Long-term and Late Effects of Childhood, Adolescent, and Young Adult Cancer Treatment

After treatment for cancer, one of the major concerns is whether you will have to be treated for cancer ever again.

Cancer that comes back

Having your cancer return after treatment is called recurrence. The likelihood of this depends on the type of cancer, how it was treated, and how the cancer responded to that treatment. In most cases though, cancer is less likely to return as more time passes after finishing treatment.

For more information on how recurrence might be treated, see our content on your specific type of cancer.

Second cancers

While the risk of recurrence often lessens as time passes, certain treatments can increase the risk of developing another type of cancer as you age. This is called a second cancer, or subsequent neoplasm. It is a different type of cancer than what you were treated for in the past. Certain treatments used to cure cancer can increase your risk of developing other cancers. For example:

• Radiation: Radiation treatments increase the risk of developing cancer where it was used. For example, someone who had brain radiation as a part of treatment has a higher risk of skin cancers over the scalp or a brain tumor later in life. Someone who was treated with radiation to the belly (abdomen) has a higher chance of developing skin cancers over the belly area or colorectal cancer as they age.
• Chemotherapy: While chemotherapies treat cancer, they work by damaging the DNA in our cells. Because of this, chemotherapy medicines can also cause cancer. This is not common, but it is important to know what medicines you were treated with to better understand your risk. For example, certain chemotherapy medicines increase the risk of developing leukemia after treatment. Other chemotherapy medicines have been shown to increase the risk of other cancers, such as breast cancer, as survivors age.

Some people diagnosed with cancer at a young age learn that they have a family cancer syndrome. If you have a family cancer syndrome, this might also affect your risk of developing another cancer later in life.

Talk to your cancer care team about your risk based on your treatment and cancer history. It’s important to understand your risk of cancer as you get older. In some cases, more screening tests may be recommended to catch any issues early when treatment is more likely to be successful.

While everyone should monitor their heart health, some survivors might have had treatments that can affect the heart as they age. Survivors might develop health conditions such as heart failure or abnormal heart rhythms if they:

• Were treated with radiation to the chest, lung, or breast area
• Had certain types of chemo, such as doxorubicin, daunorubicin, idarubicin, or mitoxantrone
• Had certain types of immunotherapy or targeted drug therapy

Heart problems caused by cancer treatment are often called cardiotoxicities. They might not show up until later in life. For this reason, it’s important for anyone who had cancer at a young age to let their doctors know what treatments they received, even if it was a long time ago. In some cases, your care team may suggest regular echocardiograms. Echocardiograms are ultrasounds to check how well the heart is working.

Heart health and pregnancy

If you are currently pregnant or planning to become pregnant, it’s important to know how your cancer treatment might affect your heart health. If you had certain cancer treatments, your care team might recommend closer monitoring during your pregnancy.

Many young people and their families worry about whether cancer treatment will affect their growth and development, fertility, and sexual health.

Treatments that can affect pubertal development, fertility, and sexual health include:

• Radiation to the brain, ovaries, testicles, or total body irradiation (TBI)
• Stem cell transplantation
• Cancer treatments or surgeries that damage or remove the testicles or ovaries
• Chemotherapy (alkylating agents or platinum chemotherapy such as cyclophosphamide, ifosfamide, or cisplatin)

Effects of cancer treatment before puberty

Cancer treatments might affect a child’s ability to go through puberty normally. Your care team will watch your child’s growth and development closely. If there are concerns, more tests and a consultation with an endocrinologist, a hormone specialist, may be recommended.

Effects of cancer treatment after puberty

Cancer treatments are more likely to affect hormone levels in adolescents and young adults who have gone through puberty. These treatments may cause symptoms or fertility problems.

Healthcare providers will monitor female and male adolescents or young adults who received these treatments after puberty for changes in:

• Sexual desire and function
• Hair, skin, or nails
• Energy level
• Sleep or mood
• Weight

Providers will also monitor menstrual periods and symptoms of early menopause, such as hot flashes, in female adolescents and young adults.

Fertility preservation

Some cancer treatments can lead to early menopause or low sex hormones in females. This is because the ovaries stop working as expected (premature ovarian insufficiency). Blood tests for hormone levels or a visit with a fertility specialist might be recommended. Females may see a reproductive endocrinologist and males may see a urologist. At this visit, they can help you to better understand how treatment has affected your sexual health.

Some people are offered fertility preservation before treatment begins. But in some cases that might not be an option. Fertility testing and preservation may be an option after treatment is finished. Talk to your cancer care team about your risk, test results, and options for family planning.

A cancer diagnosis and its treatment can have lasting effects on mental wellness.

Some of these might last a long time and can include:

• Dealing with physical changes that happened because of treatment
• Worrying about cancer returning or new health problems developing
• Being treated differently or discriminated against by friends, classmates, coworkers, employers, and others

Some people might also feel:

• Resentful for having had cancer
• Resentful for going through treatment when others didn’t have to
• Guilty for surviving cancer when other friends with cancer did not survive
• Concerned about dating, marrying, and having a family

When mental health problems affect daily life

It’s normal to have some anxiety or other strong emotions after treatment. But feeling overly worried, depressed, or angry can affect many aspects of a young person’s growth. This can get in the way of relationships, school, work, and other aspects of life.

Survivors of cancer have a higher risk of depression and other mental health problems later in life. Some people struggle with substance use or engage in risky behaviors to cope. It’s important to have support. Support can include family, friends, mental health professionals, and other survivors. You may find that therapy, counseling, or support groups help.

Learn more about common types of mental distress in people who have a history of cancer and ways to cope.

