Late Effect (1st of 10)
Stroke
Your risk is greater if:
- You have neurofibromatosis (NFI).
- You received a dose greater than 40 Gy.
Recommended Evaluations
- Clinical evaluation yearly
- Special imaging studies such as an MRI with MR angiography as indicated
Management
- You will be referred to a pediatric or adult neurologist.
Late Effect (2nd of 10)
Brain tumor (high-grade astrocytoma, meningioma, sarcoma)
Your risk is greater if:
- You were young when you were treated, especially if you were less than 6 years.
- You had central nervous system (CNS) leukemia when you were diagnosed.
- You have neurofibromatosis (NFI).
- You have Ataxia telangiectasia (hereditary disorder with many manifestations).
- You received a higher dose of radiation.
Recommended Evaluation
- History and physical exam yearly
- Special imaging such as an MRI or CT based on symptoms
Management
- You may need a neurosurgical consultation for diagnosis and possible surgery.
- You will need a neuro-oncology consultation for medical management.
Late Effect (3rd of 10)
Growth hormone deficiency
Your risk is greater if:
- You had a higher radiation dose, especially if the dose to the pituitary gland was over 18 Gy.
Recommended Evaluation
- You should have an evaluation every 6 months until your growth is completed.
- Your height, weight, and body mass should be monitored with regular physical exams.
- You will need to see a growth specialist (a pediatric endocrinologist) if you are growing poorly.
Management
- You should see an endocrinologist for further evaluation and possible treatment.
Late Effect (4th of 10)
Early onset of puberty
Your risk is greater if:
- You are female.
- You were less than 6 years of age when you were treated and you are now less than 10 years of age
Recommended Evaluation
- A complete physical exam every 6 months until you are 12-13 years of age
Management
- If there are signs of early puberty (breast development in a girl less than 8 years, sexual hair in a boy less than 9 years) you will need to see a pediatric endocrinologist.
- Drug treatments are available to temporarily stop early puberty, if indicated.
Late Effect (5th of 10)
Other pituitary hormone deficiencies (such as the hormones that regulate the thyroid [TSH], the adrenal glands [ACTH], and the testicles/ovaries [LH and FSH]
Your risk is greater if:
- Your treatment dose was high, especially if the dose to the pituitary gland was over 30 Gy.
Recommended Evaluation
- Special hormone tests should be performed yearly by an endocrinologist (a hormone specialist).
Management
- Hormone replacement therapy is available if you develop one of these hormone problems
Late Effect (6th of 10)
Obesity
Your risk is greater if:
- You were young at diagnosis, especially if you are female and were less than 4 years old.
- You had a high dose to the head (brain), especially greater than 20 Gy.
- You have growth hormone deficiency.
- You cannot or do not exercise.
Recommended Evaluation
- A complete physical exam yearly
- Fasting bloods for fat levels such as cholesterol every five years
- Fasting blood for insulin and sugar levels to look for signs of diabetes as indicated
Management
- Weight reducing diets; consider nutritional counseling
- Regular exercise (30-45 minutes) 3-5 times per week
Late Effect (7th of 10)
Chronic sinusitis
Your risk is greater if:
- You had higher cumulative dose to sinuses.
- You have hayfever or other types of allergies.
- You have reduced immunity (your immunoglobulin levels are low).
Recommended Evaluation
- History and physical exam yearly
- CT of sinuses as indicated
Management
- You may need an otolaryngology (eye, ear, nose, and throat specialist) consultation.
Late Effect (8th of 10)
Dry mouth (salivary gland dysfunction)
Your risk is greater if:
- You had head and neck radiation including the parotid gland, especially if it was greater than 30 Gy.
Recommended Evaluation
- History and physical exam yearly
Management
- You may benefit from saliva substitutes.
- You should have regular dental care including fluoride applications.
Late Effect (9th of 10)
Dental problems (small teeth, enamel dysplasia, periodontal disease, tooth decay, malocclusion [poor bite], dysfunction of the jaw bone joint)
Your risk is greater if:
- You were young when you were treated, especially if you were younger than 5 years.
- You had a higher radiation dose, especially 30 Gy or more, but dental problems are possible in children who had only 10 Gy.
Recommended Evaluation
- Dental exam and cleaning every 6 months
Management
- Have regular dental care including fluoride applications.
- Have a consultation with an orthodontist experienced in managing childhood cancer survivors.
- You may need plastic surgery for facial reconstruction.
- You may benefit from a psychological consultation if you have difficulty adjusting to a facial asymmetry/deformity.
Late Effect (10th of 10)
Craniofacial abnormalities
Your risk is greater if:
- You were at a younger age at treatment, especially age 5 or younger.
- You received a higher dose of radiation.
Recommended Evaluation
- You should have a psychosocial assessment as indicated to help with coping.
Management
- Most patients with this type of side effect will benefit from counseling.
