Known Medical Problems
Arthritis
Some cancer patients may experience chronic pain or arthritis of a joint from some aspect of their therapy. Patients who have received chronic steroids may have changes in their joints as steroids can damage the joint's blood supply. Radiation to a joint can also lead to long term problems. Finally, damage to a joint by the cancer itself can also lead to chronic pain and poor function.
Risks
- Radiation that had joints in the path. Only those joints in the path of the radiation will be affected.
- Long term use of steroids, particularly at high doses
- Surgery involving an affected joint
- Tumor that involved a joint
- Share your cancer and treatments with each new physician
- Discuss your risk of arthritis with your physician
- Consider seeking care from a joint doctor specialist (rheumatologist) or an orthopedic surgeon
- Changes in ability to perform physical activity
- Pain
- Swelling with tenderness of a joint
- Meet the calcium diet requirements. Eat at least four servings of calcium-rich foods daily to maintain strong bones about the joint.
- With your doctor's approval, discuss the need for physical therapy with a specialized exercise routine
Delayed Puberty
Some treatments for cancer can either delay or prevent the progression through normal pubertal development. Many patients will catch up over time, but others will not if there was sufficient damage to the testicles or ovaries that would prevent the production of normal hormones.
Risks
- Exposure to radiation to the area of the ovaries or testes
- Exposure to high doses of chemotherapy, particularly agents such as "alkylating agents" (nitrogen mustard, cyclophosphamide, ifosfamide, BCNU, CCNU, procarbazine)
- Share your cancer and treatments with each new physician
- Discuss your risk for delayed puberty
- Regular examinations by your physician to ensure that puberty is developing normally
- Consideration of an evaluation by a specialist (endocrinologist) if puberty appears to be delayed
Dental Caries
Some treatments for cancer may worsen already existing dental problems. This is particularly true for patients who have had radiation therapy around the head or neck or for patients who have chronic graft verses host disease. Saliva glands in the mouth can be damaged and these are important in preventing cavities. Also, radiation can directly affect the roots of the teeth leading to further problems.
Risks
- Radiation around the head or neck
- Chronic Graft vs. host disease
- Share your cancer and treatment with each new dentist.
- Talk about ways in which the risk of cavities can be minimized
- Twice a year dental exams
- Daily fluoride treatments
- Practice good dental hygiene (brushing and flossing regularly)
- Meet the calcium diet requirements (Eat at least four servings of calcium-rich foods daily.)
- Avoid smoking and smoke free tobacco products
- Seek prompt dental care for any signs of an early cavity, toothache or infection.
Fragile Bones
Some cancer treatments can lead to a weakening of bones which can last long after completion of therapy. Radiation exposure to a bone or long term use of steroids are the most commons sources. Sometimes damage to the kidney can affect the body's ability to make Vitamin D or the kidney can lose important salts which are essential for good bone health. These conditions can lead to repetitive breakage or fractures of bones which can be disabling or lead to chronic pain.
Risks
- Radiation that had bones in the path. Only those bones in the path of the radiation will be affected.
- Long term use of steroids, particularly at high doses
- Kidney damage from chemotherapy (particularly cisplatin, carboplatin, ifosfamide)
- Share your cancer and treatments with each new physician
- Discuss your risk for weak bones
- Keep track of any broken bones and fractures that may indicate particularly weak bones in your body
- Your doctor may recommend a bone density test which may give an indication of how strong your bones are and the potential need for therapy
- Changes in ability to perform physical activity
- Pain
- Swelling with tenderness above a bone
- Do not smoke
- Meet the daily calcium diet requirements (Eat at least four servings of calcium- rich foods daily)
- With your doctor's approval, include at least 20 minutes of weight bearing exercise in your workout routine
- Discuss with your doctor the need for Vitamin D supplementation
- Avoid too much alcohol and caffeine
- Avoid too much salt
Hair Loss
Although most patient's hair returns after completion of treatment, some patients have more persistent hair loss. Radiation to the scalp is a common source of this. Hair loss can invoke a variety of emotional and psychological responses. These resources address both the psychological impact and hair replacement options.
