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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65927_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65927_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65927_"><span class="title" itemprop="name">Late Effects of Treatment for Childhood Cancer (PDQ®)</span></h1><div class="subtitle whole_rhythm">Patient Version</div><p class="contrib-group"><span itemprop="author">PDQ Pediatric Treatment Editorial Board</span>.</p><p class="small">Published online: June 26, 2015.</p><p class="small">Created: <span itemprop="datePublished">March 24, 2005</span>.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000373791__965">This PDQ cancer information summary has current information about the late effects of treatment for childhood cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p><p id="CDR0000373791__966">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board.</p></div><div id="CDR0000373791__387"><h2 id="_CDR0000373791__387_">General Information about Late Effects</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000373791__485">Late effects are health problems that occur months or years after treatment has ended.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__391">Late effects in childhood cancer survivors affect the body and mind.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__523">There are three important factors that affect the risk of late effects. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__381">The chance of having late effects increases over time.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__27">Regular follow-up care is very important for survivors of childhood cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__526">Good health habits are also important for survivors of childhood cancer.</a></div></li></ul></div><div id="CDR0000373791__485"><h3>Late effects are health problems that occur months or years after treatment has ended.</h3><p id="CDR0000373791__566">The treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> may cause health problems for childhood cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450125/" class="def">survivors</a> months or years after successful treatment has ended. Cancer treatments may harm the body's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a>, or bones and cause health problems later in life. These health problems are called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">late effects</a>. </p><p id="CDR0000373791__956">Treatments that may cause late effects include the following:</p><ul id="CDR0000373791__944"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">Stem cell transplant</a>.</div></li></ul><p id="CDR0000373791__395">Doctors are studying the late effects caused by cancer treatment. They are working to improve cancer treatments and stop or lessen late effects. While most late effects are not life-threatening, they may cause serious problems that affect health and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>.</p></div><div id="CDR0000373791__391"><h3>Late effects in childhood cancer survivors affect the body and mind.</h3><p id="CDR0000373791__520">Late effects in childhood cancer survivors may affect the following:</p><ul id="CDR0000373791__393"><li class="half_rhythm"><div>Organs, tissues, and body function.</div></li><li class="half_rhythm"><div>Growth and development.</div></li><li class="half_rhythm"><div>Mood, feelings, and actions. </div></li><li class="half_rhythm"><div>Thinking, learning, and memory. </div></li><li class="half_rhythm"><div>Social and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454766/" class="def">psychological</a> adjustment.</div></li><li class="half_rhythm"><div>Risk of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046658/" class="def">second cancers</a>.</div></li></ul></div><div id="CDR0000373791__523"><h3>There are three important factors that affect the risk of late effects. </h3><p id="CDR0000373791__533">Many childhood cancer survivors will have late effects. The risk of late effects depends on factors related to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>, treatment, and patient. These include the following:</p><ul id="CDR0000373791__534"><li class="half_rhythm"><div><b>Tumor-related factors</b><dl id="CDR0000373791__535" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Type of cancer.</p></dd><dt>-</dt><dd><p class="no_top_margin">Where the tumor is in the body.</p></dd><dt>-</dt><dd><p class="no_top_margin">How the tumor affects the way tissues and organs work.</p></dd></dl></div></li><li class="half_rhythm"><div><b>Treatment-related factors</b>
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<dl id="CDR0000373791__536" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Type of surgery.</p></dd><dt>-</dt><dd><p class="no_top_margin">Chemotherapy type, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">dose</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346524/" class="def">schedule</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">Type of radiation therapy, part of the body treated, and dose.</p></dd><dt>-</dt><dd><p class="no_top_margin">Stem cell transplant.</p></dd><dt>-</dt><dd><p class="no_top_margin">Use of two or more types of treatment at the same time.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">Blood</a> product <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046001/" class="def">transfusion</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045641/" class="def">Chronic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045703/" class="def">graft-versus-host disease</a>.</p></dd></dl></div></li><li class="half_rhythm"><div><b>Patient-related factors</b><dl id="CDR0000373791__12" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">The child's gender.</p></dd><dt>-</dt><dd><p class="no_top_margin">Health problems the child had before being <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a> with cancer.</p></dd><dt>-</dt><dd><p class="no_top_margin">The child’s age and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450103/" class="def">developmental stage</a> when diagnosed and treated.</p></dd><dt>-</dt><dd><p class="no_top_margin">Length of time since diagnosis and treatment.</p></dd><dt>-</dt><dd><p class="no_top_margin">Changes in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045713/" class="def">hormone</a> levels.</p></dd><dt>-</dt><dd><p class="no_top_margin">The ability of healthy tissue affected by cancer treatment to repair itself.</p></dd><dt>-</dt><dd><p class="no_top_margin">Certain changes in the child's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">genes</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000302456/" class="def">Family history</a> of cancer or other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">Health habits.</p></dd></dl></div></li></ul></div><div id="CDR0000373791__381"><h3>The chance of having late effects increases over time.</h3><p id="CDR0000373791__383">New treatments for childhood cancer have decreased the number of deaths from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary cancer</a>. Because childhood cancer survivors are living longer, they are having more late effects after cancer treatment. Survivors may not live as long as people who did not have cancer. The most common causes of death in childhood cancer survivors are:</p><ul id="CDR0000373791__19"><li class="half_rhythm"><div>The primary cancer comes back.</div></li><li class="half_rhythm"><div>A second (different) primary cancer forms.</div></li><li class="half_rhythm"><div>Heart and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a> damage.</div></li></ul><p id="CDR0000373791__20"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044195/" class="def">Studies</a> of the causes of late effects have led to changes in treatment. This has improved the quality of life for cancer survivors and helps <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439419/" class="def">prevent</a> illness and death from late effects.
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</p></div><div id="CDR0000373791__27"><h3>Regular follow-up care is very important for survivors of childhood cancer.</h3><p id="CDR0000373791__567">Regular <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> by health professionals who are trained to find and treat late effects is important for the long-term health of childhood cancer survivors. Follow-up care will be different for each person who has been treated for cancer. The type of care will depend on the type of cancer, the type of treatment, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046391/" class="def">genetic</a> factors, and the person's general health and health habits. Follow-up care includes checking for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> of late effects and health education on how to prevent or lessen late effects.</p><p id="CDR0000373791__568">It is important that childhood cancer survivors have an exam at least once a year. The exams should be done by a health professional who knows the survivor's risk for late effects and can recognize the early signs of late effects. Blood and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689578/" class="def">imaging tests</a> may also be done.</p><p id="CDR0000373791__32">Long-term follow-up may improve the health and quality of life for cancer survivors. It also helps doctors study the late effects of cancer treatments so that safer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapies</a> for newly diagnosed children may be developed. </p></div><div id="CDR0000373791__526"><h3>Good health habits are also important for survivors of childhood cancer.</h3><p id="CDR0000373791__528">The quality of life for cancer survivors may be improved by behaviors that promote health and well-being. These include a healthy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044660/" class="def">diet</a>, exercise, and regular medical and dental checkups. These self-care behaviors are especially important for cancer survivors because of their risk of health problems related to treatment. Healthy behaviors may make late effects less severe and lower the risk of other diseases.</p><p id="CDR0000373791__529">Avoiding behaviors that are damaging to health is also important. Smoking, excess <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463134/" class="def">alcohol</a> use, illegal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drug</a> use, being exposed to sunlight, or not being physically active may worsen organ damage related to treatment and may increase the risk of second cancers.</p></div></div><div id="CDR0000373791__36"><h2 id="_CDR0000373791__36_">Second Cancers</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000373791__37">Childhood cancer survivors have an increased risk of a second cancer later in life.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__41"> Certain genetic patterns or syndromes may increase the risk of a second cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__542">Patients who have been treated for cancer need regular screening tests to check for a second cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__546">The kind of test used to screen for a second cancer depends in part on the kind of cancer treatment the patient had in the past.</a></div></li></ul></div><div id="CDR0000373791__37"><h3>Childhood cancer survivors have an increased risk of a second cancer later in life.</h3><p id="CDR0000373791__484">A different <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary cancer</a> that occurs at least two months after <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> treatment ends is called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046658/" class="def">second cancer</a>. A second cancer may occur months or years after treatment is completed. The type of second cancer that occurs depends in part on the original type of cancer and the cancer treatment.</p><p id="CDR0000373791__517">Second cancers that occur after cancer treatment include the following:</p><ul id="CDR0000373791__518"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045301/" class="def">Solid tumors</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045266/" class="def">Myelodysplastic syndrome</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046347/" class="def">acute myeloid leukemia</a>.</div></li></ul><p id="CDR0000373791__957">Solid tumors that may appear more than 10 years after primary cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosis</a> and treatment include the following:</p><ul id="CDR0000373791__958"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444971/" class="def">Breast cancer</a> after high-<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">dose</a> chest <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation treatment</a> for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270800/" class="def">Hodgkin lymphoma</a>. Treatment with low-dose chest <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> may also increase breast cancer risk.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445091/" class="def">Thyroid cancer</a> after neck radiation treatment for Hodgkin lymphoma, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046332/" class="def">acute lymphocytic leukemia</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000387264/" class="def">brain tumors</a>; after <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045855/" class="def">radioactive iodine</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a> for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045418/" class="def">neuroblastoma</a>; or after <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045930/" class="def">total-body irradiation</a> (TBI) as part of a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000387264/" class="def">Brain tumors</a> after radiation treatment to the head and/or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046681/" class="def">intrathecal chemotherapy</a> using <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045393/" class="def">methotrexate</a> for a primary brain tumor or for cancer that has spread to the brain or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>, such as acute lymphocytic leukemia or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045148/" class="def">non-Hodgkin lymphoma</a>. When intrathecal chemotherapy using methotrexate and radiation treatment are given together, the risk of a brain tumor is even higher.</div></li><li class="half_rhythm"><div>Bone and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045882/" class="def">soft tissue</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a> after radiation treatment for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046774/" class="def">retinoblastoma</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046031/" class="def">Ewing sarcoma</a>, and other cancers of the bone. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044916/" class="def">anthracyclines</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045589/" class="def">alkylating agents</a> also increases the risk of bone and soft tissue tumors.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445043/" class="def">Lung cancer</a> after radiation treatment to the chest for Hodgkin lymphoma, especially in patients who smoke.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445087/" class="def">Stomach</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044242/" class="def">liver</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444983/" class="def">colorectal cancer</a> after radiation treatment to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>. The risk increases with higher doses of radiation. Treatment with chemotherapy alone or chemotherapy and radiation treatment combined also increases the risk of stomach, liver, or colorectal cancer.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046261/" class="def">Nonmelanoma skin cancer</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046515/" class="def">basal cell carcinoma</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046595/" class="def">squamous cell carcinoma</a>) after radiation treatment; it usually appears in the area where radiation was given. Being exposed to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044472/" class="def">UV radiation</a> may increase this risk. Patients who develop nonmelanoma skin cancer after radiation treatment have an increased chance of developing other types of cancers in the future.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045135/" class="def">Malignant melanoma</a> after radiation or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">combination chemotherapy</a> with alkylating agents and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000306525/" class="def">antimitotic drugs</a> (such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045435/" class="def">vincristine</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000637631/" class="def">vinblastine</a>). <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450125/" class="def">Survivors</a> of Hodgkin lymphoma, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045983/" class="def">hereditary</a> retinoblastoma, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046584/" class="def">soft tissue sarcoma</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046147/" class="def">gonadal</a> tumors are more likely to be at a higher risk of having malignant melanoma. Malignant melanoma as a second cancer is less common after treatment than nonmelanoma skin cancer.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000641672/" class="def">Oral cavity cancer</a> after stem cell transplant and a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642019/" class="def">history</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045641/" class="def">chronic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045703/" class="def">graft-versus-host disease</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444995/" class="def">Kidney cancer</a> after treatment for neuroblastoma, radiation treatment to the middle of the back, or chemotherapy such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045230/" class="def">cisplatin</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045182/" class="def">carboplatin</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444968/" class="def">Bladder cancer</a> after chemotherapy with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045253/" class="def">cyclophosphamide</a>.</div></li></ul><p id="CDR0000373791__959">Myelodysplastic syndrome and acute myeloid leukemia may appear less than 10 years after a primary cancer diagnosis of Hodgkin lymphoma, acute lymphoblastic leukemia, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045562/" class="def">sarcoma</a> and treatment with chemotherapy that included the following:</p><ul id="CDR0000373791__960"><li class="half_rhythm"><div>Alkylating agent such as cyclophosphamide, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045267/" class="def">ifosfamide</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046603/" class="def">mechlorethamine</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045957/" class="def">melphalan</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045410/" class="def">busulfan</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045976/" class="def">carmustine</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046017/" class="def">lomustine</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046048/" class="def">chlorambucil</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045260/" class="def">dacarbazine</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000723879/" class="def">Topoisomerase II inhibitor</a> agent such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045189/" class="def">etoposide</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046766/" class="def">teniposide</a>.</div></li></ul></div><div id="CDR0000373791__41"><h3> Certain genetic patterns or syndromes may increase the risk of a second cancer.</h3><p id="CDR0000373791__43">Some childhood cancer survivors may have an increased risk of developing a second cancer because they have a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000302456/" class="def">family history</a> of cancer or an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045098/" class="def">inherited</a> cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045090/" class="def">syndrome</a> such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046322/" class="def">Li-Fraumeni syndrome</a>. Problems with the way <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045671/" class="def">DNA</a> is repaired in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> and the way anticancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> are used by the body may also affect the risk of second cancers.</p></div><div id="CDR0000373791__542"><h3>Patients who have been treated for cancer need regular screening tests to check for a second cancer.</h3><p id="CDR0000373791__544">It is important for patients who have been treated for cancer to be checked for a second cancer before <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> appear. This is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046171/" class="def">screening</a> for a second cancer and may help find a second cancer at an early <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a>. When <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread.</p><p id="CDR0000373791__545">It is important to remember that your child's doctor does not necessarily think your child has cancer if he or she suggests a screening test. Screening tests are given when your child has no cancer symptoms.
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If a screening test result is abnormal, your child may need to have more tests done to find out if he or she has a second cancer. These are called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045959/" class="def">diagnostic tests</a>.
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</p></div><div id="CDR0000373791__546"><h3>The kind of test used to screen for a second cancer depends in part on the kind of cancer treatment the patient had in the past.</h3><p id="CDR0000373791__548">All patients who have been treated for cancer should have a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689078/" class="def">medical history</a> done once a year. A physical exam of the body is done to check general <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> of health, including checking for signs of disease, such as lumps, changes in the skin, or anything else that seems unusual. A medical history is taken to learn about the patient’s health habits and past illnesses and treatments.</p><p id="CDR0000373791__553">If the patient received radiation therapy, the following tests and procedures may be used to check for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445084/" class="def">skin</a>, breast, or colorectal cancer:</p><ul id="CDR0000373791__554"><li class="half_rhythm"><div><b>Skin exam</b>: A doctor or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269445/" class="def">nurse</a> checks the skin for bumps or spots that look abnormal in color, size, shape, or texture, especially in the area where radiation was given.
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It is suggested that a skin exam be done once a year to check for signs of skin cancer.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304714/" class="def">Breast self-exam</a></b>: An exam of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304766/" class="def">breast</a> by the patient. The patient carefully feels the breasts and under the arms for lumps or anything else that seems unusual. It is suggested that women treated with a higher dose of radiation therapy to the chest do a monthly breast self-exam beginning at <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440113/" class="def">puberty</a> until age 25 years. Women who were treated with a lower dose of radiation to the chest may not need to begin checking for breast cancer at puberty. Talk to your doctor about when you should begin breast self-exams.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304715/" class="def">Clinical breast exam</a> (CBE)</b>: An exam of the breast by a doctor or other health professional. The doctor will carefully feel the breasts and under the arms for lumps or anything else that seems unusual.
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It is suggested that women treated with a higher dose of radiation therapy to the chest have a clinical breast exam every year beginning at puberty until age 25 years. After age 25 years or 8 years after radiation treatments end (whichever is first), clinical breast exams are done every 6 months. Women who were treated with a lower dose of radiation to the chest may not need to begin checking for breast cancer at puberty. Talk to your doctor about when you should begin clinical breast exams.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045775/" class="def">Mammogram</a></b>: An <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a> of the breast. A mammogram may be done in women who had a higher dose of radiation to the chest and who do not have dense breasts.
