As late as the 1950s, a diagnosis of pediatric cancer was considered an almost certain death sentence. At the time, survival rates were as low as 4 percent. Since that time, survival rates have increased dramatically; this is mainly attributed to the progress made against the most common childhood cancer, acute lymphoblastic leukemia, in which survival rates have reached 80 percent or more in the United States.
However with increased survival rates, there has been a cost in terms of the “late effects” (which are problems that arise after treatment for cancer) that childhood survivors have had to endure. The effects of providing radiation and chemotherapy to the developing bodies and organ systems of growing children are often more pronounced and toxic in children than in adults. This toxicity can put these childhood survivors at a higher risk of significant adverse health outcomes.
In addition to these common issues, childhood cancer survivors are often more at risk of developing secondary malignancies and chronic diseases as they age and into their adult life. This is why it is essential that adult survivors of childhood cancers continue to be seen annually in either a long-term follow-up clinic or by a primary care physician who is familiar with their cancer history and follow-up guidelines.
From the research on the late effects of the earlier more toxic treatments, the actual treatment protocols themselves have been modified. In turn, the late effects for many childhood cancers have improved.
Common Childhood Cancers
The 10 most common types of childhood cancer are:
- Leukemia (acute lymphoblastic leukemia and acute myeloid leukemia)
- CNS, brain, and spinal cord tumors
- Lymphomas, (including Hodgkin and non-Hodgkin lymphoma)
- Skin cancer and melanomas
- Soft tissue tumors (including rhabdomyosarcoma)
- Germ cell tumors
- Bone cancers (including osteosarcoma and Ewing sarcoma)
- Renal cancer (including Wilms tumor)
Among the major types of childhood cancers, leukemias and cancers of the brain and central nervous system account for more than half of new cases.
Late Effects after Treatment for Childhood Cancer
It’s important to catch any problems early. Here are some of the possible late effects that can happen after treatment for childhood cancer:
Treatment for cancer during childhood, especially radiation to the brain or spine, can sometimes slow or stunt growth. Bone strength or bone density can also be affected by many types of treatments for childhood cancer.
A small percentage of survivors treated with chest radiation or certain chemotherapy drugs known as “anthracyclines” (such as doxorubicin or daunomycin) may develop heart problems. This is most likely to happen when people have received higher doses of these medicines, and when these treatments were given before the heart finished growing.
Radiation to the abdomen or pelvis, and certain anticancer drugs, can affect sexual development and reproduction. Some survivors may be at risk for infertility (inability to have children) or early menopause.
Head or neck radiation can sometimes cause the thyroid gland to stop working properly. This gland helps to regulate growth, weight, and the balance of body chemicals.
Some chemotherapy drugs and radiation can increase the risk of a second (different) cancer. It is possible for survivors to have genetic changes that put them at increased risk for these second cancers.
Tobacco, excessive sun exposure, and other chemicals and behaviors can also increase this risk. We often discuss with our patients ways to lower their risk, and to detect common cancers at an early stage.
Learning Challenges at School or Work
Difficulties with schoolwork or jobs can occur as a result of some types of cancer treatment. Survivors with learning challenges often times have special needs, and may benefit from accommodations at school or work. Financial assistance for education and job training may also be available through government programs.
If you are a childhood cancer survivor, check-ups and certain blood tests can help determine if you have any of these problems. These issues are important and we frequently discuss them with our patients. If concerns are raised, arrangements are usually made for you to see specialists.
Thinking about developing late effects after surviving childhood cancer can be anxiety provoking. Yet it is very possible that you will not develop any serious complications. If you do, it’s best to catch them early, so that you can begin treatment right away. Don’t let anxiety get in the way of taking the very best care of your health.
Being treated for cancer during childhood is often a difficult experience. And having survived that experience, you’ve also learned many things. You may be a stronger person than you were before you were diagnosed. As you move forward into your future, you can use those strengths to your advantage!
Even though you are finished with treatment, it’s important to continue to have regular medical care. It can be challenging to find a healthcare provider that understands your cancer history and the screening that is recommended for you. If you have additional questions or would like to understand the types of late effects that you may be at risk for and the follow-up care you require, please contact our clinic to schedule an appointment.