Screening

Many long-term health risks are hidden and though childhood cancer survivors may feel perfectly well, they are at risk for late effects and need individualized, appropriate screening.

It is always a good idea to see your primary health care practitioner at least once a year for health checks if you have had previous cancer treatment.

You should also visit the Children’s Oncology Group (COG) website section which has detailed long term follow-up and screening guidelines.  In practice these guidelines tend to vary slightly between different institutions:

 

Children's Oncology Group screenings

 

These guidelines were developed as a collaborative effort of the Nursing Discipline and the Late Effects Committee and are maintained and updated by the Children’s Oncology Group’s Long-Term Follow-Up Guidelines Core Committee and its associated Task Forces.

The type of screening required depends on the nature of the original treatment.  Special note should be taken of the following health problems included in the COG website:

 

Second Tumors:

Young women who previously had radiation therapy to the chest (e.g. treated for Hodgkin lymphoma), especially those treated in adolescence have a high risk for the development of breast cancer and should have early and more frequent screening. To find out more:

COG Survivorship Guidelines: Breast Cancer

Previous radiation to the abdomen is linked with an increased risk of colon cancer. The Children’s Oncology Group long-term follow-up guidelines recommend colonoscopy in survivors exposed to 30 Gy of abdominal RT beginning at age 35 or 10 years after radiation therapy, whichever occurs last.

COG Survivorship Guidelines: Colorectal cancer following treatment for childhood cancer

Skin cancer is more common in areas of skin previously treated with radiation therapy.

COG Survivorship Guidelines: Skin health 

Radiation therapy to the head is associated with the development of low grade, benign tumors called meningiomas (an overgrowth of the fibrous layer around the brain).  The incidence of these tumors increases with time after treatment.  Many centers recommend screening MR scans of the brain every 3 – 5 years to rule out these tumors.

Radiation-induced meningiomas: A shadow in the success story of childhood leukemia

Thyroid cancer is much commoner in people who have previously had radiation therapy to the head and neck.  This is a very slow growing cancer and is rarely if ever, life threatening. Screening includes regular examination of the thyroid, thyroid function blood tests and intermittent ultrasound scans of the thyroid.

COG Survivorship Guidelines: Thyroid problems

Sometimes a second tumor can occur within the previous radiation therapy field called a sarcoma. This is generally a tumor that grows quickly and is very difficult to screen for. If a childhood cancer survivor ever notices any new swelling or pain in a part of the body (especially in an area where previous radiation therapy was given) medical attention should be sought immediately.

Radiation induced sarcoma

Lung cancer is much commoner in survivors who smoke and can be a very difficult tumor to treat successfully.

Lung cancer following chemotherapy and radiation therapy

 

Other risks

Long-term survivors of childhood cancer are at risk for many different health problems and these include:

Cardiovascular problems:

Childhood cancer survivors are at increased risk for hypertension (high blood pressure) and should have blood pressure checks on a regular basis.

High blood pressure and heart disease

Radiation to the heart increases the risk of heart attacks (myocardial ischemia), heart failure and abnormal heart rhythms.  Screening involves an examination of their heart every year and an echocardiogram every three years or so.

Adriamycin chemotherapy is associated with a risk of damage to the heart muscle and heart failure. Screening involves an examination of their heart every year and an echocardiogram every three years or so.

Heart disease after treatment for childhood cancer

Lung damage:

Both bleomycin chemotherapy and lung radiation therapy can cause scarring and damage to the lungs.  Screening for this problem involves physical examination, pulmonary function tests and sometimes imaging.

COG Survivorship Guidelines: Pulmonary Health

Fertility problems:

Infertility is a common complication of treatment for childhood cancer.

COG Survivorship Guidelines: Female health issues

COG Survivorship Guidelines: Male health issues