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It is suggested that these women have a mammogram once a year starting 8 years after treatment or at age 25 years, whichever is later. Talk to your doctor about when you should begin to have mammograms to check for breast cancer.</div></li><li class="half_rhythm"><div><b>Breast <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> (magnetic resonance imaging)</b>: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of the breast. This procedure is also called nuclear magnetic resonance imaging (NMRI). An MRI may be done in women who had a higher dose of radiation to the chest and who have dense breasts. It is suggested that these women have an MRI once a year starting 8 years after treatment or at age 25 years, whichever is later. If you had radiation to the chest, talk to your doctor about whether you need an MRI of the breast to check for breast cancer.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045648/" class="def">Colonoscopy</a></b>: A procedure to look inside the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046462/" class="def">colon</a> for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045844/" class="def">polyps</a>, abnormal areas, or cancer. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046463/" class="def">colonoscope</a> is inserted through the rectum into the colon. A colonoscope is a thin, tube-like instrument with a light and a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000572035/" class="def">lens</a> for viewing. It may also have a tool to remove polyps or tissue samples, which are checked under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> for signs of cancer. It is suggested that childhood cancer survivors who had a higher dose of radiation to the abdomen, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415914/" class="def">spine</a> have a colonoscopy every 5 years. This begins at age 35 years or 10 years after treatment ended, whichever is later. If you had radiation to the abdomen, pelvis, or spine, talk to your doctor about when you should begin to have a colonoscopies to check for colorectal cancer.</div></li></ul></div></div><div id="CDR0000373791__44"><h2 id="_CDR0000373791__44_">Cardiovascular System</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000373791__489">Heart and blood vessel late effects are more likely to occur after treatment for certain childhood cancers.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__120">Radiation to the chest and certain types of chemotherapy increase the risk of heart and blood vessel late effects. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__45">Late effects that affect the heart and blood vessels may cause certain health problems.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__562">Possible signs and symptoms of heart and blood vessel late effects include trouble breathing and chest pain.
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__557">Certain tests and procedures are used to detect (find) and diagnose health problems in the heart and blood vessels.
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__840">Health habits that promote a healthy heart and blood vessels are important for survivors of childhood cancer.</a></div></li></ul></div><div id="CDR0000373791__489"><h3>Heart and blood vessel late effects are more likely to occur after treatment for certain childhood cancers.</h3><p id="CDR0000373791__491">Treatment for these and other childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancers</a> may cause heart and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessel</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">late effects</a>:</p><ul id="CDR0000373791__492"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045586/" class="def">Acute lymphoblastic leukemia</a> (ALL).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046757/" class="def">Acute myelogenous leukemia</a> (AML).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000387264/" class="def">Brain</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257519/" class="def">Head and neck cancer</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270800/" class="def">Hodgkin lymphoma</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045148/" class="def">Non-Hodgkin lymphoma</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045946/" class="def">Wilms tumor</a>.</div></li><li class="half_rhythm"><div>Cancers treated with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a>.</div></li></ul></div><div id="CDR0000373791__120"><h3>Radiation to the chest and certain types of chemotherapy increase the risk of heart and blood vessel late effects. </h3><p id="CDR0000373791__480">The risk of health problems involving the heart and blood vessels increases after treatment with the following:</p><ul id="CDR0000373791__481"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">Radiation</a> to the chest, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415914/" class="def">spine</a>, brain, neck, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046325/" class="def">kidneys</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045930/" class="def">total-body irradiation</a> (TBI) as part of a stem cell transplant. The risk of problems depends on the area of the body that was exposed to radiation, the amount of radiation given, and whether the radiation was given in small or large <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">doses</a>. </div></li><li class="half_rhythm"><div>Certain types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> and the total dose of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044916/" class="def">anthracycline</a> given. Chemotherapy with anthracyclines such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045140/" class="def">doxorubicin</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045261/" class="def">daunorubicin</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045254/" class="def">idarubicin</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045194/" class="def">epirubicin</a>, and with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045595/" class="def">anthraquinones</a> such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045192/" class="def">mitoxantrone</a> increase the risk of heart and blood vessel problems. The risk of problems depends on the total dose of chemotherapy given. It also depends on whether a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drug</a> called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045220/" class="def">dexrazoxane</a> was given during treatment with anthracyclines to lessen heart and blood vessel damage. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045267/" class="def">Ifosfamide</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045393/" class="def">methotrexate</a>, and chemotherapy with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045841/" class="def">platinum</a>, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045182/" class="def">carboplatin</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045230/" class="def">cisplatin</a>, may also cause heart and blood vessel late effects.</div></li><li class="half_rhythm"><div>Stem cell transplant.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046265/" class="def">Nephrectomy</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> to remove all or part of a kidney).</div></li></ul><p id="CDR0000373791__556">Childhood cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450125/" class="def">survivors</a> who were treated with radiation to the heart or blood vessels and certain types of chemotherapy are at greatest risk. </p><p id="CDR0000373791__945">New treatments that decrease the amount of radiation given and use lower doses of chemotherapy may lessen the risk of heart and blood vessel late effects compared with older treatments.</p><p id="CDR0000373791__122">The following may also increase the risk of heart and blood vessel late effects:</p><ul id="CDR0000373791__123"><li class="half_rhythm"><div>Longer time since treatment.</div></li><li class="half_rhythm"><div>Having <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000458091/" class="def">high blood pressure</a> or other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045873/" class="def">risk factors</a> for heart disease, such as a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000302456/" class="def">family history</a> of heart disease, being <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304742/" class="def">overweight</a>, smoking, high <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407756/" class="def">cholesterol</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044911/" class="def">diabetes</a>. When these risk factors are combined, the risk of late effects is even higher. </div></li><li class="half_rhythm"><div>Having lower than normal amounts of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044558/" class="def">thyroid</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000538639/" class="def">growth</a>, or sex <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045713/" class="def">hormones</a>.</div></li></ul></div><div id="CDR0000373791__45"><h3>Late effects that affect the heart and blood vessels may cause certain health problems.</h3><p id="CDR0000373791__479">Childhood cancer survivors who received radiation or certain types of chemotherapy have an increased risk of late effects to the heart and blood vessels and related health problems. These include the following:</p><ul id="CDR0000373791__119"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">Abnormal</a> heartbeat.</div></li><li class="half_rhythm"><div>Weakened heart muscle.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044042/" class="def">Inflamed</a> heart or sac around the heart.</div></li><li class="half_rhythm"><div>Damage to the heart valves.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439400/" class="def">Coronary artery disease</a> (hardening of the heart <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440100/" class="def">arteries</a>).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045143/" class="def">Congestive heart failure</a>.</div></li><li class="half_rhythm"><div>Chest pain or heart attack.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476017/" class="def">Blood clots</a> or one or more <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439425/" class="def">strokes</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000396786/" class="def">Carotid artery</a> disease.</div></li></ul></div><div id="CDR0000373791__562"><h3>Possible signs and symptoms of heart and blood vessel late effects include trouble breathing and chest pain.
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</h3><p id="CDR0000373791__564">These and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may be caused by heart and blood vessel late effects or by other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>:</p><ul id="CDR0000373791__565"><li class="half_rhythm"><div>Trouble breathing, especially when lying down.
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</div></li><li class="half_rhythm"><div>Heartbeat that is too slow, too fast, or different from the heart's normal rhythm.
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</div></li><li class="half_rhythm"><div>Chest pain.</div></li><li class="half_rhythm"><div>Swelling of the feet, ankles, legs, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>.</div></li><li class="half_rhythm"><div>When exposed to cold or having strong emotions, the fingers, toes, ears, or nose become white and then turn blue. When this happens to the fingers, there may also be pain and tingling. </div></li><li class="half_rhythm"><div>Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body).</div></li><li class="half_rhythm"><div>Sudden <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450096/" class="def">confusion</a> or trouble speaking or understanding speech.</div></li><li class="half_rhythm"><div>Sudden trouble seeing with one or both eyes.</div></li><li class="half_rhythm"><div>Sudden trouble walking or feeling dizzy.</div></li><li class="half_rhythm"><div>Sudden loss of balance or coordination.</div></li><li class="half_rhythm"><div>Sudden severe headache for no known reason.</div></li></ul><p id="CDR0000373791__569">Talk to your child's doctor if your child has any of these problems.</p></div><div id="CDR0000373791__557"><h3>Certain tests and procedures are used to detect (find) and diagnose health problems in the heart and blood vessels.
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</h3><p id="CDR0000373791__559">These and other tests and procedures may be used to detect or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> heart and blood vessel late effects:
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</p><ul id="CDR0000373791__560"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689078/" class="def">history</a></b>: An exam of the body to check general signs of health, including checking the heart for signs of disease, such as abnormal heart beat, high blood pressure, or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
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</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000635410/" class="def">Electrocardiogram</a> (EKG)</b>: A recording of the heart's electrical activity to check its rate and rhythm. A number of small pads (electrodes) are placed on the patient’s chest, arms, and legs, and are connected by wires to the EKG machine. Heart activity is then recorded as a line graph on paper. Electrical activity that is faster or slower than normal may be a sign of heart disease or damage.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046032/" class="def">Echocardiogram</a></b>: A procedure in which high-energy sound waves (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046157/" class="def">ultrasound</a>) are bounced off the heart and nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> and make echoes. A moving picture is made of the heart and heart valves as blood is pumped through the heart.</div></li><li class="half_rhythm"><div><b>Ultrasound exam</b>: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs such as the heart and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
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</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046068/" class="def">Lipid</a> profile studies</b>: A procedure in which a blood sample is checked to measure the amounts of triglycerides, cholesterol, and low- and high-density lipoprotein cholesterol
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in the blood.</div></li></ul><p id="CDR0000373791__570">Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of heart and blood vessel late effects. If tests are needed, find out how often they should be done.</p></div><div id="CDR0000373791__840"><h3>Health habits that promote a healthy heart and blood vessels are important for survivors of childhood cancer.</h3><p id="CDR0000373791__842">Childhood cancer survivors with heart and blood vessel late effects should take care to protect their health, including:</p><ul id="CDR0000373791__843"><li class="half_rhythm"><div>Having a healthy weight.</div></li><li class="half_rhythm"><div>Eating a heart-healthy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044660/" class="def">diet</a>.</div></li><li class="half_rhythm"><div>Having regular exercise.</div></li><li class="half_rhythm"><div>Talking to their doctor before starting an intense exercise program.</div></li><li class="half_rhythm"><div>Not smoking.</div></li></ul></div></div><div id="CDR0000373791__493"><h2 id="_CDR0000373791__493_">Central Nervous System</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000373791__503">Brain and spinal cord late effects are more likely to occur after treatment for certain childhood cancers.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__499">Radiation to the brain increases the risk of brain and spinal cord late effects.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__494">Late effects that affect the brain and spinal cord may cause certain health problems.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__574">Possible signs and symptoms of brain and spinal cord late effects include headaches, loss of coordination, and seizures.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__580">Certain tests and procedures are used to detect (find) and diagnose health problems in the brain and spinal cord.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__507">Survivors of childhood cancer may have anxiety and depression related to their cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__510">Some childhood cancer survivors have post-traumatic stress disorder.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__844">Teenagers who are diagnosed with cancer may have social problems later in life.</a></div></li></ul></div><div id="CDR0000373791__503"><h3>Brain and spinal cord late effects are more likely to occur after treatment for certain childhood cancers.</h3><p id="CDR0000373791__505">Treatment for these and other childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancers</a> may cause brain and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">late effects</a>:</p><ul id="CDR0000373791__506"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045586/" class="def">Acute lymphoblastic leukemia</a> (ALL).</div></li><li class="half_rhythm"><div>Brain and spinal cord <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257519/" class="def">Head and neck cancers</a>.</div></li></ul></div><div id="CDR0000373791__499"><h3>Radiation to the brain increases the risk of brain and spinal cord late effects.</h3><p id="CDR0000373791__501">The risk of health problems that affect the brain or spinal cord increases after treatment with the following:</p><ul id="CDR0000373791__502"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">Radiation</a> to the brain or spinal cord, especially <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440106/" class="def">high doses of radiation</a>. This includes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045930/" class="def">total-body irradiation</a> given as part of a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046681/" class="def">Intrathecal</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046144/" class="def">intraventricular</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>.</div></li><li class="half_rhythm"><div>Chemotherapy with high-dose <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045393/" class="def">methotrexate</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045155/" class="def">cytarabine</a> that can cross the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046504/" class="def">blood-brain barrier</a> (protective lining around the brain). This includes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346522/" class="def">high-dose chemotherapy</a> given as part of a stem cell transplant.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> to remove a tumor on the brain or spinal cord.</div></li></ul><p id="CDR0000373791__573">When radiation to the brain and intrathecal chemotherapy are given at the same time, the risk of late effects is higher.</p><p id="CDR0000373791__571">The following may also increase the risk of brain and spinal cord late effects:</p><ul id="CDR0000373791__572"><li class="half_rhythm"><div>Being about 5 years old or younger at the time of treatment. </div></li><li class="half_rhythm"><div>Being female.</div></li><li class="half_rhythm"><div>Having <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045498/" class="def">hydrocephalus</a> and a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046579/" class="def">shunt</a> placed to removed the extra <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045939/" class="def">ventricles</a>.</div></li><li class="half_rhythm"><div>Having hearing loss.</div></li><li class="half_rhythm"><div>Having <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000691342/" class="def">cerebellar mutism</a> following surgery to remove the brain tumor. Cerebellar mutism includes not being able to speak, loss of coordination and balance, mood swings, being irritable, and having a high-pitched cry.</div></li><li class="half_rhythm"><div>Having a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642021/" class="def">personal history</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439425/" class="def">stroke</a>.</div></li></ul><p id="CDR0000373791__961"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046481/" class="def">Central nervous system</a> late effects are also affected by where the tumor has formed in the brain and spinal cord.</p></div><div id="CDR0000373791__494"><h3>Late effects that affect the brain and spinal cord may cause certain health problems.</h3><p id="CDR0000373791__496">Childhood cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450125/" class="def">survivors</a> who received radiation, certain types of chemotherapy, or surgery to the brain or spinal cord have an increased risk of late effects to the brain and spinal cord and related health problems. These include the following:
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</p><ul id="CDR0000373791__497"><li class="half_rhythm"><div>Headaches.</div></li><li class="half_rhythm"><div>Loss of coordination and balance.</div></li><li class="half_rhythm"><div>Seizures.</div></li><li class="half_rhythm"><div>Loss of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046276/" class="def">myelin</a> sheath that covers <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373935/" class="def">nerve</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046401/" class="def">fibers</a> in the brain.</div></li><li class="half_rhythm"><div>Movement <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407758/" class="def">disorders</a> that affect the legs and eyes or the ability to speak and swallow.</div></li><li class="half_rhythm"><div>Nerve damage in the hands or feet.</div></li><li class="half_rhythm"><div>Stroke.</div></li><li class="half_rhythm"><div>Hydrocephalus.</div></li><li class="half_rhythm"><div>Loss of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046501/" class="def">bladder</a> and/or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046500/" class="def">bowel</a> control.</div></li><li class="half_rhythm"><div>Cavernomas (clusters of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a>).</div></li></ul><p id="CDR0000373791__498">Survivors may also have late effects that affect thinking, learning, memory, emotions, and behavior. </p><p id="CDR0000373791__921">New ways of using more targeted and lower <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">doses</a> of radiation to the brain may lessen the risk of brain and spinal cord late effects.</p></div><div id="CDR0000373791__574"><h3>Possible signs and symptoms of brain and spinal cord late effects include headaches, loss of coordination, and seizures.</h3><p id="CDR0000373791__576">These <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may be caused by brain and spinal cord late effects or by other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>:
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</p><ul id="CDR0000373791__577"><li class="half_rhythm"><div>Headache that may go away after <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390324/" class="def">vomiting</a>.</div></li><li class="half_rhythm"><div>Seizures.</div></li><li class="half_rhythm"><div>Loss of balance, lack of coordination, or trouble walking.</div></li><li class="half_rhythm"><div>Trouble speaking or swallowing.</div></li><li class="half_rhythm"><div>Trouble with having the eyes work together.</div></li><li class="half_rhythm"><div>Numbness, tingling, or weakness in the hands or feet.</div></li><li class="half_rhythm"><div>Being unable to bend the ankle to lift the foot up.</div></li><li class="half_rhythm"><div>Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body).</div></li><li class="half_rhythm"><div>Unusual sleepiness or change in activity level.</div></li><li class="half_rhythm"><div>Unusual changes in personality or behavior.</div></li><li class="half_rhythm"><div>A change in bowel habits or trouble <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046642/" class="def">urinating</a>.</div></li><li class="half_rhythm"><div>Increase in head size (in infants).
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</div></li><li class="half_rhythm"><div>Sudden <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450096/" class="def">confusion</a> or trouble speaking or understanding speech.</div></li><li class="half_rhythm"><div>Sudden trouble seeing with one or both eyes.</div></li><li class="half_rhythm"><div>Sudden severe headache for no known reason.
