- Brain and spinal cord late effects are more likely to occur after treatment for certain childhood cancers.
- Radiation to the brain increases the risk of brain and spinal cord late effects.
- Late effects that affect the brain and spinal cord may cause certain health problems.
- Possible signs and symptoms of brain and spinal cord late effects include headaches, loss of coordination, and seizures.
- Certain tests and procedures are used to detect (find) and diagnose health problems in the brain and spinal cord.
- Survivors of childhood cancer may have anxiety and depression related to their cancer.
- Some childhood cancer survivors have post-traumatic stress disorder.
- Adolescents who are diagnosed with cancer may have social problems later in life.
Brain and spinal cord late effects are more likely to occur after treatment for certain childhood cancers.
Treatment for these and other childhood cancers
may cause brain and spinal cord
Radiation to the brain increases the risk of brain and spinal cord late effects.
The risk of health problems that affect the brain or spinal cord increases after treatment with the following:
When radiation to the brain and intrathecal chemotherapy are given at the same time, the risk of late effects is higher.
The following may also increase the risk of brain and spinal cord late effects:
- Being about 5 years old or younger at the time of treatment.
- Being female.
- Having hydrocephalus
and a shunt
placed to removed the extra fluid
from the ventricles.
- Having hearing loss.
- Having cerebellar mutism
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.
- Having a personal history
Central nervous system
late effects are also affected by where the tumor has formed in the brain and spinal cord.
Late effects that affect the brain and spinal cord may cause certain health problems.
Childhood cancer survivors
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:
- Loss of coordination and balance.
- Loss of the myelin
sheath that covers nerve
in the brain.
- Movement disorders
that affect the legs and eyes or the ability to speak and swallow.
- Nerve damage in the hands or feet.
- Stroke. A second stroke may be more likely in survivors who received radiation to the brain, have a history
of high blood pressure, or were older than 40 years when they had their first stroke.
- Loss of bladder
- Cavernomas (clusters of abnormal
- Back pain.
Survivors may also have late effects that affect thinking, learning, memory, emotions, and behavior.
New ways of using more targeted and lower doses
of radiation to the brain may lessen the risk of brain and spinal cord late effects.
Possible signs and symptoms of brain and spinal cord late effects include headaches, loss of coordination, and seizures.
may be caused by brain and spinal cord late effects or by other conditions
- Headache that may go away after vomiting.
- Loss of balance, lack of coordination, or trouble walking.
- Trouble speaking or swallowing.
- Trouble with having the eyes work together.
- Numbness, tingling, or weakness in the hands or feet.
- Being unable to bend the ankle to lift the foot up.
- Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body).
- Unusual sleepiness or change in activity level.
- Unusual changes in personality or behavior.
- A change in bowel habits or trouble urinating.
- Increase in head size (in infants).
- Sudden confusion
or trouble speaking or understanding speech.
- Sudden trouble seeing with one or both eyes.
- Sudden severe headache for no known reason.
Other signs and symptoms include the following:
- Problems with memory.
- Problems with paying attention.
- Trouble with solving problems.
- Trouble with organizing thoughts and tasks.
- Slower ability to learn and use new information.
- Trouble learning to read, write, or do math.
- Trouble coordinating movement between the eyes, hands, and other muscles.
- Delays in normal development.
- Social withdrawal or trouble getting along with others.
Talk to your child's doctor if your child has any of these problems.
Certain tests and procedures are used to detect (find) and diagnose health problems in the brain and spinal cord.
These and other tests and procedures may be used to detect or diagnose
brain and spinal cord late effects:
and history: 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.
Neurological exam: 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.
In some cases, a more complete exam may be done by a neurologist
Neuropsychological assessment: A series of tests to examine the patient's mental processes and behavior. Areas that are checked usually include:
- Knowing who and where you are and what day it is.
- Ability to learn and remember new information.
- Ability to solve problems.
- Use of spoken and written language.
- Eye-hand coordination.
- Ability to organize information and tasks.
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.
Survivors of childhood cancer may have anxiety and depression related to their cancer.
Survivors of childhood cancer may have anxiety
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 suicide. Survivors with these problems may be less likely to live on their own as adults.
Follow-up exams for childhood cancer survivors should include screening
and treatment for possible psychological
distress, such as anxiety, depression, and thoughts of suicide.
Some childhood cancer survivors have post-traumatic stress disorder.
Being diagnosed and treated for a life-threatening disease may be traumatic. This trauma
may cause post-traumatic stress disorder
(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.
PTSD can affect cancer survivors in the following ways:
- Reliving the time they were diagnosed and treated for cancer, in nightmares or flashbacks, and thinking about it all the time.
- Avoiding places, events, and people that remind them of the cancer experience.
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 radiation therapy
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 social support
from family or friends, and stress
not related to the cancer may increase the chances of having PTSD.
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.
Adolescents who are diagnosed with cancer may have social problems later in life.
who are diagnosed with cancer may reach fewer social milestones or reach them later in life than adolescents 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.
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. Adolescents and young adults who have survived cancer need special programs that give psychological, educational, and job support.