Late effects of treatments for childhood brain and spinal cord tumours

Recovery from a childhood brain or spinal cord tumour and adjusting to life after treatment is different for each child. Recovery depends on the type and dose of treatment, the child’s age at the time of treatment and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects.

The child’s healthcare team will watch for late side effects and can help to prepare you for what to expect. They can also suggest ways to help your child.

Radiation therapy to areas around the pituitary gland and hypothalamus can reduce the amount of hormones that the pituitary gland releases. Your child will see an endocrinologist (doctor who specializes in hormones) to monitor them for any hormone problems.

Lowered amounts of growth hormone (GH) can slow growth and affect bones and height. This can result in short stature and bones that don’t reach full maturity. GH replacement therapy is often given after treatment is completed to help the child grow and develop normally.

Lowered amounts of thyroid-stimulating hormone (TSH) can lead to thyroid problems such as hypothyroidism (reduced thyroid hormones), causing tiredness, dry skin, weight gain, constipation, slowed bone growth and thinning hair. Thyroid hormone replacement therapy may be given to help the thyroid function normally.

Lowered amounts of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) can lead to changes in testosterone levels in males and changes in estrogen levels in females. This could cause male or female reproductive system problems such as early puberty or failure to fully develop through puberty, impotence in males and irregular menstrual periods in females. Hormone replacement therapy may be given to maintain normal testosterone levels in males and estrogen levels in females.

Find out more about bone and muscle problems, thyroid problems, female reproductive system problems and male reproductive system problems.

The brain tumour or treatments, such as surgery, radiation therapy, high-dose chemotherapy or intrathecal chemotherapy, can cause thinking, learning and memory problems. These changes could include:

• memory loss
• shorter attention span
• reading difficulties
• reduced ability to understand what is read or heard
• writing difficulties
• spelling problems
• speech difficulties
• difficulty solving math problems
• difficulty with spatial relations, such as order, size, distance, volume and time (for example, the child may mix up the order of letters in a word or words in a sentence, forget the arrangement of items in a locker or desk or have difficulty determining the space between people in a line and the arrangement of people in that line)

Neurocognitive changes can affect a child’s education and future financial and employment opportunities. Neuropsychologists (psychologists with specialized knowledge about childhood neurocognitive issues) can do an in-depth assessment of the child’s neurocognitive abilities and identify problem areas and challenges that the child may have. Together with the child’s teachers, an individualized plan can be created to ensure that the child has the help, support and resources needed to cope with these changes.

Find out more about learning problems.

Radiation therapy to the head and certain chemotherapy drugs, such as cisplatin (Platinol AQ) and carboplatin (Paraplatin, Paraplatin AQ), may cause hearing loss when they are given to very young children. This may lead to other concerns, such as delayed language development and impaired social development. Hearing tests are usually done at the end of treatment and then once a year to monitor the child’s hearing. If necessary, the child may need a hearing aid or speech therapy.

Find out more about hearing problems and speech-language problems.

Some chemotherapy drugs and radiation therapy to the head or neck can cause oral and dental problems. These problems may include a higher risk for cavities and white or discoloured patches on the teeth. The treatments can also affect the roots of teeth so they are shorter or thinner, or sometimes teeth or roots don’t grow at all. Oral and dental problems can develop many years after treatment is finished.

Find out more about dental problems.

Surgery on a brain tumour may cause a change in the child’s muscle strength and physical coordination. Physical or occupational therapists are specialists in rehabilitation who will help the child regain as much coordination and strength as possible.

Children treated with radiation therapy to the brain are at risk for growth hormone (GH) deficiency. If the body doesn’t have enough GH, it can develop musculoskeletal problems. These problems mean the bones and muscles don’t grow as they should, which can lead to underdeveloped muscles, curvature of the spine, shorter limbs and shorter height. Some children may need artificial (synthetic) GH replacements if their growth is affected. Children treated with radiation therapy to the brain are also at risk for osteoporosis due to low levels of sex and growth hormones.

Radiation to the spine may slow the growth of the spinal cord and the bones in the spine. This could result in the child having a shortened body height, while their arms and legs grow to their normal length.

Younger children are more vulnerable to the effects of radiation. Therefore, doctors will try to avoid giving radiation to children under the age of 3.

Find out more about bone and muscle problems.

Brain tumours or their treatment may affect a child’s ability to swallow. Some children may only have a decreased gag reflex, but can still swallow. Others may not be able to swallow at all and may have to get their nutrition through a feeding tube. Speech therapists and occupational therapists can help with rehabilitation to improve the child’s ability to swallow and take foods orally again.

Find out more about difficulty swallowing.

Tumours along the optic nerve or their treatment can affect a child’s vision in a number of ways. The child’s vision may be decreased, blurry or doubled. Cataracts may form if the eyes were in the direct path of radiation. Occupational therapists may be able to help the child adjust to vision problems. It may help for a child who has double vision (diplopia) to wear a patch over one eye to reduce the discomfort and headaches that often come with seeing double. Eye surgeons may be able to remove cataracts caused by radiation and restore the child’s vision.

Find out more about eye problems.

Certain chemotherapy drugs, such as doxorubicin (Adriamycin), may cause heart problems, including weakening of the heart muscles.

The healthcare team will carefully monitor children receiving chemotherapy for any signs of heart damage. They will do regular physical exams and tests, such as echocardiograms (an ultrasound of the heart), electrocardiograms (EDG or EKG) and blood pressure monitoring. These exams and tests help doctors find heart problems early and determine if treatment is necessary.

Find out more about heart problems.

Radiation therapy to the brain and some chemotherapy drugs used to treat brain and spinal cord tumours can cause reproductive system problems.

Radiation therapy to the brain can cause lowered amounts of certain hormones. Lowered amounts of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) can lead to changes in testosterone levels in males and changes in estrogen levels in females. This could cause male or female reproductive system problems such as early puberty or failure to fully develop through puberty, impotence in males and irregular menstrual periods in females.

Certain chemotherapy drugs can affect the ovaries or testicles and cause reproductive problems for children as they get older. These problems include puberty starting earlier or later than average and infertility. The higher the total dose of chemotherapy, the greater the risk of damage.

Find out more about male reproductive system problems and female reproductive system problems.

Treatment for childhood brain and spinal cord tumours increases the risk of developing a second cancer. The level of risk depends on different factors, such as the type of the first cancer and previous treatments given. Children who received radiation therapy tend to have a higher risk of a second cancer occurring in the area that was treated.

Children treated for cancer today have a lower risk of developing a second cancer than they did in the past. New chemotherapy combinations, lower doses of chemotherapy and lower doses of radiation that are more accurately targeted to the tumour have lowered the risk of a second cancer.

Chemotherapy with alkylating agents can raise the risk of developing acute myelogenous leukemia (AML) or myelodysplastic syndrome.

Find out more about second cancers.

Find out more about watching for late effects of childhood cancer. To make the decisions that are right for your child, ask the healthcare team questions about supportive care after treatment.