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</div></li></ul><p id="CDR0000373791__578">Other signs and symptoms include the following:</p><ul id="CDR0000373791__579"><li class="half_rhythm"><div>Problems with memory.</div></li><li class="half_rhythm"><div>Problems with paying attention.</div></li><li class="half_rhythm"><div>Trouble with solving problems.</div></li><li class="half_rhythm"><div>Trouble with organizing thoughts and tasks.</div></li><li class="half_rhythm"><div>Slower ability to learn and use new information.</div></li><li class="half_rhythm"><div>Trouble learning to read, write, or do math.</div></li><li class="half_rhythm"><div>Trouble coordinating movement between the eyes, hands, and other muscles.</div></li><li class="half_rhythm"><div>Delays in normal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450103/" class="def">development</a>.</div></li><li class="half_rhythm"><div>Social withdrawal or trouble getting along with others.</div></li></ul><p id="CDR0000373791__778">Talk to your child's doctor if your child has any of these problems.</p></div><div id="CDR0000373791__580"><h3>Certain tests and procedures are used to detect (find) and diagnose health problems in the brain and spinal cord.</h3><p id="CDR0000373791__582">These and other tests and procedures may be used to detect or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> brain and spinal cord late effects:
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</p><ul id="CDR0000373791__583"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689078/" class="def">history</a></b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322871/" class="def">Neurological exam</a></b>: A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks a person’s mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam.
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In some cases, a more complete exam may be done by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046267/" class="def">neurologist</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046269/" class="def">neurosurgeon</a>.</div></li><li class="half_rhythm"><div><b>Neuropsychological <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430407/" class="def">assessment</a></b>: A series of tests to examine the patient's mental processes and behavior. Areas that are checked usually include:
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<dl id="CDR0000373791__584" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Knowing who and where you are and what day it is.</p></dd><dt>-</dt><dd><p class="no_top_margin">Ability to learn and remember new information. </p></dd><dt>-</dt><dd><p class="no_top_margin">Intelligence.</p></dd><dt>-</dt><dd><p class="no_top_margin">Ability to solve problems.</p></dd><dt>-</dt><dd><p class="no_top_margin">Use of spoken and written language.</p></dd><dt>-</dt><dd><p class="no_top_margin">Eye-hand coordination.</p></dd><dt>-</dt><dd><p class="no_top_margin">Ability to organize information and tasks.</p></dd></dl></div></li></ul><p id="CDR0000373791__787">Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of brain and spinal cord late effects. If tests are needed, find out how often they should be done.
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</p></div><div id="CDR0000373791__507"><h3>Survivors of childhood cancer may have anxiety and depression related to their cancer.</h3><p id="CDR0000373791__509">Survivors of childhood cancer may have <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430405/" class="def">anxiety</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430479/" class="def">depression</a> related to physical changes, having pain, the way they look, or the fear of cancer coming back. This may cause problems with personal relationships, education, employment, and health, and cause thoughts of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450124/" class="def">suicide</a>. Survivors with these problems may be less likely to live on their own as adults.</p><p id="CDR0000373791__868">Follow-up exams for childhood cancer survivors should include <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046171/" class="def">screening</a> and treatment for possible <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454766/" class="def">psychological</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454701/" class="def">distress</a>, such as anxiety, depression, and thoughts of suicide.</p></div><div id="CDR0000373791__510"><h3>Some childhood cancer survivors have post-traumatic stress disorder.</h3><p id="CDR0000373791__512">Being diagnosed and treated for a life-threatening disease may be traumatic. This <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454807/" class="def">trauma</a> may cause <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440112/" class="def">post-traumatic stress disorder</a> (PTSD). PTSD is defined as having certain behaviors following a stressful event that involved death or the threat of death, serious injury, or a threat to oneself or others. </p><p id="CDR0000373791__514">PTSD can affect cancer survivors in the following ways:</p><ul id="CDR0000373791__515"><li class="half_rhythm"><div>Reliving the time they were diagnosed and treated for cancer, in nightmares or flashbacks, and thinking about it all the time.
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</div></li><li class="half_rhythm"><div>Avoiding places, events, and people that remind them of the cancer experience. </div></li></ul><p id="CDR0000373791__513">In general, childhood cancer survivors show low levels of PTSD, depending in part on the coping style of patients and their parents. Survivors who received <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> to the head when younger than 4 years or survivors who received intensive treatment may be at higher risk of PTSD. Family problems, little or no <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440116/" class="def">social support</a> from family or friends, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450122/" class="def">stress</a> not related to the cancer may increase the chances of having PTSD. </p><p id="CDR0000373791__516">Because avoiding places and persons connected to the cancer may be part of PTSD, survivors with PTSD may not get the medical treatment they need.</p></div><div id="CDR0000373791__844"><h3>Teenagers who are diagnosed with cancer may have social problems later in life.</h3><p id="CDR0000373791__846">Teenagers who are diagnosed with cancer may reach fewer social milestones or reach them later in life than teenagers not diagnosed with cancer. Social milestones include having a first boyfriend or girlfriend, getting married, and having a child. They may also have trouble getting along with other people or feel like they are not liked by others their age.</p><p id="CDR0000373791__869"> Cancer survivors in this age group have reported being less satisfied with their health and their lives in general compared with others of the same age who did not have cancer. Teenagers and young adults who have survived cancer need special programs that give psychological, educational, and job support.</p></div></div><div id="CDR0000373791__152"><h2 id="_CDR0000373791__152_">Digestive System</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000373791__153">Teeth and jaws</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__169">Digestive tract</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__182">Liver and bile ducts</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__893">Pancreas</a></div></li></ul></div><div id="CDR0000373791__153"><h3>Teeth and jaws</h3><div id="CDR0000373791__585"><h4>Problems with the teeth and jaws are late effects that are more likely to occur after treatment for certain childhood cancers.</h4><p id="CDR0000373791__587">Treatment for these and other childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancers</a> may cause the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">late effect</a> of problems with teeth and jaws:</p><ul id="CDR0000373791__588"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257519/" class="def">Head and neck cancers</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270800/" class="def">Hodgkin lymphoma</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045343/" class="def">Leukemia</a> that spread to the brain and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445072/" class="def">Nasopharyngeal cancer</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045418/" class="def">Neuroblastoma</a>.</div></li><li class="half_rhythm"><div>Cancers treated with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a>.</div></li></ul></div><div id="CDR0000373791__159"><h4>Radiation to the head and neck and certain types of chemotherapy increase the risk of late effects to the teeth and jaws.</h4><p id="CDR0000373791__161">The risk of health problems that affect the teeth and jaws increases after treatment with the following:</p><ul id="CDR0000373791__162"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> to the head and neck.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045930/" class="def">Total-body irradiation</a> (TBI) as part of a stem cell transplant.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a>, especially with higher <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">doses</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045589/" class="def">alkylating agents</a> such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045253/" class="def">cyclophosphamide</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> in the head and neck area.</div></li></ul><p id="CDR0000373791__163">Risk is also increased in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450125/" class="def">survivors</a> who were younger than 5 years at the time of treatment because their permanent teeth had not fully formed.
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</p></div><div id="CDR0000373791__155"><h4>Late effects that affect the teeth and jaws may cause certain health problems.</h4><p id="CDR0000373791__157">Teeth and jaw late effects and related health problems include the following:
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</p><ul id="CDR0000373791__158"><li class="half_rhythm"><div>Teeth that are not normal.</div></li><li class="half_rhythm"><div>Tooth decay (including <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavities</a>) and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000481753/" class="def">gum</a> disease. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046196/" class="def">Salivary glands</a> do not make enough <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257526/" class="def">saliva</a>.</div></li><li class="half_rhythm"><div>Death of the bone <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> in the jaw.</div></li><li class="half_rhythm"><div>Changes in the way the face, jaw, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000763008/" class="def">skull</a> form.</div></li></ul></div><div id="CDR0000373791__599"><h4>Possible signs and symptoms of late effects of the teeth and jaws include tooth decay (cavities) and jaw pain.</h4><p id="CDR0000373791__601">These and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may be caused by late effects of the teeth and jaws or by other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>:</p><ul id="CDR0000373791__602"><li class="half_rhythm"><div>Teeth are small or do not have a normal shape.</div></li><li class="half_rhythm"><div>Missing permanent teeth.</div></li><li class="half_rhythm"><div>Permanent teeth come in at a later than normal age.</div></li><li class="half_rhythm"><div>Teeth have less enamel than normal.</div></li><li class="half_rhythm"><div>More tooth decay (cavities) and gum disease than normal.</div></li><li class="half_rhythm"><div>Dry mouth.</div></li><li class="half_rhythm"><div>Trouble chewing, swallowing, and speaking.</div></li><li class="half_rhythm"><div>Jaw pain.</div></li><li class="half_rhythm"><div>Jaws do not open and close the way they should.</div></li></ul><p id="CDR0000373791__779">Talk to your child's doctor if your child has any of these problems.</p></div><div id="CDR0000373791__592"><h4>Certain tests and procedures are used to detect (find) and diagnose health problems in the mouth and jaws.</h4><p id="CDR0000373791__594">These and other tests and procedures may be used to detect or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> late effects of the teeth and jaws:</p><ul id="CDR0000373791__595"><li class="half_rhythm"><div><b>Dental exam and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689078/" class="def">history</a></b>: An exam of the teeth, mouth, and jaws to check general signs of dental health, including checking for signs of disease, such as cavities or anything that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
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This may also be called a dental check-up.</div></li><li class="half_rhythm"><div><b>Panorex <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a></b>: An x-ray of all of the teeth and their roots. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.</div></li><li class="half_rhythm"><div><b>X-ray of the jaws</b>: An x-ray of the jaws. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> (CAT scan)</b>: A procedure that makes a series of detailed pictures of areas inside the body, such as the head and neck, taken from different angles. The pictures are made by a computer linked to an x-ray machine. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> (magnetic resonance imaging)</b>: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the head and neck. This procedure is also called nuclear magnetic resonance imaging (NMRI). </div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">Biopsy</a></b>: The removal of bone cells from the jaw so they can be viewed under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> to check for signs of bone death after radiation therapy.</div></li></ul><p id="CDR0000373791__788">Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of teeth and jaw late effects. If tests are needed, find out how often they should be done.
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</p></div><div id="CDR0000373791__596"><h4>Regular dental care is very important for survivors of childhood cancer.</h4><p id="CDR0000373791__598">Doctors suggest that survivors of childhood cancer have a dental check-up and a cleaning and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044670/" class="def">fluoride</a> treatment every 6 months. Children who had radiation therapy to the oral cavity may also see an orthodontist.</p></div></div><div id="CDR0000373791__169"><h3>Digestive tract</h3><div id="CDR0000373791__603"><h4>Digestive tract late effects are more likely to occur after treatment for certain childhood cancers.</h4><p id="CDR0000373791__605">Treatment for these and other childhood cancers may cause late effects of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046447/" class="def">digestive tract</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046408/" class="def">esophagus</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046604/" class="def">stomach</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046582/" class="def">small</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045097/" class="def">large intestines</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046523/" class="def">anus</a>):
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</p><ul id="CDR0000373791__606"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045872/" class="def">Rhabdomyosarcoma</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046501/" class="def">bladder</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046539/" class="def">prostate</a>, or near the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046611/" class="def">testicles</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045148/" class="def">Non-Hodgkin lymphoma</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045695/" class="def">Germ cell tumors</a>.</div></li><li class="half_rhythm"><div>Neuroblastoma.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045946/" class="def">Wilms tumor</a>.</div></li></ul></div><div id="CDR0000373791__607"><h4>Radiation to the bladder, prostate, or testicles and certain types of chemotherapy increase the risk of digestive tract late effects.</h4><p id="CDR0000373791__609">The risk of health problems that affect the digestive tract increases after treatment with the following:</p><ul id="CDR0000373791__610"><li class="half_rhythm"><div>Radiation therapy to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> or areas near the abdomen, such as the esophagus, bladder, prostate, or testicles, may cause digestive tract problems that begin quickly and last for a short time. In some patients, however, digestive tract problems are delayed and long-lasting. These late effects are caused by radiation therapy that damages the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a>. Receiving higher doses of radiation therapy or receiving chemotherapy such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045237/" class="def">dactinomycin</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044916/" class="def">anthracyclines</a> together with radiation therapy may increase this risk.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046684/" class="def">Abdominal</a> surgery or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045087/" class="def">pelvic</a> surgery to remove the bladder.</div></li><li class="half_rhythm"><div>Chemotherapy with alkylating agents such as cyclophosphamide, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045378/" class="def">procarbazine</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045267/" class="def">ifosfamide</a>, or with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045841/" class="def">platinum</a> agents such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045230/" class="def">cisplatin</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045182/" class="def">carboplatin</a>, or with anthracyclines such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045140/" class="def">doxorubicin</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045261/" class="def">daunorubicin</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045254/" class="def">idarubicin</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045194/" class="def">epirubicin</a>.</div></li><li class="half_rhythm"><div>Stem cell transplant.</div></li></ul><p id="CDR0000373791__832">The following may also increase the risk of digestive tract late effects:</p><ul id="CDR0000373791__833"><li class="half_rhythm"><div>Older age at diagnosis or when treatment begins.</div></li><li class="half_rhythm"><div>Treatment with both radiation therapy and chemotherapy.</div></li><li class="half_rhythm"><div>A history of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045641/" class="def">chronic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045703/" class="def">graft-versus-host disease</a>.</div></li></ul></div><div id="CDR0000373791__171"><h4>Late effects that affect the digestive tract may cause certain health problems.</h4><p id="CDR0000373791__173">Digestive tract late effects and related health problems include the following:</p><ul id="CDR0000373791__174"><li class="half_rhythm"><div>A narrowing of the esophagus or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046335/" class="def">intestine</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000306496/" class="def">Diarrhea</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407757/" class="def">constipation</a>, or blocked <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046500/" class="def">bowel</a>.</div></li><li class="half_rhythm"><div>Bowel perforation (a hole in the intestine).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044042/" class="def">Inflammation</a> of the intestines.</div></li><li class="half_rhythm"><div>Death of part of the intestine.</div></li><li class="half_rhythm"><div>Intestine is not able to absorb <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044697/" class="def">nutrients</a> from food.</div></li></ul></div><div id="CDR0000373791__611"><h4>Possible signs and symptoms of digestive tract late effects include abdominal pain and diarrhea.</h4><p id="CDR0000373791__613">These and other signs and symptoms may be caused by digestive tract late effects or by other conditions:</p><ul id="CDR0000373791__614"><li class="half_rhythm"><div>Trouble swallowing or feeling like food is stuck in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439429/" class="def">throat</a>.</div></li><li class="half_rhythm"><div>Heartburn.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450108/" class="def">Fever</a> with severe pain in the abdomen and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390302/" class="def">nausea</a>.</div></li><li class="half_rhythm"><div>Pain in the abdomen.</div></li><li class="half_rhythm"><div>A change in bowel habits (constipation or diarrhea).</div></li><li class="half_rhythm"><div>Nausea and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390324/" class="def">vomiting</a>.</div></li><li class="half_rhythm"><div>Frequent gas pains, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476585/" class="def">bloating</a>, fullness, or cramps.
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044207/" class="def">Hemorrhoids</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046558/" class="def">Reflux</a>.</div></li></ul><p id="CDR0000373791__780">Talk to your child's doctor if your child has any of these problems.</p></div><div id="CDR0000373791__615"><h4>Certain tests and procedures are used to detect (find) and diagnose health problems in the digestive tract.</h4><p id="CDR0000373791__617">These and other tests and procedures may be used to detect or diagnose digestive tract late effects:</p><ul id="CDR0000373791__618"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and history</b>: An exam of the body to check general signs of health, including checking for signs of disease, such as abdominal tenderness or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045668/" class="def">Digital rectal exam</a></b>: An exam of the rectum. The doctor or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269445/" class="def">nurse</a> inserts a lubricated, gloved finger into the rectum to feel for lumps or anything else that seems unusual.
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</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304685/" class="def">Blood chemistry studies</a></b>: A procedure in which a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> sample is checked to measure the amounts of certain substances released into the blood by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.</div></li><li class="half_rhythm"><div><b>X-ray</b>: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. An x-ray may be taken of the abdomen, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046325/" class="def">kidney</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046638/" class="def">ureter</a>, or bladder to check for signs of disease.</div></li></ul><p id="CDR0000373791__789">Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of digestive tract late effects. If tests are needed, find out how often they should be done.