Resources
American Society for Dermatologic Surgery
MedlinePlus
Hearing Loss
Some treatments for cancer may lead to loss of hearing. This can be due to a variety of treatments including exposure to radiation at the ear, exposure to chemotherapy agents which can hurt the ear (cisplatin, carboplatin) exposure to other medications including antibiotics (gentamicin, tobramycin) or diuretics (furosamide) or hearing loss can be due to invasion of the tumor into the ear. Problems may arise in the development of speech problems, or patients may experience ringing in the ears (tinnitus).
Risks
- Treatment with chemotherapy agents such as cisplatin or carboplatin
- Exposure to the ear with radiation therapy
- Treatment with antibiotics known to be harmful to hearing (aminoglycosides)
- Share your cancer and treatments with each new physician
- Discuss your risk for hearing loss
- Hearing test (audiogram) should be done at long-term follow-up clinic or by an experienced audiologist. Long-term follow-up should be done two years after completion of treatment. Yearly testing should be done if the problem persists.
- Speech and language evaluation for those patients with a significant hearing loss.
- Difficulties in school, particularly in loud classrooms or where the patient sits far from the teacher
- Behavior problems in young children due to frustration from the inability to hear well
- Changes in speech or a delay in speech development
- Complaints of ringing in the ear in older children (tinnitus)
- Avoid further injury to hearing
- Wear protective haring devices when around excessive noise
- Avoid loud music particularly with headphones
- Avoid further exposure to medications that can damage hearing (aminoglycoside)
Heart failure
Heart failure can occur due to exposures to radiation or chemotherapy known to be damaging to the heart (doxorubicin, daunorubicin, epirubicin, idarubicin, mitoxantrone). This can slowly develop, even after several years of therapy.
Risks
- Exposure to radiation to the heart
- Exposure to chemotherapy known to be damaging to the heart (doxorubicin, daunorubicin, epirubicin, idarubicin, mitoxantrone)
- Shortness of breath
- Severe fatigue
- Wheezing or coughing that does not go away
- Anxiety
- Poor exercise tolerance
- Rapid or irregular heartbeat
- Dizziness or lightedheadness
- Chest pain
- Talk to your doctor before beginning an exercise program
- Do not over exert yourself
- Regular monitoring of your heart function
- Maintain a healthy diet
- Do not smoke
- Maintain a healthy weight
- Be aware of your blood pressure and take steps to keep it under control.
- Manage stress
- Exercise regularly
Infertility
Potentially infertility can result from any chemotherapy treatment or radiation to the reproductive organs. Patients who are at greatest risk are those who have received large amounts of "alkylator agents" (nitrogen mustard, cyclophosphamide, ifosfamide, BCNU, CCNU, procarbazine) over time.
Patients may experience no symptoms, as males will simply have low sperm counts, while female patients any experience irregular menses or experience signs of menopause (hot flashes, vaginal dryness, etc.).
Discussions about infertility can be difficult. In addition, it can invoke a variety of emotions. The resources listed on this web site deal with fertility options and the fertility section deals with many of the other aspects of infertility.
Resources
The Center for Young Women's Health-Children's Hospital Boston (http://www.youngwomenshealth.org/cancer.html)
Fertile Hope
http://www.fertilehope.org/
Learning Disability
Some treatments for cancer may lead to difficulties with school. This can cover a wide range of problems from apparent behavior problems in the classroom to difficulties with one particular subject, to more profound problems. Many problems are subtle and may not be apparent to the casual observer. Appropriate evaluation and management can lead to better school performance and an overall improvement.
Risks
- Exposure to radiation to the brain
- Exposure to chemotherapy administered to the brain or spinal core (intrathecal therapy)
- Exposure to high doses of chemotherapy that perntrates into the brain ( methotrexate, Ara-C, bulsulfan)
- Surgical procedures to the brain
- Share your cancer and treatments with school personnel
- Close monitoring of school performance looking for changes in behavior, grades, or amount of effort to perform relative to peers
- Comprehensive neurocognitive evaluation including evaluation of memory
- Familiarize yourself with your rights as a parent and student with regard to resources available to assist students in your school as mandated by law.