Survivors of cancer may experience low energy levels or trouble sleeping. This can be more common in people who also have mental health conditions, such as depression or anxiety, or other health conditions such as heart problems, obesity, or chronic pain.

The exact cause of this for many people is not known, but it seems to be more common in female survivors of cancer and people who had a brain tumor or chest radiation.

Treatments such as radiation therapy to the head and chemotherapy can impact the ability to learn and make new memories. This is especially true when treatments are given directly to the brain or into the spinal fluid. Problems after treatment can include difficulty concentrating, remembering information, or learning skills.

Cancer treatment in adolescence and young adulthood can also cause delays and disruptions in school and early career development. This can affect self-worth, independence, and financial wellbeing.

For children, adolescents, and young adults in school, additional support may be available. See Going to School During and After Cancer Treatment.

For young adults returning to work after a cancer diagnosis or its treatment, legal protections exist to require employers to make reasonable accommodations when they are needed. See Returning to Work After Cancer Treatment.

Some chemo (such as cisplatin and carboplatin) can cause hearing loss. Radiation therapy to the head can cause hearing and vision problems. In the case of retinoblastoma, an eye may be removed as a part of treatment.

Finding problems with vision or hearing early can help make transitions back to school or work easier.

Depending on your treatment, your healthcare team might recommend regular audiograms (hearing testing). All cancer survivors should have regular vision exams. If there are problems, visits might be recommended more frequently.

This includes problems with the pituitary and thyroid glands.

Pituitary health

People who receive radiation therapy to the head, brain, or upper spine have an increased risk of developing hormone issues. This is because a small part of the brain, called the pituitary gland, makes many hormones that are essential for body function. It makes growth hormone, thyroid hormone, cortisol, and reproductive (sex) hormones.

Hypopituitarism is the medical term for when the pituitary gland doesn’t make enough of one or more hormones. Radiation therapy is the most common cause of hypopituitarism in children with cancer. Brain tumors or brain surgery near the pituitary gland or hypothalamus can also cause cancer-related hormone problems.

Children who receive cancer treatments that involve the head, brain, neck, or upper spine should be monitored for hormone or growth problems. A doctor or healthcare provider might refer you to see a hormone specialist called an endocrinologist.

Thyroid health

Cancer treatment can affect the thyroid gland’s ability to make hormones. The thyroid is a small gland in the front of your neck. Thyroid hormones play an important role in metabolism, cognitive function, growth and development. Treatments that can affect it include radiation to thyroid or neck area, surgery in this area, and certain targeted therapy medications such as BCR-ABL tyrosine kinase inhibitors.

Depending on your treatment, your care team might monitor your thyroid with blood tests or ultrasounds. If your thyroid does not work well, there are medicines that can replace thyroid hormone.

Certain cancer treatments, like radiation therapy, stem cell transplant, and certain types of chemo, can affect bone growth. This is especially true in younger people whose bones are still developing. Radiation can cause bone loss that leads to osteoporosis, a disease that causes bones to be brittle and break easily. Steroids, which are commonly used in treatment of leukemias and lymphomas, can also impact bone growth.

Doing weight-bearing exercise and making sure you have calcium and vitamin D in your diet can support strong, healthy bones after cancer treatment.

Radiation therapy to the head and neck, as well as certain types of chemo, can cause problems with the mouth and teeth. This can include dry mouth, gum disease, cavities, or tooth development problems.

Seeing a dentist for regular cleanings every six months can help identify problems early and get treatment.

Radiation therapy to the chest area and certain types of chemo (such as bleomycin, busulfan, carmustine, and lomustine) can harm lung tissue. This can cause breathing problems later in life.

Cancer treatments such as radiation to the belly (abdomen), stem cell transplant, and some chemotherapies (mercaptopurine, thioguanine) can affect the liver.

Some cancer treatments can cause damage to the kidneys. These include certain chemotherapies (ifosfamide, cisplatin, carboplatin), stem cell transplant, and radiation. In some cases, a kidney or part of a kidney might be removed as a part of treatment.

For some survivors, it is important to monitor the kidneys with lab tests and stay well hydrated. Your care team may also watch your blood pressure more closely if your cancer treatment might have affected your kidney health.

Certain treatments can affect how well the immune system functions. This might include treatments that can damage the spleen (such as radiation or surgery), stem cell transplantation, or immunotherapy treatments such as blinatumomab.

If your immune system has been affected by treatment, you might get sick more often than others. Sometimes, vaccines or treatments may be recommended.

Certain chemotherapy medicines (such as vincristine and platinum chemotherapies such as cisplatin and carboplatin), radiation, and tumors that grow on or near a nerve can affect how nerves function.

Nerves help our bodies move and sense our environment. Neuropathy is when nerves don’t work properly.

Neuropathies can affect how the body moves or feels. This might cause symptoms like numbness, tingling, pain, or trouble walking. It can also affect small tasks like buttoning a shirt or tying shoelaces. Many people who have neuropathy during treatment get better when the treatment is done. But some people have nerve damage that does not get better.

Surgery for some types of cancer can have obvious effects on muscle and bone growth in certain parts of the body. This is most likely with cancers that start in bones (such as osteosarcoma or Ewing tumors) or muscles (such as rhabdomyosarcoma).

Some types of surgeries affect younger children more than they do older children or adults. That is because their bodies are still growing and haven’t fully developed yet. These changes can affect physical function as well as confidence and self-esteem.

Radiation therapy can also affect how bones, muscles, and other tissues grow, especially for people treated at a young age. Radiation can also affect hair growth after treatment. Hair after radiation might be thinner or a different texture.

Learn more about the possible long-term or late side effects of surgery for cancer treatment.

Learn more about the possible long-term or late side effects of radiation for cancer treatment.