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</p></div></div><div id="CDR0000373791__182"><h3>Liver and bile ducts</h3><div id="CDR0000373791__619"><h4>Liver and bile duct late effects are more likely to occur after treatment for certain childhood cancers.</h4><p id="CDR0000373791__621">Treatment for these and other childhood cancers may cause <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046738/" class="def">bile duct</a> late effects:
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</p><ul id="CDR0000373791__622"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044242/" class="def">Liver cancer</a>.</div></li><li class="half_rhythm"><div>Wilms tumor.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045586/" class="def">Acute lymphoblastic leukemia</a> (ALL).</div></li><li class="half_rhythm"><div>Cancers treated with a stem cell transplant.</div></li></ul></div><div id="CDR0000373791__623"><h4>Certain types of chemotherapy and radiation to the liver or bile ducts increase the risk of late effects.</h4><p id="CDR0000373791__625">The risk of liver or bile duct late effects may be increased in childhood cancer survivors treated with one of the following:</p><ul id="CDR0000373791__626"><li class="half_rhythm"><div>Surgery to remove part of the liver or a liver <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046631/" class="def">transplant</a>.</div></li><li class="half_rhythm"><div>Chemotherapy that includes high-dose cyclophosphamide as part of a stem cell transplant.</div></li><li class="half_rhythm"><div>Chemotherapy such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046639/" class="def">6-mercaptopurine</a>, 6-<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046765/" class="def">thioguanine</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045393/" class="def">methotrexate</a>.</div></li><li class="half_rhythm"><div>Radiation therapy to the liver and bile ducts. The risk depends on the following:<dl id="CDR0000373791__627" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">The dose of radiation and how much of the liver is treated.</p></dd><dt>-</dt><dd><p class="no_top_margin">Age when treated (the younger the age, the higher the risk).</p></dd><dt>-</dt><dd><p class="no_top_margin">Whether there was surgery to remove part of the liver.</p></dd><dt>-</dt><dd><p class="no_top_margin">Whether chemotherapy, such as doxorubicin or dactinomycin, was given together with radiation therapy.</p></dd></dl></div></li><li class="half_rhythm"><div>Stem cell transplant (and a history of chronic graft-versus-host disease).</div></li></ul></div><div id="CDR0000373791__184"><h4>Late effects that affect the liver and bile ducts may cause certain health problems.
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</h4><p id="CDR0000373791__186">Liver and bile duct late effects and related health problems include the following:</p><ul id="CDR0000373791__187"><li class="half_rhythm"><div>Liver doesn’t work the way it should or stops working.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322135/" class="def">Gallstones</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045614/" class="def">Benign</a> liver lesions.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046146/" class="def">Hepatitis B</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044139/" class="def">C</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a>.</div></li><li class="half_rhythm"><div>Liver damage caused by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044806/" class="def">veno-occlusive disease</a>/<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000723872/" class="def">sinusoidal obstruction syndrome</a> (VOD/SOS). </div></li><li class="half_rhythm"><div>Liver <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045690/" class="def">fibrosis</a> (an overgrowth of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044013/" class="def">connective tissue</a> in the liver) or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045478/" class="def">cirrhosis</a>.</div></li><li class="half_rhythm"><div>Fatty liver with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046187/" class="def">insulin</a> resistance (a condition in which the body makes insulin but cannot use it well). </div></li><li class="half_rhythm"><div>Tissue and organ damage from the buildup of extra <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446805/" class="def">iron</a> after having many <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045991/" class="def">blood transfusions</a>.</div></li></ul></div><div id="CDR0000373791__629"><h4>Possible signs and symptoms of liver and bile duct late effects include abdominal pain and jaundice.</h4><p id="CDR0000373791__631"> These and other signs and symptoms may be caused by liver and bile duct late effects or by other conditions:
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</p><ul id="CDR0000373791__632"><li class="half_rhythm"><div>Weight gain or weight loss.</div></li><li class="half_rhythm"><div>Swelling of the abdomen.</div></li><li class="half_rhythm"><div>Nausea and vomiting.</div></li><li class="half_rhythm"><div>Pain in the abdomen. Pain may occur near the ribs, often on the right side, or after eating a fatty meal.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046328/" class="def">Jaundice</a> (yellowing of the skin and whites of the eyes).
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</div></li><li class="half_rhythm"><div>Light-colored bowel movements.</div></li><li class="half_rhythm"><div>Dark-colored <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046642/" class="def">urine</a>.</div></li><li class="half_rhythm"><div>A lot of gas.</div></li><li class="half_rhythm"><div>Lack of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454699/" class="def">appetite</a>.</div></li><li class="half_rhythm"><div>Feeling tired or weak.</div></li></ul><p id="CDR0000373791__781">Talk to your child's doctor if your child has any of these problems.</p><p id="CDR0000373791__934">Sometimes there are no signs or symptoms of liver or bile duct late effects and treatment may not be needed.</p></div><div id="CDR0000373791__633"><h4>Certain tests and procedures are used to detect (find) and diagnose health problems in the liver and bile duct.</h4><p id="CDR0000373791__635">These and other tests and procedures may be used to detect or diagnose liver or bile duct late effects:
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</p><ul id="CDR0000373791__636"><li class="half_rhythm"><div><b>Physical exam and history</b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.</div></li><li class="half_rhythm"><div><b>Blood chemistry studies</b>: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease For example, there may be a higher level of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044518/" class="def">bilirubin</a> in the body if the liver has been damaged.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000687214/" class="def">Ferritin</a> level</b>: A procedure in which a blood sample is checked to measure the amount of ferritin. Ferritin is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">protein</a> that binds to iron and stores it for use by the body. After a stem cell transplant, a high ferritin level may be a sign of liver disease.</div></li><li class="half_rhythm"><div><b>Blood studies to check how well the blood clots</b>: A procedure in which a blood sample is checked to measure the amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045840/" class="def">platelets</a> in the body or how long it takes for the blood to clot.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046371/" class="def">Hepatitis</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044528/" class="def">assay</a></b>: A procedure in which a blood sample is checked for pieces of the hepatitis <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045941/" class="def">virus</a>. The blood sample may also be used to measure how much hepatitis virus is in the blood. All patients who had a blood transfusion before 1972 should have a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046171/" class="def">screening</a> test for hepatitis B. Patients who had a blood transfusion before 1993 should have a screening test for hepatitis C.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046157/" class="def">Ultrasound</a> exam</b>: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs, such as the gall bladder, and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
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</div></li><li class="half_rhythm"><div><b>Biopsy</b>: The removal of cells or tissues from the liver so they can be viewed under a microscope to check for signs of a fatty liver.</div></li></ul><p id="CDR0000373791__790">Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of liver or bile duct late effects. If tests are needed, find out how often they should be done.
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</p></div><div id="CDR0000373791__638"><h4>Health habits that promote a healthy liver are important for survivors of childhood cancer. </h4><p id="CDR0000373791__640">Childhood cancer survivors with liver late effects should take care to protect their health, including:</p><ul id="CDR0000373791__641"><li class="half_rhythm"><div>Having a healthy weight.</div></li><li class="half_rhythm"><div>Not drinking <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463134/" class="def">alcohol</a>.</div></li><li class="half_rhythm"><div>Getting <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045938/" class="def">vaccines</a> for hepatitis A and hepatitis B viruses.</div></li></ul></div></div><div id="CDR0000373791__893"><h3>Pancreas</h3><div id="CDR0000373791__896"><h4>Radiation therapy increases the risk of pancreatic late effects.</h4><p id="CDR0000373791__909">The risk of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044074/" class="def">pancreatic</a> late effects may be increased in childhood cancer survivors after treatment with one of the following:
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</p><ul id="CDR0000373791__910"><li class="half_rhythm"><div>Radiation therapy to the abdomen.</div></li><li class="half_rhythm"><div>Total-body irradiation (TBI) as part of a stem cell transplant.</div></li></ul></div><div id="CDR0000373791__897"><h4>Late effects that affect the pancreas may cause certain health problems.</h4><p id="CDR0000373791__912">Pancreatic late effects and related health problems include the following:</p><ul id="CDR0000373791__898"><li class="half_rhythm"><div><b>Insulin resistance</b>: A condition in which the body does not use insulin the way it should. Insulin is needed to help control the amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044033/" class="def">glucose</a> (a type of sugar) in the body. Because the insulin does not work the way it should, glucose and fat levels rise.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044129/" class="def">Diabetes mellitus</a></b>: A disease in which the body does not make enough insulin or does not use it the way it should. When there is not enough insulin, the amount of glucose in the blood increases and the kidneys make a large amount of urine.</div></li></ul></div><div id="CDR0000373791__899"><h4>Possible signs and symptoms of pancreatic late effects include frequent urination and being thirsty.</h4><p id="CDR0000373791__913">These and other signs and symptoms may be caused by pancreatic late effects or by other conditions:
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</p><ul id="CDR0000373791__914"><li class="half_rhythm"><div>Frequent urination.</div></li><li class="half_rhythm"><div>Feeling very thirsty.</div></li><li class="half_rhythm"><div>Feeling very hungry.</div></li><li class="half_rhythm"><div>Weight loss for no known reason.</div></li><li class="half_rhythm"><div>Feeling very tired.</div></li><li class="half_rhythm"><div>Frequent infections, especially of the skin, gums, or bladder.</div></li><li class="half_rhythm"><div>Blurred vision.</div></li><li class="half_rhythm"><div>Cuts or bruises that are slow to heal.</div></li><li class="half_rhythm"><div>Numbness or tingling in the hands or feet.</div></li></ul><p id="CDR0000373791__915">Talk to your child's doctor if your child has any of these problems.</p></div><div id="CDR0000373791__900"><h4>Certain tests and procedures are used to detect (find) and diagnose health problems in the pancreas.</h4><p id="CDR0000373791__916">These and other tests and procedures may be used to detect or diagnose pancreatic late effects:</p><ul id="CDR0000373791__917"><li class="half_rhythm"><div><b>Glycated <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045108/" class="def">hemoglobin</a> (A1C) test</b>: A procedure in which a sample of blood is drawn and the amount of glucose that is attached to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046124/" class="def">red blood cells</a> is measured. A higher than normal amount of glucose attached to red blood cells can be a sign of diabetes mellitus. </div></li><li class="half_rhythm"><div><b>Fasting blood sugar test</b>: A test in which a blood sample is checked to measure the amount of glucose in the blood. This test is done after the patient has had nothing to eat overnight. A higher than normal amount of glucose in the blood can be a sign of diabetes mellitus. </div></li></ul></div></div></div><div id="CDR0000373791__198"><h2 id="_CDR0000373791__198_">Endocrine System</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000373791__870">Thyroid gland</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__430">Pituitary gland</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__877">Testicles and ovaries</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__847">Metabolic syndrome</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__885">Obesity and body fat</a></div></li></ul></div><div id="CDR0000373791__870"><h3>Thyroid gland</h3><div id="CDR0000373791__642"><h4>Thyroid late effects are more likely to occur after treatment for certain childhood cancers.</h4><p id="CDR0000373791__644">Treatment for these and other childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancers</a> may cause <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046036/" class="def">thyroid</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">late effects</a>:</p><ul id="CDR0000373791__645"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045586/" class="def">Acute lymphoblastic leukemia</a> (ALL).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000387264/" class="def">Brain tumors</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257519/" class="def">Head and neck cancers</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270800/" class="def">Hodgkin lymphoma</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045418/" class="def">Neuroblastoma</a>.</div></li><li class="half_rhythm"><div>Cancers treated with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a>.</div></li></ul></div><div id="CDR0000373791__646"><h4>Radiation therapy to the head and neck increases the risk of thyroid late effects. </h4><p id="CDR0000373791__911">The risk of thyroid late effects may be increased in childhood cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450125/" class="def">survivors</a> after treatment with any of the following:</p><ul id="CDR0000373791__649"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> to the thyroid as part of radiation therapy to the head and neck or to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046229/" class="def">pituitary gland</a> in the brain.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045930/" class="def">Total-body irradiation</a> (TBI) as part of a stem cell transplant.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a>.</div></li><li class="half_rhythm"><div>mIBG (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045855/" class="def">radioactive iodine</a>) <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a> for neuroblastoma.</div></li></ul><p id="CDR0000373791__650">The risk also is increased in females, in survivors who were a young age at the time of treatment, in survivors who had a higher <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">dose</a>, and as the time since <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosis</a> and treatment gets longer.</p></div><div id="CDR0000373791__398"><h4>Late effects that affect the thyroid may cause certain health problems.</h4><p id="CDR0000373791__200">Thyroid late effects and related health problems include the following:</p><ul id="CDR0000373791__201"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044547/" class="def">Hypothyroidism</a> (not enough <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044558/" class="def">thyroid hormone</a>)</b>: This is the most common thyroid late effect. It usually occurs 2 to 5 years after treatment ends but may occur later. It is more common in girls than boys.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045717/" class="def">Hyperthyroidism</a> (too much thyroid hormone)</b>: It usually occurs 3 to 5 years after treatment ends.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044545/" class="def">Goiter</a></b> (an enlarged thyroid).</div></li><li class="half_rhythm"><div><b>Lumps in the thyroid</b>: Usually occur 10 or more years after treatment ends. It is more common in girls than boys. These growths may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045614/" class="def">benign</a> (not cancerous) or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045772/" class="def">malignant</a> (cancer). </div></li></ul></div><div id="CDR0000373791__651"><h4>Signs and symptoms of thyroid late effects depend on whether there is too little or too much thyroid hormone in the body.</h4><p id="CDR0000373791__653">These and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may be caused by thyroid late effects or by other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>:
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</p><h5><span class="title">Hypothyroidism (too little thyroid hormone)</span></h5><ul id="CDR0000373791__654"><li class="half_rhythm"><div>Feeling tired or weak.</div></li><li class="half_rhythm"><div>Being more sensitive to cold.</div></li><li class="half_rhythm"><div>Pale, dry skin.</div></li><li class="half_rhythm"><div>Coarse and thinning hair.</div></li><li class="half_rhythm"><div>Brittle fingernails.</div></li><li class="half_rhythm"><div>Hoarse voice.</div></li><li class="half_rhythm"><div>Puffy face.</div></li><li class="half_rhythm"><div>Muscle and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000458080/" class="def">joint</a> aches and stiffness.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407757/" class="def">Constipation</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045784/" class="def">Menstrual periods</a> that are heavier than normal.</div></li><li class="half_rhythm"><div>Weight gain for no known reason.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430479/" class="def">Depression</a> or trouble with memory or being able to concentrate.
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</div></li></ul><p id="CDR0000373791__924">Rarely, hypothyroidism does not cause any symptoms.</p><h5><span class="title">Hyperthyroidism (too much thyroid hormone)</span></h5><ul id="CDR0000373791__655"><li class="half_rhythm"><div>Feeling nervous, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430405/" class="def">anxious</a>, or moody.</div></li><li class="half_rhythm"><div>Trouble sleeping.</div></li><li class="half_rhythm"><div>Feeling tired or weak.</div></li><li class="half_rhythm"><div>Having shaky hands.</div></li><li class="half_rhythm"><div>Having a fast heartbeat.</div></li><li class="half_rhythm"><div>Having red, warm skin that may be itchy.</div></li><li class="half_rhythm"><div>Having fine, soft hair that is falling out.</div></li><li class="half_rhythm"><div>Having frequent or loose <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046500/" class="def">bowel</a> movements.</div></li><li class="half_rhythm"><div>Weight loss for no known reason.</div></li></ul><p id="CDR0000373791__782">Talk to your child's doctor if your child has any of these problems.</p></div><div id="CDR0000373791__656"><h4>Certain tests and procedures are used to detect (find) and diagnose health problems in the thyroid.</h4><p id="CDR0000373791__658">These and other tests and procedures may be used to detect or diagnose thyroid late effects:
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</p><ul id="CDR0000373791__659"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689078/" class="def">history</a></b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">Blood</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045713/" class="def">hormone</a> studies</b>: A procedure in which a blood sample is checked to measure the amounts of certain hormones released into the blood by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it. The blood may be checked for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a> levels of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044559/" class="def">thyroid-stimulating hormone</a> (TSH) or free <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000533434/" class="def">thyroxine</a> (T4). </div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046157/" class="def">Ultrasound</a> exam</b>: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later. This procedure can show the size of the thyroid and whether there are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044502/" class="def">nodules</a> (lumps) on the thyroid.</div></li></ul><p id="CDR0000373791__791">Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of thyroid late effects. If tests are needed, find out how often they should be done.
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</p></div></div><div id="CDR0000373791__430"><h3>Pituitary gland</h3><div id="CDR0000373791__441"><h4>Neuroendocrine late effects may be caused after treatment for certain childhood cancers.</h4><p id="CDR0000373791__443">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045803/" class="def">neuroendocrine</a> system is the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000446114/" class="def">nervous system</a> and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000468796/" class="def">endocrine system</a> working together. </p><p id="CDR0000373791__925">Treatment for these and other childhood cancers may cause neuroendocrine late effects:</p><ul id="CDR0000373791__444"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045645/" class="def">Brain and spinal cord tumors</a>.
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</div></li><li class="half_rhythm"><div>Acute lymphoblastic leukemia (ALL).
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445072/" class="def">Nasopharyngeal cancer</a>.</div></li><li class="half_rhythm"><div>Cancers treated with total-body irradiation (TBI) before a stem cell transplant.</div></li></ul></div><div id="CDR0000373791__431"><h4>Treatment that affects the hypothalamus or pituitary gland increases the risk of neuroendocrine system late effects.
