Possible long-term side effects of cancer treatment on children
It‘s important for you and your child to attend follow-up clinics when treatment is over.
The doctors will want to check that everything is well and ensure that your child doesn’t have any long-term problems following their cancer treatment.
Certain treatments can sometimes affect a child’s future development. We discuss some of these effects below.
The doctors will be able to discuss any specific long-term effects your child might have in more detail with you.
Some treatments may affect your child’s puberty and fertility. These include:
Your child will be checked regularly for signs of puberty. If this appears to be delayed, hormone replacement therapy may be needed so that puberty can occur.
Understandably, it’s very distressing to think that your child may not be able to have children in the future. They may also find this difficult to cope with, either now or in the future, as they move towards adulthood.
For children who have already reached puberty, it can be difficult to know whether or not cancer treatment has affected their fertility until they’re old enough to have hormone tests. This will be discussed at follow-up clinics.
If fertility is likely to be a problem, older boys may be given the option of storing sperm before they start treatment. It may also be possible for girls to have ovarian tissue stored. The hospital staff can tell you more about this.
Growth and development
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Radiotherapy can have an effect on a child’s growth and development. It may affect growing bones - for example, if radiotherapy is given to the spine, your child may not grow as tall as expected, or if radiotherapy is given to a leg, that leg may be shorter than the other.
The pituitary gland at the base of the brain produces hormones that help to regulate growth and development from childhood to adulthood. Radiotherapy to the brain may affect the production of growth hormone by the pituitary gland. If your child doesn’t produce enough of this, they will not grow normally and may need treatment with a man-made growth hormone.
Your child will be regularly weighed and measured at the follow-up clinics. If their growth has been affected, tests will be done to see if replacement growth hormone is needed.
Effects on the heart and lungs
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Certain treatments can affect the heart and lungs. These treatments include some chemotherapy drugs and radiotherapy. The effects may not be seen for some time after treatment finishes. If your child is at risk of these problems, they'll be regularly followed up with echocardiograms (heart ultrasound scans). Sometimes, special tests on the lungs (lung function tests) are also needed.
Hearing problems after cancer treatment are uncommon but they may occur with certain drugs and after radiotherapy to the head, in the region of the ear. Cisplatin is the drug most likely to cause hearing impairment (i.e. partial deafness). This causes particular difficulty in hearing high-pitched noises, and can be detected by sensitive hearing tests. It is seldom severe enough to be noticeable by either the patient, their family or friends, since the lower pitched noises used for speech are not usually affected.
These can occur after some types of treatment for children’s cancer, but fortunately they aren’t usually severe. Removal of one kidney as part of treatment doesn’t usually cause any problems because the remaining kidney can make up for the one removed.
Some chemotherapy drugs can cause kidney problems. If your child has had these drugs, their doctor will arrange tests, such as GFR, to check their kidneys from time to time. Children whose kidneys are working well at the end of treatment shouldn’t develop problems in the future.
Intellectual development and education
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Following treatment, most children are able to continue with normal education and the development of their ability to think and understand (intellectual development) is not affected. However, some children, especially children treated for brain tumours, may develop learning difficulties and need to have special help at school. The extent of these difficulties will depend on the age of your child when they were treated, and the treatment they had.
Some children will need a statement of special educational needs to provide the necessary help in the school environment. You can discuss this with your child’s doctor who can give details of treatment and, if necessary, contact the school or education authority.
A very small number of children who are cured of cancer may develop a different cancer later on in life. There are two main reasons for this. Firstly, some families have an inherited risk factor for cancer, although this is rare. Also, some cancer treatments can themselves increase the risk of developing other cancers. Your child’s doctor will be able to discuss any worries you may have about this.
The information about children’s cancer was written by the Children’s Cancer and Leukaemia Group (CCLG). It has been reviewed and edited by their publications committee, which includes medical experts from all fields of children’s cancer and care.