Long-term Side Effects of Cancer

Many people who have had cancer treatment have a risk of developing long-term side effects. These side effects can happen months or years after treatment. Evaluating and treating late effects is an important part of cancer survivorship care.

Types of late effects

Nearly any cancer treatment can cause late effects. And different treatments can cause different late effects. Below is a list of the more common late effects. Talk with your doctor about any concerns you have about a specific late effect.

Problems from surgery. Late side effects from surgery depend on the type of cancer and where in the body you had surgery:

• Survivors of Hodgkin lymphoma, especially those diagnosed before 1988, often had their spleens removed. The spleen is a vital organ for the immune system. Removing it is linked with a higher risk of infections.

• Survivors of bone and soft-tissue cancers may have lost part or all of a limb. This can cause physical and emotional effects. One example is phantom limb pain. This is feeling pain in the limb that was removed even though it is no longer there. Rehabilitation can help people cope with physical changes from treatment.

• People who had radiation therapy or surgery to remove lymph nodes may develop lymphedema. Lymph nodes are tiny, bean-shaped organs that help fight infection. Lymphedema is when lymph fluid builds up and causes swelling and pain.

• People who had certain surgeries in the pelvis or abdomen may not be able to have children. This is called infertility. Learn more about fertility concerns and preserving fertility in men and in women.

Heart problems. Both chemotherapy and radiation therapy to the chest can cause heart problems. Some survivors may have a higher risk. This includes those who:

• Received treatment for Hodgkin lymphoma as a child

• Are 65 and older

• Received higher doses of chemotherapy

• Received certain medicines, such as trastuzumab (Herceptin, Ogivri) and doxorubicin (Adriamycin, Doxil)

Below is a list of common heart conditions. Talk with your doctor right away if you have any of these symptoms:

• Congestive heart failure (CHF) is weakening of the heart muscle. Symptoms include shortness of breath, dizziness, and swollen hands or feet.

• Coronary artery disease is a type of heart disease. It is more common in those who had high doses of radiation therapy to the chest. Symptoms include chest pain and shortness of breath.

• Arrhythmia is an irregular heartbeat. Symptoms include lightheadedness, chest pain, and shortness of breath.

Examples of drugs that can cause heart problems:

• Trastuzumab

• Doxorubicin

• Daunorubicin (Cerubidine)

• Epirubicin (Ellence)

• Cyclophosphamide (Genoxal, Mitoxan)

• Osimertinib (Tagrisso)

Ask your doctor if the treatments you are receiving can affect your heart. He or she may check your heart function and watch for damage during and after treatment. Your doctor may use a test called echocardiography, also called an echo. Other heart tests may include a physical examination, an electrocardiogram (EKG or ECG), and a multigated acquisition scan (MUGA) scan.

Hypertension. This is also called high blood pressure. It may happen along with CHF (see above). Or it may be a separate symptom. If you have high blood pressure, your doctor may watch it more closely during cancer treatment. Accelerated hypertension is when blood pressure suddenly and rapidly rises. It often causes organ damage. So it is vital to get medical help right away.

Some cancer drugs can cause high blood pressure. Examples of these drugs include:

• Bevacizumab (Avastin, Mvasi)

• Sorafenib (Nexavar)

• Sunitinib (Sutent)

The risk of high blood pressure lowers once a person stops taking these drugs. But the long-term effects are not known. Survivors with increased risk for high blood pressure should work with their health care team to lower this risk. This may include testing blood pressure, losing weight, eating less salt, taking medicine, and being active.

Lung problems. Chemotherapy and radiation therapy to the chest may hurt the lungs. Cancer survivors who received both chemotherapy and radiation therapy may have a higher risk of lung damage. People who have had lung disease and older adults may have more lung problems.

Drugs that may cause lung damage include:

• Bleomycin (Blexane)

• Carmustine (Becenum, BiCNU, Carmubris)

• Methotrexate (multiple brand names)

The late effects to the lungs may include:

• A change in how well the lungs work

• Thickening of the lining of the lungs

• Inflammation of the lungs

• Difficulty breathing

Endocrine system problems. Some types of cancer treatments may affect the endocrine system. This system includes the glands and other organs that make hormones and make eggs or sperm. Cancer survivors at risk for hormone changes from treatment need regular blood tests to measure hormone levels.

• Menopause. Many cancer treatments may cause a woman to have menopausal symptoms. These treatments include:

  • Surgery to remove a woman’s ovaries (oophorectomy)

  • Chemotherapy

  • Hormone therapy

  • Radiation therapy to the pelvic area

  The symptoms of menopause caused by cancer treatment may be worse than the symptoms of natural menopause. This is because the decrease in hormones happens more quickly. Symptoms include:

  • Changes in mood or sexual desire

  • Hot flashes

  • Osteoporosis

  • Bladder control problems

  Women taking hormone therapy who have not been through menopause may have lighter and fewer menstrual periods. Menstrual periods may stop completely for other women. After treatment, menstrual periods may come back for some younger women. But women older than 40 are less likely to have them return. Some times cancer treatment causes menopause sooner than normal. It may also cause menopause to start right away.