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</h4><p id="CDR0000373791__445">Childhood cancer survivors have an increased risk for neuroendocrine late effects. These effects are caused by radiation therapy to the brain in the area of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046359/" class="def">hypothalamus</a>. The hypothalamus controls the way hormones are made and released into the bloodstream by the pituitary gland. Radiation therapy may be given to treat cancer near the hypothalamus or as total-body irradiation (TBI) before a stem cell transplant. These effects are also caused by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> in the area of the hypothalamus or pituitary gland.</p><p id="CDR0000373791__532">Childhood cancer survivors who have neuroendocrine late effects may have low levels of any of the following hormones made in the pituitary gland and released into the blood:</p><ul id="CDR0000373791__446"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000538639/" class="def">Growth hormone</a> (GH; helps promote growth and control <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046173/" class="def">metabolism</a>).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476632/" class="def">Adrenocorticotropic hormone</a> (ACTH; controls the making of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045295/" class="def">glucocorticoids</a>).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476644/" class="def">Prolactin</a> (controls the making of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304766/" class="def">breast</a> milk).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044559/" class="def">Thyroid-stimulating hormone</a> (TSH; controls the making of thyroid hormones).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643019/" class="def">Luteinizing hormone</a> (LH; controls reproduction).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643012/" class="def">Follicle-stimulating hormone</a> (FSH; controls reproduction).</div></li></ul></div><div id="CDR0000373791__720"><h4>Late effects that affect the hypothalamus may cause certain health problems.</h4><p id="CDR0000373791__722">Neuroendocrine late effects and related health problems include the following:
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</p><ul id="CDR0000373791__723"><li class="half_rhythm"><div class="half_rhythm"><b>Growth hormone deficiency</b>: A low level of growth hormone is a common late effect of radiation to the brain in childhood cancer survivors. The higher the radiation dose and the longer the time since treatment, the greater the risk of this late effect. A low level of growth hormone may also occur in childhood ALL and stem cell transplant survivors who received radiation therapy to the brain and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a> and/or chemotherapy. </div><div class="half_rhythm">A low level of growth hormone in childhood results in adult height that is shorter than normal. If the child's bones have not fully developed, low growth hormone levels may be treated with growth <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046127/" class="def">hormone replacement therapy</a> beginning one year after the end of treatment.</div></li><li class="half_rhythm"><div class="half_rhythm"><b>Adrenocorticotropin <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000321364/" class="def">deficiency</a></b>: A low level of adrenocorticotropic hormone is an uncommon late effect. It may occur in childhood brain tumor survivors, survivors with low growth hormone levels or central hypothyroidism, or after radiation therapy to the brain. </div><div class="half_rhythm">Symptoms of deficiency may not be severe and may not be noticed. Signs and symptoms of adrenocorticotropin deficiency include the following: <dl id="CDR0000373791__928" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Weight loss for no known reason.</p></dd><dt>-</dt><dd><p class="no_top_margin">Not feeling hungry.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390302/" class="def">Nausea</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390324/" class="def">Vomiting</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">Low <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000462668/" class="def">blood pressure</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">Feeling tired.</p></dd></dl></div><div class="half_rhythm">Low levels of adrenocorticotropin may be treated with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045205/" class="def">hydrocortisone</a> therapy.</div></li><li class="half_rhythm"><div class="half_rhythm"><b>Hyperprolactinemia</b>: A high level of the hormone prolactin may occur after a high dose of radiation to the brain or surgery that affects part of the pituitary gland. A high level of prolactin may cause the following:<dl id="CDR0000373791__922" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440113/" class="def">Puberty</a> at a later age than normal.</p></dd><dt>-</dt><dd><p class="no_top_margin">Flow of breast milk in a woman who is not pregnant or breast-feeding.</p></dd><dt>-</dt><dd><p class="no_top_margin">Less frequent or no menstrual periods or menstrual periods with a very light flow.</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000256567/" class="def">Hot flashes</a> (in women).</p></dd><dt>-</dt><dd><p class="no_top_margin">Inability to become pregnant.</p></dd><dt>-</dt><dd><p class="no_top_margin">Inability to have an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373933/" class="def">erection</a> needed for sexual intercourse.</p></dd><dt>-</dt><dd><p class="no_top_margin">Lower <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651212/" class="def">sex drive</a> (in men and women).</p></dd><dt>-</dt><dd><p class="no_top_margin"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000538637/" class="def">Osteopenia</a> (low bone mineral density).</p></dd></dl></div><div class="half_rhythm">Sometimes there are no signs and symptoms. Treatment is rarely needed.</div></li><li class="half_rhythm"><div class="half_rhythm"><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044559/" class="def">Thyroid-stimulating hormone</a> deficiency</b> (central hypothyroidism): A low level of thyroid hormone may occur very slowly over time after radiation therapy to the brain. </div><div class="half_rhythm">Sometimes the symptoms of thyroid-stimulating hormone deficiency are not noticed. Low thyroid hormone levels may cause slow growth and delayed puberty, as well as <a href="#CDR0000373791__651">other symptoms</a>. A low level of thyroid hormone may be treated with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000563955/" class="def">thyroid hormone replacement therapy</a>.</div></li><li class="half_rhythm"><div class="half_rhythm"><b>Luteinizing hormone or follicle-stimulating hormone deficiency</b>: Low levels of these hormones can cause different health problems. The type of problem depends on the radiation dose. </div><div class="half_rhythm">Childhood cancer survivors who were treated with lower doses of radiation to the brain may develop central precocious puberty (a condition that causes puberty to start before age 8 years in girls and 9 years in boys). This condition may be treated with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000306500/" class="def">gonadotropin-releasing hormone (GnRH) agonist</a> therapy to delay puberty and help the child's growth.</div><div class="half_rhythm">Childhood cancer survivors who were treated with higher doses of radiation to the brain may have low levels of luteinizing hormone or follicle-stimulating hormone. This condition may be treated with sex hormone replacement therapy. The dose will depend on the child's age and whether the child has reached puberty.</div></li><li class="half_rhythm"><div class="half_rhythm"><b>Central <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000683346/" class="def">diabetes insipidus</a></b>: Central diabetes insipidus may be caused by the absence of or low amounts of all of the hormones made in the front part of the pituitary gland and released into the blood. It may occur in childhood cancer survivors treated with surgery in the area of the hypothalamus or pituitary gland. Signs and symptoms of central diabetes insipidus may include the following:<ul id="CDR0000373791__954"><li class="half_rhythm"><div>Having large amounts of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046642/" class="def">urine</a> or unusually wet diapers.</div></li><li class="half_rhythm"><div>Feeling very thirsty.</div></li><li class="half_rhythm"><div>Headache.</div></li><li class="half_rhythm"><div>Trouble with vision.</div></li><li class="half_rhythm"><div>Slowed growth and development.</div></li><li class="half_rhythm"><div>Weight loss
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for no known reason.</div></li></ul></div><div class="half_rhythm">Treatment may include hormone replacement therapy with vasopressin, the hormone that controls the amount of urine that is made in the body.</div></li></ul></div><div id="CDR0000373791__724"><h4>Certain tests and procedures are used to detect (find) and diagnose health problems in the neuroendocrine system.</h4><p id="CDR0000373791__726">These and other tests and procedures may be used to detect or diagnose thyroid late effects:</p><ul id="CDR0000373791__727"><li class="half_rhythm"><div><b>Physical exam and history</b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
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</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304685/" class="def">Blood chemistry study</a></b>: A procedure in which a blood sample is checked to measure the amounts of certain substances, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044033/" class="def">glucose</a>, released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.</div></li><li class="half_rhythm"><div><b>Blood hormone studies</b>: A procedure in which a blood sample is checked to measure the amounts of certain hormones released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it. The blood may be checked for abnormal levels of follicle-stimulating hormone, luteinizing hormone, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000305990/" class="def">estradiol</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045581/" class="def">testosterone</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000597113/" class="def">cortisol</a>, or free thyroxine (T4).</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046068/" class="def">Lipid</a> profile studies</b>: A procedure in which a blood sample is checked to measure the amounts of triglycerides, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407756/" class="def">cholesterol</a>, and low- and high-density lipoprotein cholesterol
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in the blood.</div></li></ul><p id="CDR0000373791__794">Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of neuroendocrine late effects. If tests are needed, find out how often they should be done.
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</p></div></div><div id="CDR0000373791__877"><h3>Testicles and ovaries</h3><p id="CDR0000373791__879">See the <a href="#CDR0000373791__417">Reproductive System</a> section of this summary for information about late effects in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046611/" class="def">testicles</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a>.</p></div><div id="CDR0000373791__847"><h3>Metabolic syndrome</h3><div id="CDR0000373791__849"><h4>Metabolic syndrome is more likely to occur after treatment for certain childhood cancers.</h4><p id="CDR0000373791__851"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643126/" class="def">Metabolic syndrome</a> is a group of medical conditions that includes having too much fat around the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> and at least two of the following:</p><ul id="CDR0000373791__852"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000458091/" class="def">High blood pressure</a>.</div></li><li class="half_rhythm"><div>High levels of triglycerides and low levels of high-density lipoprotein (HDL) cholesterol in the blood.</div></li><li class="half_rhythm"><div>High levels of glucose (sugar) in the blood.</div></li></ul><p id="CDR0000373791__853">Treatment for these and other childhood cancers may cause metabolic syndrome to occur later in life:</p><ul id="CDR0000373791__854"><li class="half_rhythm"><div>Acute lymphoblastic leukemia (ALL).</div></li><li class="half_rhythm"><div>Cancers treated with a stem cell transplant.</div></li><li class="half_rhythm"><div>Cancers treated with radiation to the abdomen, such as Wilms tumor or neuroblastoma.</div></li></ul></div><div id="CDR0000373791__855"><h4>Radiation therapy increases the risk of metabolic syndrome.</h4><p id="CDR0000373791__962">The risk of metabolic syndrome may be increased in childhood cancer survivors after treatment with any of the following:</p><ul id="CDR0000373791__963"><li class="half_rhythm"><div>Radiation therapy to the brain or abdomen.</div></li><li class="half_rhythm"><div>Total-body irradiation (TBI) as part of a stem cell transplant.</div></li></ul></div><div id="CDR0000373791__946"><h4>Certain tests and procedures are used to detect (find) and diagnose metabolic syndrome.</h4><p id="CDR0000373791__948">These and other tests and procedures may be used to detect or diagnose metabolic syndrome:</p><ul id="CDR0000373791__949"><li class="half_rhythm"><div><b>Physical exam and history</b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
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</div></li><li class="half_rhythm"><div><b>Blood chemistry studies</b>: A procedure in which a blood sample is checked to measure the amounts of certain substances, such as glucose, released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.</div></li><li class="half_rhythm"><div><b>Lipid profile studies</b>: A procedure in which a blood sample is checked to measure the amounts of triglycerides, cholesterol, and low- and high-density lipoprotein cholesterol
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in the blood.</div></li></ul><p id="CDR0000373791__950">Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of metabolic syndrome. If tests are needed, find out how often they should be done.</p></div><div id="CDR0000373791__857"><h4>Metabolic syndrome may cause heart and blood vessel disease and diabetes.</h4><p id="CDR0000373791__859">Metabolic syndrome is linked to an increased risk of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000748138/" class="def">heart and blood vessel disease</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044911/" class="def">diabetes</a>. Health habits that decrease these risks include:</p><ul id="CDR0000373791__951"><li class="half_rhythm"><div>Having a healthy weight.</div></li><li class="half_rhythm"><div>Eating a heart-healthy diet.</div></li><li class="half_rhythm"><div>Having regular exercise.</div></li><li class="half_rhythm"><div>Not smoking.</div></li></ul></div></div><div id="CDR0000373791__885"><h3>Obesity and body fat</h3><div id="CDR0000373791__248"><h4>Obesity is a late effect that is more likely to occur after treatment for certain childhood cancers.
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</h4><p id="CDR0000373791__250">Treatment for these and other childhood cancers may cause <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000527371/" class="def">obesity</a>:</p><ul id="CDR0000373791__251"><li class="half_rhythm"><div>Acute lymphoblastic leukemia (ALL).</div></li><li class="half_rhythm"><div>Brain tumors, especially <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046131/" class="def">craniopharyngiomas</a>.</div></li><li class="half_rhythm"><div>Cancers treated with radiation to the brain, including total-body irradiation (TBI) as part of a stem cell transplant.</div></li></ul></div><div id="CDR0000373791__244"><h4>Radiation therapy to the brain increases the risk of obesity.</h4><p id="CDR0000373791__246">The risk of obesity increases after treatment with the following:
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</p><ul id="CDR0000373791__247"><li class="half_rhythm"><div>Radiation therapy to the brain.</div></li><li class="half_rhythm"><div>Surgery that damages the hypothalamus or pituitary gland.</div></li></ul><p id="CDR0000373791__829">The following may also increase the risk of obesity:</p><ul id="CDR0000373791__830"><li class="half_rhythm"><div>Being diagnosed with cancer when aged 5 to 9 years.</div></li><li class="half_rhythm"><div>Being female.</div></li><li class="half_rhythm"><div>Having growth hormone deficiency or low levels of the hormone <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000766473/" class="def">leptin</a>.</div></li><li class="half_rhythm"><div>Not doing enough physical activity to stay at a healthy body weight.</div></li><li class="half_rhythm"><div>Taking an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044105/" class="def">antidepressant</a> called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045553/" class="def">paroxetine</a>.</div></li></ul><p id="CDR0000373791__902">Childhood cancer survivors who get enough exercise and have a normal amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430405/" class="def">anxiety</a> have a lower risk of obesity.</p></div><div id="CDR0000373791__716"><h4>Certain tests and procedures are used to detect (find) and diagnose obesity.</h4><p id="CDR0000373791__718">These and other tests and procedures may be used to detect or diagnose obesity:</p><ul id="CDR0000373791__719"><li class="half_rhythm"><div><b>Physical exam and history</b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
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</div></li><li class="half_rhythm"><div><b>Blood chemistry studies</b>: A procedure in which a blood sample is checked to measure the amounts of certain substances, such as glucose, released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
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</div></li><li class="half_rhythm"><div><b>Lipid profile studies</b>: A procedure in which a blood sample is checked to measure the amounts of triglycerides, cholesterol, and low- and high-density lipoprotein cholesterol
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in the blood.</div></li></ul><p id="CDR0000373791__964">Obesity may be measured by weight, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000455136/" class="def">body mass index</a>, percent of body fat, or size of the abdomen (belly fat).</p><p id="CDR0000373791__793">Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of obesity. If tests are needed, find out how often they should be done.
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</p></div></div></div><div id="CDR0000373791__211"><h2 id="_CDR0000373791__211_">Immune System</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000373791__660">Surgery to remove the spleen increases the risk of immune system late effects.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__664">Late effects that affect the immune system may cause infection.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__670">Children who have had their spleen removed may need antibiotics to lessen the risk of infection.</a></div></li></ul></div><div id="CDR0000373791__660"><h3>Surgery to remove the spleen increases the risk of immune system late effects.</h3><p id="CDR0000373791__662">The risk of health problems that affect the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> increases after treatment with the following:
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</p><ul id="CDR0000373791__663"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> to remove the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046593/" class="def">spleen</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440106/" class="def">High-dose radiation</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a> to the spleen which causes the spleen to stop working.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">Stem cell transplant</a> followed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045703/" class="def">graft-versus-host disease</a> which causes the spleen to stop working.</div></li></ul></div><div id="CDR0000373791__664"><h3>Late effects that affect the immune system may cause infection.</h3><p id="CDR0000373791__666"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">Late effects</a> that affect the immune system may increase the risk of very serious <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044123/" class="def">bacterial</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infections</a>. This risk is higher in younger children than in older children and may be greater in the early years after the spleen stops working or is removed by surgery. These <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may be caused by infection:
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</p><ul id="CDR0000373791__667"><li class="half_rhythm"><div>Redness, swelling, or warmth of a part of the body.</div></li><li class="half_rhythm"><div>Pain that is in one part of the body, such as the eye, ear, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439429/" class="def">throat</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450108/" class="def">Fever</a>.</div></li></ul><p id="CDR0000373791__668">An infection may cause other symptoms that depend on the part of the body affected. For example, a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a> infection may cause a cough and trouble breathing.</p></div><div id="CDR0000373791__670"><h3>Children who have had their spleen removed may need antibiotics to lessen the risk of infection.</h3><p id="CDR0000373791__919">Daily <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045967/" class="def">antibiotics</a> may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044711/" class="def">prescribed</a> for children younger than 5 years of age whose spleen is no longer working or for at least 1 year after surgery to remove the spleen. For certain high-risk patients, daily antibiotics may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044711/" class="def">prescribed</a> throughout childhood and into adulthood. </p><p id="CDR0000373791__673">In addition, children with an increased risk of infection should be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044841/" class="def">vaccinated</a> on a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346524/" class="def">schedule</a> through adolescence against the following:</p><ul id="CDR0000373791__674"><li class="half_rhythm"><div>Pneumococcal disease.</div></li><li class="half_rhythm"><div>Meningococcal disease.</div></li><li class="half_rhythm"><div><i>Haemophilus influenzae</i> type b (Hib) disease.</div></li></ul><p id="CDR0000373791__864">Talk to your child's doctor about whether other childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045937/" class="def">vaccinations</a> given before cancer treatment need to be repeated.</p></div></div><div id="CDR0000373791__459"><h2 id="_CDR0000373791__459_">Musculoskeletal System</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000373791__452">Bone and joint</a></div></li></ul></div><div id="CDR0000373791__452"><h3>Bone and joint</h3><div id="CDR0000373791__675"><h4>Bone and joint late effects are more likely to occur after treatment for certain childhood cancers.</h4><p id="CDR0000373791__677">Treatment for these and other childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancers</a> may cause bone and joint <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">late effects</a>:
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</p><ul id="CDR0000373791__678"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045586/" class="def">Acute lymphoblastic leukemia</a> (ALL).