- Implement appropriate measures to optimize school performance based upon documented problems and strategies recommended by experienced meuropsychologists and educators.
Loss of libido
Some treatments for cancer may lead to difficulties with sexual function. This can include a loss of libido. This may be due to an inadequate production of sex hormones produced by the body.
Risks
- Exposure to radiation to the area of the ovaries or testes
- Exposure to high doses of chemotherapy, particularly agents such as "alkylating agents" (nitrogen mustard, cyclophosphamide, ifosfamide, BCNU, CCNU, procarbazine)
- Share your cancer and treatments with each new physician
- Discuss your risk for decreased sex hormone production
- Regular examinations by your physician to assess sex organ function
- Consideration of an evaluation by a specialist (endrocrinologist) if condition persists
Second Cancer
Some treatments for cancer may lead to the development of another cancer caused by the treatment of the first. These "secondary malignancies" are due to the inherent property of cancer therapy to attack the DNA of both normal and cancer cells. Such damaged cells can then change into a cancer just as a carcinogen can cause cancer to develop in previously normal people. The presentation, evaluation and treatment varies with the type of cancer developed. This risk is possibly lifelong and requires continuous follow- up for all patients treated for cancer.
Risks
- Treatment with chemotherapy agents, particularly "alkylating agents" (nitrogen mustard, cylcophosphamide, ifosfamide, BCNU, CCNU, procarbazine) or topoisomerase inhibitors (etoposide, doxorubicin, daunorubicin, epirubicin, idarubicin, mitoxantrone)
- Typically gives rise to a new leukemia
- Exposure to radiation therapy
- Often solid tumors in the path of the radiation therapy
- Share your cancer and treatments with each new physician
- Discuss your risk for second cancers
- Cancer Warning Signs
- Changes in bowel movements or urination, such as constipation, diarrhea, or a pinkish brown urine
- A sore that does not heal
- An unexplainable weight change
- Unusual bleeding or discharge
- A thickening or lump
- Frequent indigestion or difficulty swallowing
- Changes in warts or moles, especially if they grow or begin to bleed
- A nagging cough or hoarseness
- Excessive fatigue or bruising
- Recurrent infections
- Maintain a healthy diet
- Do not smoke
- Maintain a healthy weight
- Be aware of your blood pressure and take steps to keep it under control
- Manage stress
- Exercise regularly
Short Stature
Some cancer treatments can lead to a failure for children to achieve normal height. There are many factors that may lead to this, but it primarily fall into one of three categories:
- Inadequate production of hormones important for growth
- Damage to bones impairing further growth
- Damage to other organs (heart, lung, kidney) which can compromise growth
- Radiation that had bone in the path. Particularly spine or head or neck.
- Long term use of steroids, particularly at high doses
- Share your cancer and treatments with each new physician
- Discuss your risk for endocrine problems
- Keep track of your growth with regular visits to ensure that the growth rate is normal
- Your doctor may recommend a specialist (endocrinologist) to evaluate for the potential need for therapy
Thyroid-Recommendations
- Yearly check-up including blood test to measure thyroid levels and feeling the thyroid gland.
- Females planning to become pregnant should have their thyroid level checked before attempting pregnancy.
- Yearly check-ups that include evaluation of menstrual history, blood tests for hormone levels and possibly bone density test.
- Yearly physical that includes height and weight measurements. Prior to completion of growth, this should be done every six months.
Vision problems
Risks
Cancer treatment may compound vision problems that were already present. Symptoms of problems
- Blurry vision
- Double vision
- Blind spots
- Sensitivity to light
- Poor night vision
- Persistent irritation of surface of eye or eyelids
- Excessive tearing/watering or dryness of eyes
- Pain
- Be sure your yearly eye exam includes testing for cataracts.
- Wear sunglasses with UV protection
