What is it about ?
Cancer in children can in many cases be treated successfully. However, much later, physical and psychological problems can arise. They depend on many factors: the type of tumor, the location of the tumor, the treatment, the possible role of hereditary factors, the environment and psychological support …
The problems fall into three groups:
- Problems related to treatment;
- Secondary cancers, which are other cancers caused by cancer treatment;
- Psychological problems.
What is their frequency?
About half of the people who had cancer in their childhood develop, at a later age, a problem because of the cancer treatment.
The risk of secondary cancer is between 3 and 10%. This is 10 to 20 times more than in the general population.
How to recognize them?
Problems due to treatment
These are especially the radiotherapy and the chemotherapy which can have consequences later. These consequences are mainly related to the location of the cancer. A well-localized tumor is often treated topically, causing very specific abnormalities. Cancers such as leukemia require more general treatment, and the consequences are therefore more general as well.
The head
The radiotherapy in the head and brain at a young age can damage the central nervous system. From memory problems and learning problems can arise. From tumors in the brain can also appear at an older age. It is especially seen after radiotherapy of the head in case of leukemia in children. Fine motor and gross motor disorders can also occur.
After one radiotherapy in the brain, the secretion of growth hormone may decrease, which may prevent growth. The radiotherapy at the level of growth cartilages in the bones can cause growth to slow down. Usually, children who had cancer as a child still reach their normal size.
The neck
After one radiotherapy neck, there is a risk ofhypothyroidism (decrease and stop of the function of the thyroid gland). This problem can be present for a long time without causing symptoms.
The heart
The heart can be damaged after certain types of chemotherapy and of radiotherapy thorax, especially in children under 4 years old. Treatments can damage the muscle of the heart, decrease the functioning of the ventricles, cause obstruction of the coronary arteries or chronic inflammation of the pericardium (pericarditis). Sometimes these problems do not appear for several years after treatment. They do not always cause symptoms and often occur at the same time as other problems, such as a viral infection, or during pregnancy.
Cardiovascular risk factors
THE’excess weight and the metabolic syndrome are more common in people who had cancer as a child and especially after a radiotherapy of the head. There appear to be changes in the metabolism of sugars and fats, the cause of which is not well known. These people are therefore more at risk of developing arteriosclerosis and, consequently, of having an heart attack or one stroke. Conversely, we sometimes observe an insufficient weight in adulthood.
Lungs
As a result of the disease and the treatment, the mobility of the chest may decrease, resulting in a reduction in the volume of air that the lung can hold. Some chemotherapy can cause chemical inflammation of the lungs. Sometimes this causes scarring of the lungs, which also limits the function of the lungs.
Sexual organs
In women, the radiotherapy lower abdomen and high doses of certain chemotherapy in childhood damage the ovaries and uterus. However, experience shows that ovarian function can often still recover and that the ovaries of non-pubescent girls are less susceptible to the negative effects of chemotherapy.
Currently, there is greater success in preventing infertility when treating children with cancer. If a infertility occurs anyway, there are different treatment options. Sometimes the doctor needs to give hormone replacement therapy.
In boys, the radiotherapy and the chemotherapy damage the testicles. Fortunately, healing of sperm-producing cells is common. Usually, testosterone production remains sufficient.
Childhood cancer survivors are only at risk of passing cancer to their own children if they have genetic cancer syndrome. No risk of birth defects has been shown in their children.
Kidneys and urinary tract
Certain types of chemotherapy are harmful to the kidneys and cause damage. Usually, this damage remains stable after stopping treatment. These types of chemotherapy and of radiotherapy kidneys can also causearterial hypertension.
Bones and teeth
The radiotherapy of the bone system or brain can cause underdevelopment of the bones and reduced bone density. In some people, hormone deficiency can also reduce bone strength, which makes it easier for them to break bones.
Over time, the bones will spontaneously become stronger again. Hormone and calcium treatments may optionally be given. In adulthood, you can also take drugs that strengthen bones.
Sometimes the teeth are missing or smaller in size. The enamel layer of the teeth can also be reduced, which facilitates the development of cavities.
The development of secondary cancers
Secondary cancers can occur in all irradiated areas and in the skin. Benign tumors are also diagnosed more often. the bone cancer and the breast cancer are the most common forms of secondary cancer, next to the skin cancer, tumors of the thyroid gland, brain tumors and colorectal cancer. Most secondary cancers occur after treatment with a Hodgkin lymphoma and after a stem cell transplant.
Chemotherapy can be responsible for leukemia a few years after treatment.
Psychosocial problems
People can have problems later in life because of the cancer they have had. These may be physical disabilities that are sometimes difficult to accept and which must be psychologically managed. Cancer and its treatment can be very traumatic for children. It can resurface years later in difficult times.
How is the diagnosis made?
Especially during their growth, survivors of childhood cancer are closely followed in a specialized center. Individual follow-up is also important afterwards, depending on the type of cancer, age and treatment.
Here are a few examples:
- A ultrasound of the heart is carried out as a check after the end of treatment, then 5 and 10 years later (or more often in the event of a problem);
- During pregnancy, a ultrasound of the heart should take place quarterly;
- Those at risk should have a stress test (stress test on a bicycle) ;
- In case of complaints fromshortness of breath, the doctor should perform a more detailed examination of the lungs;
- To control the kidneys, the doctor must monitor the blood pressure.
What can you do ?
Take good care of your body: eat healthy, do not smoke, pay attention to your physical condition. Protect your skin against sunburn.
Watch over your sanity. If necessary, get help.
Pay attention to your body and the changes in your body. Go to the doctor in time for a check-up.
What can the doctor do?
Secondary cancers sometimes occur in the years after treatment, but may also not appear until 30 years later. In people with a history of cancer in childhood, the doctor should consider a higher risk of developing other cancers. He should always perform a clinical examination and consider ordering additional examinations (by imaging).
The doctor must also be attentive to psychological aspects and remain alert to possible traumatic experiences in the past.
Want to know more?
Are you looking for more specialized help?
- Cancerinfo 0800 15 801 – Information and support telephone line – Fondation contre le cancer
- Mental Health Services – The Social Guide
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