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000434562/" class="def">Bone cancer</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000387264/" class="def">Brain</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000340937/" class="def">spinal cord</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046031/" class="def">Ewing sarcoma</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257519/" class="def">Head and neck cancers</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045148/" class="def">Non-Hodgkin lymphoma</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045395/" class="def">Osteosarcoma</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046774/" class="def">Retinoblastoma</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046584/" class="def">Soft tissue sarcoma</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045946/" class="def">Wilms tumor</a>.
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</div></li><li class="half_rhythm"><div>Cancers treated with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a>.</div></li></ul><p id="CDR0000373791__939">Poor <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044698/" class="def">nutrition</a> and not enough exercise may also cause bone late effects.</p></div><div id="CDR0000373791__679"><h4>Surgery, chemotherapy, radiation therapy, and other treatments increase the risk of bone and joint late effects.</h4><div id="CDR0000373791__697"><h5>Radiation therapy</h5><p id="CDR0000373791__699"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> can stop or slow the growth of bone. The type of bone and joint late effect depends on the part of the body that received radiation therapy. Radiation therapy may cause any of the following:</p><ul id="CDR0000373791__700"><li class="half_rhythm"><div>Changes in the way the face or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000763008/" class="def">skull</a> form, especially when treatment is given to children before age 5 or when <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440106/" class="def">high-dose radiation</a> is given. </div></li><li class="half_rhythm"><div>Short <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000633093/" class="def">stature</a> (being shorter than normal).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000723831/" class="def">Scoliosis</a> (curving of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415914/" class="def">spine</a>) or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000723841/" class="def">kyphosis</a> (rounding of the spine).</div></li><li class="half_rhythm"><div>One arm or leg is shorter than the other arm or leg.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045371/" class="def">Osteoporosis</a> (weak or thin bones that can break easily).</div></li><li class="half_rhythm"><div>Osteoradionecrosis (parts of the jaw bone die from a lack of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> flow).</div></li></ul></div><div id="CDR0000373791__701"><h5>Surgery</h5><p id="CDR0000373791__703"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046210/" class="def">Amputation</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689062/" class="def">limb-sparing surgery</a> to remove the cancer and prevent it from coming back may cause late effects depending on where the tumor was, age of the patient, and type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>. Health problems after amputation or limb-sparing surgery may include:</p><ul id="CDR0000373791__704"><li class="half_rhythm"><div>Having problems with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430401/" class="def">activities of daily living</a>.</div></li><li class="half_rhythm"><div>Not being able to be as active as normal.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044654/" class="def">Chronic pain</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a>.</div></li><li class="half_rhythm"><div>Problems with the way <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046542/" class="def">prosthetics</a> fit or work.</div></li><li class="half_rhythm"><div>Broken bone.</div></li><li class="half_rhythm"><div>The bone may not heal well after surgery.</div></li><li class="half_rhythm"><div>One arm or leg is shorter than the other.</div></li></ul><p id="CDR0000373791__706">Studies show no difference in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a> in childhood cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450125/" class="def">survivors</a> who had amputation compared to those who had limb-sparing surgery.</p></div><div id="CDR0000373791__707"><h5>Chemotherapy and other drug therapy</h5><p id="CDR0000373791__709">Risk may be increased in childhood cancer survivors who receive <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000639945/" class="def">anticancer therapy</a> that includes <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045393/" class="def">methotrexate</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045658/" class="def">corticosteroids</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045295/" class="def">glucocorticoids</a> such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045262/" class="def">dexamethasone</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651195/" class="def">Drug therapy</a> may cause any of the following:</p><ul id="CDR0000373791__710"><li class="half_rhythm"><div>Osteoporosis (weak or thin bones that can break easily).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000723852/" class="def">Osteonecrosis</a> (</div></li><li class="half_rhythm"><div>one or more parts of a bone die from a lack of blood flow), especially in the hip or knee.</div></li></ul></div><div id="CDR0000373791__711"><h5>Stem cell transplant</h5><p id="CDR0000373791__713">A stem cell transplant can affect the bone and joints in different ways: </p><ul id="CDR0000373791__714"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045930/" class="def">Total-body irradiation</a> (TBI) given as part of a stem cell transplant may affect the body's ability to make <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000538639/" class="def">growth hormone</a> and cause short stature (being shorter than normal). It may also cause osteoporosis (weak or thin bones that can break easily).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000723860/" class="def">Osteochondroma</a> (a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046079/" class="def">benign tumor</a> of the long bones, such as the arm or leg bones) may form. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045641/" class="def">Chronic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045703/" class="def">graft-versus-host disease</a> may occur after a stem cell transplant and cause <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000458080/" class="def">joint</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000723866/" class="def">contractures</a> (tightening of the muscles that causes the joint to shorten and become very stiff). It may also cause osteonecrosis (one or more parts of a bone dies from a lack of blood flow).</div></li></ul></div></div><div id="CDR0000373791__687"><h4>Possible signs and symptoms of bone and joint late effects include swelling over a bone or bone and joint pain.</h4><p id="CDR0000373791__689">These and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may be caused by bone and joint late effects or by other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>:</p><ul id="CDR0000373791__690"><li class="half_rhythm"><div>Swelling over a bone or bony part of the body.</div></li><li class="half_rhythm"><div>Pain in a bone or joint.</div></li><li class="half_rhythm"><div>Redness or warmth over a bone or joint.</div></li><li class="half_rhythm"><div>Joint stiffness or trouble moving normally.</div></li><li class="half_rhythm"><div>A bone that breaks for no known reason or breaks easily.
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</div></li><li class="half_rhythm"><div>Short stature (being shorter than normal).</div></li><li class="half_rhythm"><div>One side of the body looks higher than the other side or the body tilts to one side.</div></li><li class="half_rhythm"><div>Always sitting or standing in a slouching position or having the appearance of a hunched back.</div></li></ul><p id="CDR0000373791__783">Talk to your child's doctor if your child has any of these problems.</p></div><div id="CDR0000373791__691"><h4>Certain tests and procedures are used to detect (find) and diagnose health problems in the bone and joint.</h4><p id="CDR0000373791__693">These and other tests and procedures may be used to detect or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> bone and joint late effects:</p><ul id="CDR0000373791__694"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689078/" class="def">history</a></b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits, past illnesses and treatments will also be taken. An exam of the bones and muscles by a specialist may also be done.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000562728/" class="def">Bone mineral density scan</a></b>: An <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689578/" class="def">imaging test</a> that measures <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407755/" class="def">bone density</a> (the amount of bone <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045787/" class="def">mineral</a> in a certain amount of bone) by passing <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-rays</a> with two different energy levels through the bone. It is used to diagnose osteoporosis (weak or thin bones that can break easily). Also called BMD scan, DEXA, DEXA scan, dual energy x-ray absorptiometric scan, dual x-ray absorptiometry, and DXA. </div></li><li class="half_rhythm"><div><b>X-ray</b>: An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body, such as bones.</div></li></ul><p id="CDR0000373791__792">Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of bone and joint late effects. If tests are needed, find out how often they should be done.
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</p></div></div></div><div id="CDR0000373791__417"><h2 id="_CDR0000373791__417_">Reproductive System</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000373791__267">Testicles</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__418">Ovaries</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__299">Fertility and reproduction</a></div></li></ul></div><div id="CDR0000373791__267"><h3>Testicles</h3><div id="CDR0000373791__482"><h4>Testicular late effects are more likely to occur after treatment for certain childhood cancers.</h4><p id="CDR0000373791__278">Treatment for these and other childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancers</a> may cause <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046611/" class="def">testicular</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">late effects</a>:
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</p><ul id="CDR0000373791__483"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045586/" class="def">Acute lymphoblastic leukemia</a> (ALL).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045695/" class="def">Germ cell tumors</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270800/" class="def">Hodgkin lymphoma</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045148/" class="def">Non-Hodgkin lymphoma</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045562/" class="def">Sarcoma</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445090/" class="def">Testicular cancer</a>.</div></li><li class="half_rhythm"><div>Cancers treated with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045930/" class="def">total-body irradiation</a> (TBI) before a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a>.</div></li></ul></div><div id="CDR0000373791__269"><h4>Surgery, radiation therapy, and certain types of chemotherapy increase the risk of late effects that affect the testicles. </h4><p id="CDR0000373791__728">The risk of health problems that affect the testicles increases after treatment with one or more of the following:
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</p><ul id="CDR0000373791__729"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a>, such as the removal of a testicle, part of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046539/" class="def">prostate</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045589/" class="def">alkylating agents</a>, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045253/" class="def">cyclophosphamide</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045260/" class="def">dacarbazine</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045378/" class="def">procarbazine</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045267/" class="def">ifosfamide</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> to the abdomen, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>, or in the area of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046359/" class="def">hypothalamus</a> in the brain.</div></li><li class="half_rhythm"><div>Total-body irradiation (TBI) before a stem cell transplant.</div></li></ul></div><div id="CDR0000373791__730"><h4>Late effects that affect the testicles may cause certain health problems. </h4><p id="CDR0000373791__732">Late effects of the testicles and related health problems include the following:
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</p><ul id="CDR0000373791__733"><li class="half_rhythm"><div>Low <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440117/" class="def">sperm count</a>: A zero <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257221/" class="def">sperm</a> count or a low sperm count may be temporary or permanent. This depends on the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">dose</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346524/" class="def">schedule</a>, the area of the body treated, and the age when treated.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046348/" class="def">Infertility</a>: The inability to father a child.</div></li><li class="half_rhythm"><div>Retrograde <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046433/" class="def">ejaculation</a>: Very little or no <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046703/" class="def">semen</a> comes out of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257215/" class="def">penis</a> during <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476622/" class="def">orgasm</a>.</div></li></ul><p id="CDR0000373791__943">After treatment with chemotherapy or radiation, the body’s ability to make sperm may come back over time.</p></div></div><div id="CDR0000373791__418"><h3>Ovaries</h3><div id="CDR0000373791__734"><h4>Ovarian late effects are more likely to occur after treatment for certain childhood cancers.</h4><p id="CDR0000373791__736">Treatment for these and other childhood cancers may cause <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044984/" class="def">ovarian</a> late effects:</p><ul id="CDR0000373791__737"><li class="half_rhythm"><div>Acute lymphoblastic leukemia (ALL).</div></li><li class="half_rhythm"><div>Germ cell tumors.</div></li><li class="half_rhythm"><div>Hodgkin lymphoma.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445074/" class="def">Ovarian cancer</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045946/" class="def">Wilms tumor</a>.</div></li><li class="half_rhythm"><div>Cancers treated with total-body irradiation (TBI) before a stem cell transplant.</div></li></ul></div><div id="CDR0000373791__424"><h4>Radiation therapy to the abdomen and certain types of chemotherapy increase the risk of ovarian late effects.
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</h4><p id="CDR0000373791__426">The risk of ovarian late effects may be increased after treatment with any of the following:</p><ul id="CDR0000373791__427"><li class="half_rhythm"><div>Surgery to remove one or both <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046687/" class="def">ovaries</a>.</div></li><li class="half_rhythm"><div>Chemotherapy with alkylating agents, such as cyclophosphamide, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046603/" class="def">mechlorethamine</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045230/" class="def">cisplatin</a>, ifosfamide, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046017/" class="def">lomustine</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045410/" class="def">busulfan</a>, and especially procarbazine.</div></li><li class="half_rhythm"><div>Radiation therapy to the abdomen, pelvis, or lower back. In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450125/" class="def">survivors</a> who had radiation to the abdomen, the damage to the ovaries depends on the radiation dose, age at the time of treatment, and whether all or part of the abdomen received radiation.</div></li><li class="half_rhythm"><div>Radiation therapy to the abdomen or pelvis together with alkylating agents.</div></li><li class="half_rhythm"><div>Radiation therapy to the area near the hypothalamus in the brain.</div></li><li class="half_rhythm"><div>Total-body irradiation (TBI) before a stem cell transplant. </div></li></ul></div><div id="CDR0000373791__420"><h4>Late effects that affect the ovaries may cause certain health problems.
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</h4><p id="CDR0000373791__422">Ovarian late effects and other health related problems include the following:</p><ul id="CDR0000373791__423"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000449953/" class="def">Early menopause</a>, especially in women who had their ovaries removed or were treated with both an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045589/" class="def">alkylating agent</a> and radiation therapy to the abdomen.</div></li><li class="half_rhythm"><div>Changes in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045784/" class="def">menstrual periods</a>.</div></li><li class="half_rhythm"><div>Infertility (inability to conceive a child).</div></li><li class="half_rhythm"><div>Puberty does not begin.</div></li></ul><p id="CDR0000373791__918">After treatment with chemotherapy, the ovaries may begin to work over time.</p></div><div id="CDR0000373791__739"><h4>Possible signs and symptoms of ovarian late effects include irregular or absent menstrual periods and hot flashes.</h4><p id="CDR0000373791__741">These and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may be caused by ovarian late effects or by other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>:</p><ul id="CDR0000373791__742"><li class="half_rhythm"><div>Irregular or no menstrual periods.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000256567/" class="def">Hot flashes</a>.</div></li><li class="half_rhythm"><div>Night sweats.</div></li><li class="half_rhythm"><div>Trouble sleeping.</div></li><li class="half_rhythm"><div>Mood changes.</div></li><li class="half_rhythm"><div>Lowered <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651212/" class="def">sex drive</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044308/" class="def">Vaginal</a> dryness.</div></li><li class="half_rhythm"><div>Inability to conceive a child.</div></li><li class="half_rhythm"><div>Sex traits, such as developing arm, pubic, and leg hair or having the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304766/" class="def">breasts</a> enlarge, do not occur at puberty.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045371/" class="def">Osteoporosis</a> (weak or thin bones that can break easily).
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</div></li></ul><p id="CDR0000373791__784">Talk to your child's doctor if your child has any of these problems.</p></div></div><div id="CDR0000373791__299"><h3>Fertility and reproduction</h3><div id="CDR0000373791__743"><h4>Treatment for cancer may cause infertility in childhood cancer survivors. </h4><p id="CDR0000373791__745">The risk of infertility increases after treatment with the following:</p><ul id="CDR0000373791__746"><li class="half_rhythm"><div>In boys, treatment with radiation therapy to the testicles.</div></li><li class="half_rhythm"><div>In girls, treatment with radiation therapy to the pelvis, including the ovaries and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046645/" class="def">uterus</a>.</div></li><li class="half_rhythm"><div>Radiation therapy to an area near the hypothalamus in the brain or lower back.</div></li><li class="half_rhythm"><div>Total-body irradiation (TBI) before a stem cell transplant.</div></li><li class="half_rhythm"><div>Chemotherapy with alkylating agents, such as cyclophosphamide, busulfan, and procarbazine.</div></li><li class="half_rhythm"><div>Surgery, such as the removal of a testicle or an ovary or lymph nodes in the abdomen.</div></li></ul></div><div id="CDR0000373791__301"><h4>Childhood cancer survivors may have late effects that affect pregnancy. </h4><p id="CDR0000373791__303">Late effects on <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000666677/" class="def">pregnancy</a> include increased risk of the following:</p><ul id="CDR0000373791__304"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000458091/" class="def">High blood pressure</a>.</div></li><li class="half_rhythm"><div>Miscarriage or stillbirth.</div></li><li class="half_rhythm"><div>Low birth-weight babies.</div></li><li class="half_rhythm"><div>Early labor and/or delivery.</div></li><li class="half_rhythm"><div>Delivery by Cesarean section.</div></li><li class="half_rhythm"><div>The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046400/" class="def">fetus</a> is not in the right position for birth (for example, the foot or buttock is in position to come out before the head).</div></li></ul></div><div id="CDR0000373791__309"><h4>There are methods that may be used to help childhood cancer survivors have children.</h4><p id="CDR0000373791__311">The following methods may be used so that childhood cancer survivors can have children: </p><ul id="CDR0000373791__312"><li class="half_rhythm"><div>Freezing the eggs or sperm before cancer treatment in patients who have reached puberty.</div></li><li class="half_rhythm"><div>Testicular sperm extraction (the removal of a small amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> containing sperm from the testicle).</div></li><li class="half_rhythm"><div>Intracytoplasmic sperm <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injection</a> (an egg is fertilized with one sperm that is injected into the egg outside the body).</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440108/" class="def">In vitro fertilization</a> (IVF) (eggs and sperm are placed together in a container, giving the sperm the chance to enter an egg).