• Hormone problems for men. Some treatments may cause men to experience symptoms similar to menopause. These include hormone therapy for prostate cancer or surgery to remove the testicles. Symptoms may include:

  • Change in sexual desire

  • Hot flashes

  • Osteoporosis

• Infertility. Treatments that affect reproductive organs or the endocrine system increase risk of infertility. Infertility means not being able to become pregnant or father a child. Sometimes infertility from cancer treatment lasts a short time. But some times it is permanent. Learn more about fertility concerns and preserving fertility in men and in women.

• Hormone problems from head and neck radiation therapy. Radiation therapy to the head and neck area can lower hormone levels. It can also cause changes to the thyroid gland.

Bone, joint, and soft tissue problems. Chemotherapy, steroid medications, or hormonal therapy may cause thinning of the bones, called osteoporosis, or joint pain. Immunotherapy may cause problems in the joints or muscles. These are known as rheumatologic issues. People who are not physically active may have a higher risk of these conditions.

Cancer survivors can lower their risk of osteoporosis in these ways:

• Avoiding tobacco products

• Eating foods rich in calcium and vitamin D

• Becoming physically active

• Limiting how much alcohol they drink

Brain, spinal cord, and nerve problems. Chemotherapy and radiation therapy can cause long-term side effects to the brain, spinal cord, and nerves. These include:

• Hearing loss from high doses of chemotherapy, especially drugs like cisplatin (multiple brand names)

• Increased risk of stroke from high doses of radiation to the brain

• Nervous system side effects, including damage to the nerves outside the brain and spinal cord, called peripheral neuropathy

Cancer survivors should have regular physical examinations and hearing tests after treatment to check for these effects.

Learning, memory, and attention difficulties. Chemotherapy and high-dose radiation therapy to the head and other areas of the body may cause cognitive problems for adults and children. Cognitive problems occur when a person has trouble processing information. Talk with your doctor if you experience any of these issues.

Dental and oral health and vision problems. Cancer survivors may have dental and oral health and vision problems, depending on the treatments they received:

• Chemotherapy may affect tooth enamel and increase the risk of long-term dental problems.

• High doses of radiation therapy to the head and neck area may change tooth development. It can also cause gum disease and lower saliva production, causing a dry mouth.

• Steroid medications may increase the risk of eye problems. This includes clouding of the eye that affects vision, called cataracts.

To watch for future problems, survivors should schedule regular appointments with a dentist and an ophthalmologist. An ophthalmologist is a doctor who specializes in treating eye conditions.

Digestion problems. Chemotherapy, radiation therapy, and surgery may affect how a person digests food. Surgery or radiation therapy to the abdominal area can cause tissue scarring, long-term pain, and intestinal problems. Some survivors may have chronic diarrhea that reduces the body’s ability to absorb nutrients.

A registered dietitian (RD) can help people with digestion problems get enough nutrients. It may also be helpful to see a doctor who specializes in the digestive tract, called a gastroenterologist.

Emotional difficulties. Cancer survivors often have various positive and negative emotions:

• Relief

• A sense of gratitude to be alive

• Fear of recurrence

• Anger

• Guilt

• Depression

• Anxiety

• Feeling alone

Cancer survivors, caregivers, family, and friends may also have post-traumatic stress disorder. This is an anxiety disorder. It may develop after living through a very frightening or life-threatening event, such as cancer diagnosis and treatment.

Each person’s post-treatment experience is different. For example, some survivors struggle with negative emotional effects of cancer. Others say that they have a renewed, positive outlook on life because of the cancer.

Secondary cancers. This may be a new primary cancer. It may develop as a late effect of previous cancer treatments, such as chemotherapy and radiation therapy. Or it may be the original cancer that has spread to other parts of the body from where it started.

Chemotherapy and radiation therapy can also damage bone marrow stem cells. This increases the risk of either acute leukemia or myelodysplasia. Myelodysplasia is a blood cancer where the normal parts of the blood are either not made or are abnormal. Talk with your doctor about any new symptoms or side effects that you experience.

Fatigue. Fatigue is a constant feeling of physical, emotional, or mental tiredness. It is the most common side effect of cancer treatment. Some cancer survivors have fatigue for months or even years after finishing treatment. Learn more about cancer-related fatigue.

Questions to ask the health care team

Learn as much as you can about the potential long-term effects of your cancer treatment from your health care team. You may want to schedule a special appointment to review your treatment summary. This document should include information about your cancer, treatment, and follow-up care. The American Society of Clinical Oncology (ASCO) offers cancer treatment summary forms to store this information.

Consider asking your health care team these questions:

• Can you write down which treatment(s) I received?

• Am I at risk for specific late effects?

• Is there anything I can do to help prevent long-term side effects?

• What other specialists (such as a cardiologist or endocrinologist) should I see to watch for potential late effects?

• What signs or symptoms of late effects should I watch for?

This information was originally published at https://www.cancer.net/survivorship/long-term-side-effects-cancer-treatment.