Late Effects of Treatment for Childhood Cancer (PDQ®)—Patient Version - National Cancer Institute 5/7

Late Effects of Treatment for Childhood Cancer (PDQ®)—Patient Version - National Cancer Institute

Late Effects of Treatment for Childhood Cancer (PDQ®)–Patient Version

Reproductive System

KEY POINTS

• Testicles
  • Testicular late effects are more likely to occur after treatment for certain childhood cancers.
  • Surgery, radiation therapy, and certain types of chemotherapy increase the risk of late effects that affect the testicles.
  • Late effects that affect the testicles may cause certain health problems.
• Ovaries
  • Ovarian late effects are more likely to occur after treatment for certain childhood cancers.
  • Radiation therapy to the abdomen and certain types of chemotherapy increase the risk of ovarian late effects.
  • Late effects that affect the ovaries may cause certain health problems.
  • Possible signs and symptoms of ovarian late effects include irregular or absent menstrual periods and hot flashes.
• Fertility and reproduction
  • Treatment for cancer may cause infertility in childhood cancer survivors.
  • Childhood cancer survivors may have late effects that affect pregnancy.
  • There are methods that may be used to help childhood cancer survivors have children.
  • Children of childhood cancer survivors are not affected by the parent’s previous treatment for cancer.

Testicles

Testicular late effects are more likely to occur after treatment for certain childhood cancers.

Treatment for these and other childhood cancers may cause testicular late effects:

• Acute lymphoblastic leukemia (ALL).
• Germ cell tumors.
• Hodgkin lymphoma.
• Non-Hodgkin lymphoma.
• Sarcoma.
• Testicular cancer.
• Cancers treated with total-body irradiation (TBI) before a stem cell transplant.

Surgery, radiation therapy, and certain types of chemotherapy increase the risk of late effects that affect the testicles.

The risk of health problems that affect the testicles increases after treatment with one or more of the following:

• Surgery, such as the removal of a testicle, part of the prostate, or lymph nodes in the abdomen.
• Chemotherapy with alkylating agents, such as cyclophosphamide, dacarbazine, procarbazine, and ifosfamide.
• Radiation therapy to the abdomen, pelvis, or in the area of the hypothalamus in the brain.
• Total-body irradiation (TBI) before a stem cell transplant.

Late effects that affect the testicles may cause certain health problems.

Late effects of the testicles and related health problems include the following:

• Low sperm count: A zero sperm count or a low sperm count may be temporary or permanent. This depends on the radiation dose and schedule, the area of the body treated, and the age when treated.
• Infertility: The inability to father a child.
• Retrograde ejaculation: Very little or no semen comes out of the penis during orgasm.

After treatment with chemotherapy or radiation, the body’s ability to make sperm may come back over time.

Ovaries

Ovarian late effects are more likely to occur after treatment for certain childhood cancers.

Treatment for these and other childhood cancers may cause ovarian late effects:

• Acute lymphoblastic leukemia (ALL).
• Germ cell tumors.
• Hodgkin lymphoma.
• Ovarian cancer.
• Wilms tumor.
• Cancers treated with total-body irradiation (TBI) before a stem cell transplant.

Radiation therapy to the abdomen and certain types of chemotherapy increase the risk of ovarian late effects.

The risk of ovarian late effects may be increased after treatment with any of the following:

• Surgery to remove one or both ovaries.
• Chemotherapy with alkylating agents, such as cyclophosphamide, mechlorethamine, cisplatin, ifosfamide, lomustine, busulfan, and especially procarbazine.
• Radiation therapy to the abdomen, pelvis, or lower back. In survivors 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.
• Radiation therapy to the abdomen or pelvis together with alkylating agents.
• Radiation therapy to the area near the hypothalamus in the brain.
• Total-body irradiation (TBI) before a stem cell transplant.

Late effects that affect the ovaries may cause certain health problems.

Ovarian late effects and other health related problems include the following:

• Early menopause, especially in women who had their ovaries removed or were treated with both an alkylating agent and radiation therapy to the abdomen.
• Changes in menstrual periods.
• Infertility (inability to conceive a child).
• Puberty does not begin.

After treatment with chemotherapy, the ovaries may begin to work over time.

Possible signs and symptoms of ovarian late effects include irregular or absent menstrual periods and hot flashes.

These and other signs and symptoms may be caused by ovarian late effects or by other conditions:

• Irregular or no menstrual periods.
• Hot flashes.
• Night sweats.
• Trouble sleeping.
• Mood changes.
• Lowered sex drive.
• Vaginal dryness.
• Inability to conceive a child.
• Sex traits, such as developing arm, pubic, and leg hair or having the breasts enlarge, do not occur at puberty.
• Osteoporosis (weak or thin bones that can break easily).

Talk to your child's doctor if your child has any of these problems.

Fertility and reproduction

Treatment for cancer may cause infertility in childhood cancer survivors.

The risk of infertility increases after treatment with the following:

• In boys, treatment with radiation therapy to the testicles.
• In girls, treatment with radiation therapy to the pelvis, including the ovaries and uterus.
• Radiation therapy to an area near the hypothalamus in the brain or lower back.
• Total-body irradiation (TBI) before a stem cell transplant.
• Chemotherapy with alkylating agents, such as cisplatin, cyclophosphamide, busulfan, lomustine, and procarbazine.
• Surgery, such as the removal of a testicle or an ovary or lymph nodes in the abdomen.

Childhood cancer survivors may have late effects that affect pregnancy.

Late effects on pregnancy include increased risk of the following:

• High blood pressure.
• Diabetes during pregnancy.
• Anemia.
• Miscarriage or stillbirth.
• Low birth-weight babies.
• Early labor and/or delivery.
• Delivery by Cesarean section.
• The fetus is not in the right position for birth (for example, the foot or buttock is in position to come out before the head).

Some studies have not shown an increased risk of late effects on pregnancy.

There are methods that may be used to help childhood cancer survivors have children.

The following methods may be used so that childhood cancer survivors can have children:

• Freezing the eggs or sperm before cancer treatment in patients who have reached puberty.
• Testicular sperm extraction (the removal of a small amount of tissue containing sperm from the testicle).
• Intracytoplasmic sperm injection (an egg is fertilized with one sperm that is injected into the egg outside the body).
• In vitro fertilization (IVF) (eggs and sperm are placed together in a container, giving the sperm the chance to enter an egg).

Children of childhood cancer survivors are not affected by the parent’s previous treatment for cancer.

The children of childhood cancer survivors do not appear to have an increased risk of birth defects, genetic disease, or cancer.