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</div></li></ul></div><div id="CDR0000373791__314"><h4>Children of childhood cancer survivors are not affected by the parent’s previous treatment for cancer.</h4><p id="CDR0000373791__952">The children of childhood cancer survivors do not appear to have an increased risk of birth defects, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046391/" class="def">genetic</a> disease, or cancer.</p></div></div></div><div id="CDR0000373791__318"><h2 id="_CDR0000373791__318_">Respiratory System</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000373791__329">Lung late effects are more likely to occur after treatment for certain childhood cancers.
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__323">Certain types of chemotherapy and radiation to the lungs increase the risk of lung late effects.
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__319">Late effects that affect the lungs may cause certain health problems.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__748">Possible signs and symptoms of lung late effects include trouble breathing and cough.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__753">Certain tests and procedures are used to detect (find) and diagnose health problems in the lung.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__860">Health habits that promote healthy lungs are important for survivors of childhood cancer.</a></div></li></ul></div><div id="CDR0000373791__329"><h3>Lung late effects are more likely to occur after treatment for certain childhood cancers.
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</h3><p id="CDR0000373791__331">Treatment for these and other childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancers</a> may cause <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">late effects</a>:
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</p><ul id="CDR0000373791__332"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270800/" class="def">Hodgkin lymphoma</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045946/" class="def">Wilms tumor</a>.</div></li><li class="half_rhythm"><div>Cancers treated with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a>.</div></li></ul></div><div id="CDR0000373791__323"><h3>Certain types of chemotherapy and radiation to the lungs increase the risk of lung late effects.
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</h3><p id="CDR0000373791__327">The risk of health problems that affect the lungs increases after treatment with the following:
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</p><ul id="CDR0000373791__328"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> to remove all or part of the lung or chest wall.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a>. In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450125/" class="def">survivors</a> treated with chemotherapy, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045169/" class="def">bleomycin</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045410/" class="def">busulfan</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045976/" class="def">carmustine</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046017/" class="def">lomustine</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> to the chest, there is a high risk of lung damage.</div></li><li class="half_rhythm"><div>Radiation therapy to the chest. In survivors who had <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> to the chest, the damage to the lungs and chest wall depends on the radiation <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">dose</a>, whether all or part of the lungs and chest wall received radiation, and whether the radiation was given in small, divided daily doses.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045930/" class="def">Total-body irradiation</a> (TBI) or certain types of chemotherapy before a stem cell transplant.</div></li></ul><p id="CDR0000373791__325">The risk of lung late effects is greater in childhood cancer survivors who are treated with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000688810/" class="def">combination</a> of surgery, chemotherapy, and/or radiation therapy. The risk is also increased in survivors who have a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642019/" class="def">history</a> of the following:
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</p><ul id="CDR0000373791__326"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">Infections</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045703/" class="def">graft-versus-host disease</a> after a stem cell transplant. </div></li><li class="half_rhythm"><div>Lung or airway disease, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440101/" class="def">asthma</a>, before cancer treatment.</div></li><li class="half_rhythm"><div>Smoking <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000748148/" class="def">cigarettes</a> or other substances.</div></li></ul></div><div id="CDR0000373791__319"><h3>Late effects that affect the lungs may cause certain health problems.</h3><p id="CDR0000373791__321">Lung late effects and related health problems include the following:</p><ul id="CDR0000373791__322"><li class="half_rhythm"><div>Radiation <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000482345/" class="def">pneumonitis</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044042/" class="def">inflamed</a> lung caused by radiation therapy).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045852/" class="def">Pulmonary</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045690/" class="def">fibrosis</a> (the build-up of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000640078/" class="def">scar tissue</a> in the lung).</div></li><li class="half_rhythm"><div>Other lung and airway problems such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000524193/" class="def">chronic obstructive pulmonary disease</a> (COPD), <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045476/" class="def">pneumonia</a>, cough that does not go away, and asthma.</div></li></ul></div><div id="CDR0000373791__748"><h3>Possible signs and symptoms of lung late effects include trouble breathing and cough.</h3><p id="CDR0000373791__750">These and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may be caused by lung late effects or by other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>:
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</p><ul id="CDR0000373791__751"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046183/" class="def">Dyspnea</a> (shortness of breath), especially when being active.</div></li><li class="half_rhythm"><div>Wheezing when breathing.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450108/" class="def">Fever</a>.</div></li><li class="half_rhythm"><div>Dry cough.</div></li><li class="half_rhythm"><div>Congestion (a feeling of fullness in the lungs from extra <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046274/" class="def">mucus</a>).</div></li><li class="half_rhythm"><div>Feeling tired.</div></li></ul><p id="CDR0000373791__785">Talk to your child's doctor if your child has any of these problems.</p><p id="CDR0000373791__752">Lung late effects in childhood cancer survivors may occur slowly over time or there may be no symptoms. Sometimes lung damage can be detected only by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046361/" class="def">imaging</a> or pulmonary function testing. Lung late effects may improve over time.</p></div><div id="CDR0000373791__753"><h3>Certain tests and procedures are used to detect (find) and diagnose health problems in the lung.</h3><p id="CDR0000373791__755">These and other tests and procedures may be used to detect or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> lung late effects:
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</p><ul id="CDR0000373791__756"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689078/" class="def">history</a></b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304687/" class="def">Chest x-ray</a></b>: An <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000658018/" class="def">Pulmonary function test</a> (PFT)</b>: A test to see how well the lungs are working. It measures how much air the lungs can hold and how quickly air moves into and out of the lungs. It also measures how much <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000538149/" class="def">oxygen</a> is used and how much <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000538147/" class="def">carbon dioxide</a> is given off during breathing. This is also called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000658017/" class="def">lung function test</a>.
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</div></li></ul><p id="CDR0000373791__795">Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of lung late effects. If tests are needed, find out how often they should be done.
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</p></div><div id="CDR0000373791__860"><h3>Health habits that promote healthy lungs are important for survivors of childhood cancer.</h3><p id="CDR0000373791__862">Childhood cancer survivors with lung late effects should take care to protect their health, including:</p><ul id="CDR0000373791__863"><li class="half_rhythm"><div>Not smoking.</div></li><li class="half_rhythm"><div>Getting <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045938/" class="def">vaccines</a> for flu and pneumococcus.</div></li></ul></div></div><div id="CDR0000373791__333"><h2 id="_CDR0000373791__333_">Senses</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000373791__334">Hearing</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__347">Seeing</a></div></li></ul></div><div id="CDR0000373791__334"><h3>Hearing</h3><div id="CDR0000373791__343"><h4>Hearing problems are a late effect that is more likely to occur after treatment for certain childhood cancers.</h4><p id="CDR0000373791__345">Treatment for these and other childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancers</a> may cause hearing <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">late effects</a>:</p><ul id="CDR0000373791__346"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000387264/" class="def">Brain tumors</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257519/" class="def">Head and neck cancers</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045418/" class="def">Neuroblastoma</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046774/" class="def">Retinoblastoma</a>.</div></li></ul></div><div id="CDR0000373791__338"><h4>Radiation therapy to the brain and certain types of chemotherapy increase the risk of hearing loss. </h4><p id="CDR0000373791__340">The risk of hearing loss is increased in childhood cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450125/" class="def">survivors</a> after treatment with the following:
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</p><ul id="CDR0000373791__341"><li class="half_rhythm"><div>Certain types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a>, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045230/" class="def">cisplatin</a> or high-<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">dose</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045182/" class="def">carboplatin</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> to the brain.
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</div></li></ul><p id="CDR0000373791__342">The risk of hearing loss is greater in childhood cancer survivors who were young at the time of treatment (the younger the child, the greater the risk), were treated for a brain tumor, or received radiation therapy to the brain and chemotherapy at the same time.
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</p></div><div id="CDR0000373791__757"><h4>Hearing loss is the most common sign of hearing late effects.</h4><p id="CDR0000373791__759">These and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may be caused by hearing late effects or by other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>:
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</p><ul id="CDR0000373791__760"><li class="half_rhythm"><div>Hearing loss.</div></li><li class="half_rhythm"><div>Ringing in the ears.</div></li><li class="half_rhythm"><div>Feeling dizzy.</div></li><li class="half_rhythm"><div>Too much hardened wax in the ear.</div></li></ul><p id="CDR0000373791__761">Hearing loss may occur slowly over time or may occur several months or years after treatment ends. Talk to your child's doctor if your child has any of these problems.</p></div><div id="CDR0000373791__762"><h4>Certain tests and procedures are used to detect (find) and diagnose health problems in the ear and hearing problems.</h4><p id="CDR0000373791__764">These and other tests and procedures may be used to detect or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> hearing late effects:
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</p><ul id="CDR0000373791__765"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689078/" class="def">history</a></b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.</div></li><li class="half_rhythm"><div><b>Otoscopic exam</b>: An exam of the ear. An otoscope is used to look at the ear canal and the eardrum to check for signs of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a> or hearing loss. Sometimes the otoscope has a plastic bulb that is squeezed to release a small puff air into the ear canal. In a healthy ear, the eardrum will move. If there is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> behind the eardrum, it will not move.</div></li><li class="half_rhythm"><div><b>Hearing test</b>: A hearing test can be done in different ways depending on the child's age. The test is done to check if the child can hear soft and loud sounds and low- and high-pitched sounds. Each ear is checked separately. The child may also be asked if he or she can hear the high-pitched hum of a tuning fork when it is placed behind the ear or on the forehead. </div></li></ul><p id="CDR0000373791__796">Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of hearing late effects. If tests are needed, find out how often they should be done.
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</p></div></div><div id="CDR0000373791__347"><h3>Seeing</h3><div id="CDR0000373791__359"><h4>Eye and vision problems are a late effect that is more likely to occur after treatment for certain childhood cancers.</h4><p id="CDR0000373791__361">Treatment for these and other childhood cancers may cause eye and vision late effects:
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</p><ul id="CDR0000373791__362"><li class="half_rhythm"><div>Retinoblastoma, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045872/" class="def">rhabdomyosarcoma</a>, and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a> of the eye.</div></li><li class="half_rhythm"><div>Brain tumors.</div></li><li class="half_rhythm"><div>Head and neck cancers.
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045586/" class="def">Acute lymphoblastic leukemia</a> (ALL).</div></li><li class="half_rhythm"><div>Cancers treated with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045930/" class="def">total-body irradiation</a> (TBI) before a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">stem cell transplant</a>.</div></li></ul></div><div id="CDR0000373791__353"><h4>Radiation therapy to the brain or head increases the risk of eye problems or vision loss.</h4><p id="CDR0000373791__766">The risk of eye problems or vision loss may be increased in childhood cancer survivors after treatment with any of the following:</p><ul id="CDR0000373791__767"><li class="half_rhythm"><div>Radiation therapy to the brain, eye, or eye socket.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> to remove the eye or a tumor near the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046248/" class="def">optic nerve</a>.</div></li><li class="half_rhythm"><div>Certain types of chemotherapy, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045410/" class="def">busulfan</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045658/" class="def">corticosteroids</a>.</div></li><li class="half_rhythm"><div>Total-body irradiation (TBI) as part of a stem cell transplant.</div></li><li class="half_rhythm"><div>Stem cell transplant (and a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642019/" class="def">history</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045641/" class="def">chronic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045703/" class="def">graft-versus-host disease</a>).
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</div></li></ul></div><div id="CDR0000373791__349"><h4>Late effects that affect the eye may cause certain health problems.</h4><p id="CDR0000373791__351">Eye late effects and related health problems include the following:</p><ul id="CDR0000373791__352"><li class="half_rhythm"><div>Having a small eye socket that affects the shape of the child’s face as it grows.</div></li><li class="half_rhythm"><div>Loss of vision.</div></li><li class="half_rhythm"><div>Vision problems, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440102/" class="def">cataracts</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000534224/" class="def">glaucoma</a>.</div></li><li class="half_rhythm"><div>Not being able to make tears.</div></li><li class="half_rhythm"><div>Damage to the optic nerve and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440115/" class="def">retina</a>.</div></li><li class="half_rhythm"><div>Eyelid tumors.</div></li></ul></div><div id="CDR0000373791__768"><h4>Possible signs and symptoms of eye and vision late effects include changes in vision and dry eyes.</h4><p id="CDR0000373791__770">These and other signs and symptoms may be caused by eye and vision late effects or by other conditions:</p><ul id="CDR0000373791__771"><li class="half_rhythm"><div>Changes in vision, such as:<dl id="CDR0000373791__772" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Not being able to see objects that are close.</p></dd><dt>-</dt><dd><p class="no_top_margin">Not being able to see objects that are far away.</p></dd><dt>-</dt><dd><p class="no_top_margin">Double vision.</p></dd><dt>-</dt><dd><p class="no_top_margin">Cloudy or blurred vision.</p></dd><dt>-</dt><dd><p class="no_top_margin">Colors seem faded.</p></dd><dt>-</dt><dd><p class="no_top_margin">Being sensitive to light or trouble seeing at night.</p></dd><dt>-</dt><dd><p class="no_top_margin">Seeing a glare or halo around lights at night.</p></dd></dl></div></li><li class="half_rhythm"><div>Dry eyes that may feel like they are itchy, burning, or swollen, or like there is something in the eye.</div></li><li class="half_rhythm"><div>Eye pain.</div></li><li class="half_rhythm"><div>Eye redness.</div></li><li class="half_rhythm"><div>Having a growth on the eyelid.</div></li><li class="half_rhythm"><div>Drooping of the upper eyelid.</div></li></ul><p id="CDR0000373791__786">Talk to your child's doctor if your child has any of these problems.</p></div><div id="CDR0000373791__773"><h4>Certain tests and procedures are used to detect (find) and diagnose health problems in the eye and vision problems.</h4><p id="CDR0000373791__775">These and other tests and procedures may be used to detect or diagnose eye and vision late effects:</p><ul id="CDR0000373791__776"><li class="half_rhythm"><div><b>Eye exam with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257207/" class="def">dilated</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000546600/" class="def">pupil</a></b>: An exam of the eye in which the pupil is dilated (widened) with medicated eye drops to allow the doctor to look through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000572035/" class="def">lens</a> and pupil to the retina. The inside of the eye, including the retina and the optic nerve, is checked using an instrument that makes a narrow beam of light. This is sometimes called a slit-lamp exam. If there is a tumor, the doctor may take pictures over time to keep track of changes in the size of the tumor and how fast it is growing.
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</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000534231/" class="def">Indirect ophthalmoscopy</a></b>: An exam of the inside of the back of the eye using a small magnifying lens and a light.
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</div></li></ul><p id="CDR0000373791__797">Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of eye and vision late effects. If tests are needed, find out how often they should be done.
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</p></div></div></div><div id="CDR0000373791__363"><h2 id="_CDR0000373791__363_">Urinary System</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000373791__399">Kidney</a></div></li><li class="half_rhythm"><div><a href="#CDR0000373791__402">Bladder</a></div></li></ul></div><div id="CDR0000373791__399"><h3>Kidney</h3><div id="CDR0000373791__364"><h4>Certain types of chemotherapy increase the risk of kidney late effects.</h4><p id="CDR0000373791__366">The risk of health problems that affect the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046325/" class="def">kidney</a> increases after treatment with the following: </p><ul id="CDR0000373791__798"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> including <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045230/" class="def">cisplatin</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045182/" class="def">carboplatin</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045267/" class="def">ifosfamide</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045393/" class="def">methotrexate</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> or middle of the back.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> to remove part or all of a kidney.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046695/" class="def">Stem cell transplant</a>.</div></li></ul><p id="CDR0000373791__953">The risk of kidney <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">late effects</a> is greater in childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450125/" class="def">survivors</a> who are treated with a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000688810/" class="def">combination</a> of surgery, chemotherapy, and/or radiation therapy.</p><p id="CDR0000373791__942">The following may also increase the risk of kidney late effects:</p><ul id="CDR0000373791__800"><li class="half_rhythm"><div>Having cancer in both kidneys.</div></li><li class="half_rhythm"><div>Having a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046391/" class="def">genetic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045090/" class="def">syndrome</a> that increases the risk of kidney problems, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440104/" class="def">Denys-Drash syndrome</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000559084/" class="def">WAGR syndrome</a>.</div></li><li class="half_rhythm"><div>Being treated with more than one type of treatment.</div></li></ul></div><div id="CDR0000373791__801"><h4>Late effects that affect the kidney may cause certain health problems.</h4><p id="CDR0000373791__803">Kidney late effects or related health problems include the following:
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</p><ul id="CDR0000373791__804"><li class="half_rhythm"><div>Damage to the parts of the kidney that filter and clean the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>.</div></li><li class="half_rhythm"><div>Damage to the parts of the kidney that remove extra water from the blood.</div></li><li class="half_rhythm"><div>Loss of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044338/" class="def">electrolytes</a>, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373087/" class="def">magnesium</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045632/" class="def">calcium</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044344/" class="def">potassium</a>, from the body.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044038/" class="def">Hypertension</a> (high blood pressure).</div></li></ul></div><div id="CDR0000373791__805"><h4>Possible signs and symptoms of kidney late effects include problems urinating and swelling of the feet or hands.</h4><p id="CDR0000373791__807">These and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may be caused by kidney late effects or by other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>:</p><ul id="CDR0000373791__808"><li class="half_rhythm"><div>Feeling the need to urinate without being able to do so.</div></li><li class="half_rhythm"><div>Frequent <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046642/" class="def">urination</a> (especially at night).</div></li><li class="half_rhythm"><div>Trouble urinating.</div></li><li class="half_rhythm"><div>Feeling very tired.</div></li><li class="half_rhythm"><div>Swelling of the legs, ankles, feet, face, or hands.</div></li><li class="half_rhythm"><div>Itchy skin.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390302/" class="def">Nausea</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390324/" class="def">vomiting</a>.</div></li><li class="half_rhythm"><div>A metal-like taste in the mouth or bad breath.</div></li><li class="half_rhythm"><div>Headache.</div></li></ul><p id="CDR0000373791__809">Sometimes there are no signs or symptoms in the early <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stages</a>. Signs or symptoms may appear as damage to the kidney continues over time. Talk to your child's doctor if your child has any of these problems.
