woman to have menopausal symptoms. These include surgery to remove a woman’s ovaries (oophorectomy), chemotherapy, hormone therapy, and radiation therapy to the pelvic area.The symptoms of menopause caused by cancer treatment may be worse than the symptoms of natural menopause. This is because the decrease in hormones happens more quickly. These symptoms include changes in mood or sexual desire, hot flashes, osteoporosis, and bladder control problems. Learn about managing the symptoms of menopause. Women taking hormone therapy who have not been through menopause may have lighter and fewer regular menstrual periods. Some women taking hormone therapy may have their menstrual periods stop completely. For some younger women, menstrual periods may return after treatment. But women older than 40 are less likely to have their menstrual periods return. Even if cancer treatment does not cause menopause right away, it may still cause menopause to start sooner than normal.

  • Hormone problems for men. Men may experience symptoms similar to menopause from some treatments. These include hormone therapy for prostate cancer or surgery to remove the testicles. Symptoms may include a change in sexual desire, hot flashes, and osteoporosis. Learn more about managing hormone deprivation symptoms in men.

  • Infertility. Treatments that affect reproductive organs or the endocrine system increase risk of infertility. Infertility from cancer treatment may last a short time or it may be permanent. Learn more about fertility concerns and preserving fertility in men and in women.

  • Hormone problems from head and neck radiation therapy. Radiation therapy to the head and neck area can lower hormone levels or cause changes to the thyroid.

Bone, joint, and soft tissue problems. Chemotherapy, steroid medications, or hormonal therapy may cause osteoporosis, which is thinning of the bones, or joint pain. Immunotherapy may cause problems in the joints or muscles, also known as rheumatological issues. Some people may have a higher 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 (multiple brand names)

  • Increased risk of stroke from high-dose radiation therapy to the brain

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

To check for these effects, cancer survivors should have regular physical examinations and hearing tests after treatment.

Learning, memory, and attention difficulties. Chemotherapy and high-dose radiation therapy to the head and other areas of the body may cause cognitive problems for both adults and children. Cognitive problems occur when a person has trouble processing information. 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 to the head and neck area may change tooth development. It can also 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. An ophthalmologist is a doctor who specializes in treating eye conditions. Ask your cancer doctor if you should make an appointment with an opthamologist or dentist.

Digestion problems. Chemotherapy, radiation therapy, and surgery may affect how well a person digests food. Surgery or radiation therapy to the abdominal area can cause tissue scarring, long-term pain, and intestinal problems affecting digestion. Moreover, some survivors may have chronic diarrhea that reduces the body’s ability to absorb nutrients. A registered dietitian (RD) can help make sure people with digestion problems are getting enough nutrients. It may also be helpful to see a doctor who specializes in the GI tract, called a gastroenterologist.

Emotional difficulties. Cancer survivors often experience various 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 living through an extremely frightening or life-threatening event, 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 may be a new primary cancer. Or, it may be a cancer that has spread to other parts of the body from 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 acute leukemia or myelodysplasia. Myelodysplasia is a blood cancer where the normal parts of the blood are either not made or are abnormal. Talk with your doctor about any new symptoms or signs that you experience.

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

Questions to ask the health care team

Learn as much as you can about the potential long-term effects of your cancer treatment from your health care team. You may want to schedule a special appointment to review your treatment summary. This document should include information about your cancer, cancer treatment, and follow-up care. The American Society of Clinical Oncology (ASCO) offers cancer treatment summary forms to store this information.

Consider asking your health care team these 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?

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

Related Resources

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Fear of Treatment-Related Side Effects

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