Recovering from the effects of the tumor and its treatment
The possible effects of the tumor and its treatment on physical and mental function can range from very mild to fairly severe. A child’s brain is often better able to adjust to changes than an adult’s, but it is also more sensitive to treatments such as radiation, and some effects may be long lasting.
Once your child has recovered from treatment, doctors will try to determine the extent of any damage to the brain or other areas. In a very young child this may take time. Physical exams and imaging tests (CT or MRI scans) will be done after treatment to determine the extent and location of any changes in the brain.
Several types of doctors and other health professionals may be involved in assessing any damage and helping your child recover.
A neurologist (a doctor who specializes in medical treatment of the nervous system) may assess your child’s physical coordination, muscle strength, and other aspects of nervous system function.
If there is muscle weakness or paralysis, your child will be seen by physical and/or occupational therapists and perhaps a physiatrist (a doctor who specializes in rehabilitation) while in the hospital and/or as an outpatient for physical therapy.
If speech is affected, a speech therapist will help your child improve talking and communicating.
If needed, an ophthalmologist (a doctor who specializes in eye problems) will check your child’s vision, and an audiologist can check your child’s hearing. If problems with vision or hearing are found, your child may require some type of special education.
After surgery, your child may also be seen by a psychiatrist or psychologist to determine the extent of any damage caused by the tumor and surgery. If your child gets radiation therapy and/or chemotherapy, this process may be repeated again after treatment is finished. The doctor will document your child’s development in areas such as general intelligence, speech and hearing, memory, and learning skills.
If your child is in school, a teacher working with the hospital (called a school liaison) may become involved. Before going (back) to school, the liaison may help pave the way for your child by talking with the teachers, explaining your child’s health issues, and discussing any special education techniques that may be needed. In some cases, medicines may be used to try to help with memory and attention issues as well. (For more information, see our separate document, Children Diagnosed With Cancer: Returning to School.)
If the tumor was in or near the base of the brain (such as a craniopharyngioma) or if radiation therapy was given to this area, hormone levels may be affected. Symptoms of pituitary problems can include fatigue, listlessness, poor appetite, cold intolerance, and constipation, which may point to low levels of cortisol and/or thyroid hormone. Other problems can include delayed growth and/or sexual maturation. Sometimes these symptoms may appear even before treatment, as a result of the tumor.
If there is reason to think the pituitary may have been affected, your child may be seen by an endocrinologist (a doctor who specializes in hormone disorders). Hormone treatments may be prescribed to restore normal hormone levels. For example, growth hormone can be given to help restore normal growth.
Late and long-term effects
A major concern of both parents and doctors is the potential for lasting effects from treatment, as well as effects that don’t show up until years later. Some of these, such as learning problems or delayed growth and development, were mentioned above. Others may include effects on the reproductive system or an increased risk of other cancers later in life. While doctors do everything they can to limit the chance of these complications, in some cases they may be an unavoidable part of making sure the tumor is treated properly.
To help increase awareness of late effects and improve follow-up care of childhood cancer survivors throughout their lives, the Children’s Oncology Group (COG) has developed long-term follow-up guidelines for survivors of childhood cancers. These guidelines can help you know what to watch for, what type of screening tests should be done to look for problems, and how late effects may be treated.
It is very important to discuss possible long-term complications with your child’s health care team, and to make sure there is a plan in place to watch for these problems and treat them, if needed. To learn more, ask your child’s doctors about the COG survivor guidelines. You can also visit the COG Web site at www.survivorshipguidelines.org. The guidelines themselves are written for health professionals, so you might want to go over the information with the child’s treatment team. Information based on some of the guidelines, written for families of children with cancer, is also available (as “Health Links”) on the site.
For more about some of the possible long-term effects of treatment, see our document, Children Diagnosed With Cancer: Late Effects of Cancer Treatment.
Last Medical Review: 03/22/2013
Last Revised: 01/31/2014