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</p></div><div id="CDR0000373791__810"><h4>Certain tests and procedures are used to detect (find) and diagnose health problems in the kidney.</h4><p id="CDR0000373791__812">These and other tests and procedures may be used to detect or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> kidney late effects:</p><ul id="CDR0000373791__813"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689078/" class="def">history</a></b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000304685/" class="def">Blood chemistry study</a></b>: A procedure in which a blood sample is checked to measure the amounts of certain substances, such as magnesium, calcium, and potassium, released into the blood by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> in the body. An unusual (higher or lower than normal) amount of a substance may be a sign of kidney disease.
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</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046641/" class="def">Urinalysis</a></b>: A test to check the color of urine and its contents, such as sugar, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">protein</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046124/" class="def">red blood cells</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045993/" class="def">white blood cells</a>.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046157/" class="def">Ultrasound</a> exam</b>: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs, such as the kidney, and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.</div></li></ul><p id="CDR0000373791__815">Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of kidney late effects. If tests are needed, find out how often they should be done.
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</p></div><div id="CDR0000373791__816"><h4>Health habits that promote healthy kidneys are important for survivors of childhood cancer.</h4><p id="CDR0000373791__818">Childhood cancer survivors who had all or part of their kidney removed should talk to their doctor about the following: </p><ul id="CDR0000373791__819"><li class="half_rhythm"><div>Whether it is safe to play sports that have a high risk of heavy contact or impact such as football or hockey. </div></li><li class="half_rhythm"><div>Bicycle safety and avoiding handlebar injuries.</div></li><li class="half_rhythm"><div>Wearing a seatbelt around the hips, not the waist.</div></li></ul></div></div><div id="CDR0000373791__402"><h3>Bladder</h3><div id="CDR0000373791__408"><h4>Surgery to the pelvic area and certain types of chemotherapy increase the risk of bladder late effects.</h4><p id="CDR0000373791__410">The risk of health problems that affect the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046501/" class="def">bladder</a> increases after treatment with the following:</p><ul id="CDR0000373791__411"><li class="half_rhythm"><div>Surgery to remove all or part of the bladder.</div></li><li class="half_rhythm"><div>Surgery to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046246/" class="def">pelvis</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415914/" class="def">spine</a>, or brain.</div></li><li class="half_rhythm"><div>Certain types of chemotherapy, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045253/" class="def">cyclophosphamide</a> or ifosfamide.</div></li><li class="half_rhythm"><div>Radiation therapy to areas near the bladder, pelvis, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046095/" class="def">urinary tract</a>.</div></li><li class="half_rhythm"><div>Stem cell transplant.</div></li></ul></div><div id="CDR0000373791__404"><h4>Late effects that affect the bladder may cause certain health problems.</h4><p id="CDR0000373791__406">Bladder late effects and related health problems include the following:</p><ul id="CDR0000373791__407"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000695987/" class="def">Hemorrhagic cystitis</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044042/" class="def">inflammation</a> of the inside of the bladder wall, which leads to bleeding).</div></li><li class="half_rhythm"><div>Thickening of the bladder wall.</div></li><li class="half_rhythm"><div>Trouble emptying the bladder.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046354/" class="def">Incontinence</a>.</div></li><li class="half_rhythm"><div>A blockage in the kidney, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046638/" class="def">ureter</a>, bladder, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046640/" class="def">urethra</a>.</div></li><li class="half_rhythm"><div>Urinary tract <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045641/" class="def">chronic</a>).</div></li></ul></div><div id="CDR0000373791__820"><h4>Possible signs and symptoms of bladder late effects include changes in urination and swelling of the feet or hands.</h4><p id="CDR0000373791__822">These and other signs and symptoms may be caused by bladder late effects or by other conditions:
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</p><ul id="CDR0000373791__823"><li class="half_rhythm"><div>Feeling the need to urinate without being able to do so.</div></li><li class="half_rhythm"><div>Frequent urination (especially at night).</div></li><li class="half_rhythm"><div>Trouble urinating.</div></li><li class="half_rhythm"><div>Feeling like the bladder does not empty completely after urination.</div></li><li class="half_rhythm"><div>Swelling of the legs, ankles, feet, face, or hands.</div></li><li class="half_rhythm"><div>Little or no bladder control.</div></li><li class="half_rhythm"><div>Blood in the urine.</div></li></ul><p id="CDR0000373791__824">Talk to your child's doctor if your child has any of these problems.</p></div><div id="CDR0000373791__825"><h4>Certain tests and procedures are used to detect (find) and diagnose health problems in the bladder.</h4><p id="CDR0000373791__827">These and other tests and procedures may be used to detect or diagnose bladder late effects:
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</p><ul id="CDR0000373791__828"><li class="half_rhythm"><div><b>Physical exam and history</b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.</div></li><li class="half_rhythm"><div><b>Blood chemistry study</b>: A procedure in which a blood sample is checked to measure the amounts of certain substances, such as magnesium, calcium, and potassium, released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance may be a sign of bladder problems.</div></li><li class="half_rhythm"><div><b>Urinalysis</b>: A test to check the color of urine and its contents, such as sugar, protein, red blood cells, and white blood cells.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750105/" class="def">Urine culture</a></b>: A test to check for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044123/" class="def">bacteria</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000770605/" class="def">yeast</a>, or other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044059/" class="def">microorganisms</a> in the urine when there are symptoms of infection. Urine cultures can help identify the type of microorganism that is causing an infection. Treatment of the infection depends on the type of microorganism that is causing the infection.</div></li><li class="half_rhythm"><div><b>Ultrasound exam</b>: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs, such as the bladder, and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.</div></li></ul><p id="CDR0000373791__831">Talk to your child's doctor about whether your child needs to have tests and procedures to check for signs of bladder late effects. If tests are needed, find out how often they should be done.</p></div></div></div><div id="CDR0000373791__111"><h2 id="_CDR0000373791__111_">To Learn More About Late Effects of Treatment for Childhood Cancer</h2><p id="CDR0000373791__112">For more information about <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390292/" class="def">late effects</a> of treatment for childhood <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>, see the following:</p><ul id="CDR0000373791__113"><li class="half_rhythm"><div><a href="http://www.survivorshipguidelines.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers</a></div></li><li class="half_rhythm"><div><a href="http://applications.childrensoncologygroup.org/Surveys/lateEffects/lateEffects.PublicSearch.asp" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Late Effects Directory of Services</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/diagnosis-staging/ct-scans-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Computed Tomography (CT) Scans and Cancer</a></div></li></ul><p id="CDR0000373791__891">For more childhood cancer information and other general cancer resources from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044266/" class="def">National Cancer Institute</a>, see the following:</p><ul id="CDR0000373791__892"><li class="half_rhythm"><div><a href="http://www.cancer.gov/types/childhood-cancers" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Childhood Cancers</a></div></li><li class="half_rhythm"><div><a href="http://www.curesearch.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">CureSearch for Children's Cancer</a>
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</div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/types/aya" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Adolescents and Young Adults with Cancer</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/publications/patient-education/young-people" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Young People with Cancer: A Handbook for Parents</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/types/childhood-cancers/child-adolescent-cancers-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Care for Children and Adolescents with Cancer</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/diagnosis-staging/staging/staging-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Staging</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/coping" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Coping with Cancer: Supportive and Palliative Care</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/coping/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor About Cancer</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/publications" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Library</a></div></li><li class="half_rhythm"><div><a href="http://cancercontrol.cancer.gov/ocs/resources/survivors.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Information for Survivors/Caregivers/Advocates</a></div></li></ul></div><div id="CDR0000373791__114"><h2 id="_CDR0000373791__114_">Changes to This Summary (06/26/2015)</h2><p id="CDR0000373791__115">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> information summaries are reviewed regularly
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and updated as new information becomes available. This section
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describes the latest changes made to this summary as of the
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date above.</p><p id="CDR0000373791__116">
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Changes were made to this summary to match those made to the health professional version.</p></div><div id="CDR0000373791__AboutThis_1"><h2 id="_CDR0000373791__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000373791__AboutThis_2"><h3>About PDQ</h3><p id="CDR0000373791__AboutThis_3">Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in <a href="http://www.cancer.gov/espanol/publicaciones/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Spanish</a>.</p><p id="CDR0000373791__AboutThis_4">PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.</p></div><div id="CDR0000373791__AboutThis_5"><h3>Purpose of This Summary</h3><p id="CDR0000373791__AboutThis_6">This PDQ cancer information summary has current information about the late effects of treatment for childhood cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p></div><div id="CDR0000373791__AboutThis_7"><h3>Reviewers and Updates</h3><p id="CDR0000373791__AboutThis_8">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change.
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</p><p id="CDR0000373791__AboutThis_9">The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the <a href="http://www.cancer.gov/publications/pdq/editorial-boards/pediatric-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Pediatric Treatment Editorial Board</a>.
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</p></div><div id="CDR0000373791__AboutThis_10"><h3>Clinical Trial Information</h3><p id="CDR0000373791__AboutThis_11">A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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</p><p id="CDR0000373791__AboutThis_12">Clinical trials are listed in PDQ and can be found online at <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).
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</p></div><div id="CDR0000373791__AboutThis_13"><h3>Permission to Use This Summary</h3><p id="CDR0000373791__AboutThis_14">PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
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</p><p id="CDR0000373791__AboutThis_15">The best way to cite this PDQ summary is:</p><p id="CDR0000373791__AboutThis_21">National Cancer Institute: PDQ® Late Effects of Treatment for Childhood Cancer. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: <a href="http://www.cancer.gov/types/childhood-cancers/late-effects-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www.cancer.gov/types/childhood-cancers/late-effects-pdq</a>. Accessed <MM/DD/YYYY>.</p><p id="CDR0000373791__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in <a href="http://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 2,000 scientific images.
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</p></div><div id="CDR0000373791__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000373791__AboutThis_18">The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the <a href="http://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000373791__AboutThis_19"><h3>Contact Us</h3><p id="CDR0000373791__AboutThis_20">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="http://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="http://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div><div id="CDR0000373791__GetMore_3"><h2 id="_CDR0000373791__GetMore_3_">Get More Information From NCI</h2><p id="CDR0000373791__GetMore_15"><i><b>Call 1-800-4-CANCER</b></i></p><p id="CDR0000373791__GetMore_16">For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.</p><p id="CDR0000373791__GetMore_25"><i><b>Chat online
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</b></i></p><p id="CDR0000373791__GetMore_26">The <a href="https://livehelp.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's LiveHelp®</a> online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 8:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI websites and answer questions about cancer.
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</p><p id="CDR0000373791__GetMore_27"><i><b>Write to us</b></i></p><p id="CDR0000373791__GetMore_28">For more information from the NCI, please write to this address:</p><ul id="CDR0000373791__GetMore_29" class="simple-list"><li class="half_rhythm"><div>NCI Public Inquiries Office</div></li><li class="half_rhythm"><div>9609 Medical Center Dr. </div></li><li class="half_rhythm"><div>Room 2E532 MSC 9760</div></li><li class="half_rhythm"><div>Bethesda, MD 20892-9760</div></li></ul><p id="CDR0000373791__GetMore_17"><i><b>Search the NCI websites</b></i></p><p id="CDR0000373791__GetMore_18">The <a href="http://www.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a> provides online access to information on cancer, clinical trials, and other websites and organizations that offer support and resources for cancer patients and their families. For a quick search, use the search box in the upper right corner of each web page. The results for a wide range of search terms will include a list of "Best Bets," editorially chosen web pages that are most closely related to the search term entered.</p><p id="CDR0000373791__GetMore_30">There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.</p><p id="CDR0000373791__GetMore_19"><i><b>Find Publications</b></i></p><p id="CDR0000373791__GetMore_20">The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the <a href="https://pubs.cancer.gov/ncipl" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI Publications Locator</a>. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237).</p></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65927.1/?report=reader">PubReader</a></li><li><a href="/books/NBK65927.1/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65927" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65927" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Pediatric Treatment Editorial Board. Late Effects of Treatment for Childhood Cancer (PDQ®): Patient Version. 2015 Jun 26. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></div></div></li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Version History</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter shutter_closed" title="Show/hide content" remembercollapsed="true" pgsec_name="version_history" id="Shutter"></a></div><div class="portlet_content" style="display: none;"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><span class="bk_col_itm"><a href="/books/NBK65927.21/">NBK65927.21</a></span> October 29, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK65927.20/">NBK65927.20</a></span> October 13, 2022</li><li><span class="bk_col_itm"><a 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class="bk_col_itm"><a href="/books/NBK65927.9/">NBK65927.9</a></span> November 21, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65927.8/">NBK65927.8</a></span> April 25, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65927.7/">NBK65927.7</a></span> August 11, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65927.6/">NBK65927.6</a></span> May 26, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65927.5/">NBK65927.5</a></span> April 7, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65927.4/">NBK65927.4</a></span> April 1, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65927.3/">NBK65927.3</a></span> December 16, 2015</li><li><span class="bk_col_itm"><a href="/books/NBK65927.2/">NBK65927.2</a></span> October 30, 2015</li><li><span class="bk_col_itm">NBK65927.1</span> June 26, 2015 (Displayed Version)</li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000373791__387" ref="log$=inpage&link_id=inpage">General Information about Late Effects</a></li><li><a href="#CDR0000373791__36" ref="log$=inpage&link_id=inpage">Second Cancers</a></li><li><a href="#CDR0000373791__44" ref="log$=inpage&link_id=inpage">Cardiovascular System</a></li><li><a href="#CDR0000373791__493" ref="log$=inpage&link_id=inpage">Central Nervous System</a></li><li><a href="#CDR0000373791__152" ref="log$=inpage&link_id=inpage">Digestive System</a></li><li><a href="#CDR0000373791__198" ref="log$=inpage&link_id=inpage">Endocrine System</a></li><li><a href="#CDR0000373791__211" ref="log$=inpage&link_id=inpage">Immune System</a></li><li><a href="#CDR0000373791__459" ref="log$=inpage&link_id=inpage">Musculoskeletal System</a></li><li><a href="#CDR0000373791__417" ref="log$=inpage&link_id=inpage">Reproductive System</a></li><li><a href="#CDR0000373791__318" ref="log$=inpage&link_id=inpage">Respiratory System</a></li><li><a href="#CDR0000373791__333" ref="log$=inpage&link_id=inpage">Senses</a></li><li><a href="#CDR0000373791__363" ref="log$=inpage&link_id=inpage">Urinary System</a></li><li><a href="#CDR0000373791__111" ref="log$=inpage&link_id=inpage">To Learn More About Late Effects of Treatment for Childhood Cancer</a></li><li><a href="#CDR0000373791__114" ref="log$=inpage&link_id=inpage">Changes to This Summary (06/26/2015)</a></li><li><a href="#CDR0000373791__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li><li><a href="#CDR0000373791__GetMore_3" ref="log$=inpage&link_id=inpage">Get More Information From NCI</a></li></ul></div></div><div class="portlet"><div 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xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Testicular Cancer (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Testicular Cancer (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/29337473" 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2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/29337471" ref="ordinalpos=1&linkpos=5&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Salivary Gland Tumors (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Childhood Salivary Gland Tumors (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" 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