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== Late Side Effects of Cancer Treatment ==
 
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Some have described survivorship as being "disease-free, but not free of your disease." What you experience with your body may be related to the type of cancer you had and the treatment you received. You may find that you’re still coping with the effects of treatment on your body. It can take time to get over these effects.

'''It's important to remember that no two people are alike'''. You may experience changes that are very different from someone else's, even if that person had the same type of cancer and treatment.

Many physical changes can be controlled. See Side Effects for more information about these physical changes and ways to manage them.  Talk to your doctor as soon as you notice any new problems.

For more information about physical changes after treatment for childhood cancer, see Late Effects of Treatment for Childhood Cancer (PDQ®)-Patient Version.

Cancer treatment also can cause side effects that may not show up for months or years after you’ve finished treatment. Late effects are specific to certain types of treatments and the dose received. When you and your doctor discuss your follow-up care, your doctor should talk with you about which late effects to watch for. Early medical attention often can reduce problems that can come from late effects.

=== Bone Loss ===

Chemotherapy, steroid medicines, hormonal therapy, or radiation therapy may cause thinning of the bones. With radiation therapy, bone loss will occur only in the part of the body that was treated.

'''Ways to Manage'''

After cancer treatment, you should have regular check-ups. During these visits, your doctor or nurse will do a physical exam and may order tests to check for bone loss. You can help lower your risk of bone loss by:

*Not smoking or using other tobacco products

*Eating foods that are rich in calcium and vitamin D

*Walking, jogging, or doing other weight-bearing exercise

*Limiting how much alcohol you drink

If you had radiation to the head and neck, also see Mouth Changes for tips on managing bone loss in your jaw.

=== Brain Changes ===

Some chemotherapy drugs and radiation therapy to the brain can cause problems months or years after treatment ends. Late effects may include:

*Memory loss

*Problems doing math

*Problems concentrating

*Slow processing of information

*Personality changes

*Movement problems

Radiation to the brain can cause radiation necrosis. This problem may happen when an area of dead tissue forms at the site of the brain tumor. Radiation necrosis can cause movement problems, problems concentrating, slow processing of information, and headaches.

'''Ways to Manage'''

After cancer treatment, you should have regular check-ups. If you have symptoms of brain changes, you will have tests to see whether they are due to the cancer or are late side effects of your treatment. If you have late side effects, your doctor or nurse:

*Will talk with you about ways to manage late side effects

*May refer you to a physical, occupational, or speech therapist who can help with problems caused by late side effects

*May prescribe medicine or suggest surgery to help with the symptoms

See our information about Memory or Concentration Problems for more information about brain changes.

=== Endocrine System Changes ===

Some cancer drugs and radiation to the head and neck can damage parts of the endocrine system. The endocrine system is a collection of organs and glands that control body functions such as growth, sexual development, reproduction, sleep, hunger, and the way the body uses food.

Parts of the endocrine system that may be damaged by cancer treatment include the thyroid, ovaries, and testes. Radiation to the head and neck may damage the thyroid. Radiation to the pelvis may damage the ovaries in women or the testes in men. Problems caused by these changes may include early menopause, infertility, under-active thyroid, and weight gain.

'''Ways to Manage'''

'''Early menopause'''. See Hot Flashes and Night Sweats (PDQ®) for more information about managing the symptoms of early menopause.

'''Sexuality and fertility'''. For information about sexual problems or managing infertility, see:

*Sexual Health Issues in Women

*Fertility Issues in Girls and Women

*Sexual Health Issues in Men

*Fertility Issues in Boys and Men

'''Thyroid problems'''. If you develop problems with your thyroid, your doctor may prescribe a hormone replacement therapy and closely watch your response to the medication.

=== Eye Problems ===

Chemotherapy, hormone therapy, immunotherapy, and steroid medicines may increase the risk of cataracts. Cataracts are a problem in which the lens of your eye becomes cloudy. Cataracts can cause:

*Blurred, cloudy, or double vision

*Sensitivity to light

*Trouble seeing at night

Some chemotherapy drugs can cause dry eye syndrome. This is a problem in which your eyes do not produce enough tears. Symptoms include feeling as if your eyes are dry or have something in them.

'''Ways to Manage'''

If you are at risk for cataracts, you should have regular visits with an ophthalmologist (a medical doctor who treats eye problems).

If cataracts become serious, they can be treated with surgery. In this type of surgery, an eye surgeon will remove the clouded lens and replace it with a plastic lens. You will usually have local anesthesia and be able to go home the same day.

If you develop dry eye syndrome, your doctor may prescribe regular treatment with eye drops or ointments.

=== Hearing Loss ===

Treatment with certain chemotherapy drugs (in particular, cisplatin and high doses of carboplatin) and high doses of radiation to the brain can cause hearing loss.

'''Ways to Manage'''

'''See an audiologist'''. If you had a cancer treatment that can cause hearing loss, you should have at least one visit with an audiologist after you have finished treatment. An audiologist is a professional trained in hearing disorders. Depending on the type and dose of cancer treatment that you received, you may need to see an audiologist more often.

'''Watch for signs of hearing loss'''. Let your doctor know right away if you notice changes in your hearing.

===Heart Problems===

Certain cancer drugs and radiation therapy to the chest may cause heart problems. Drugs that tend to cause heart problems include:

*Trastuzumab

*Doxorubicin

*Daunorubicin (Cerubidine)

*Epirubicin (Ellence)

*Cyclophosphamide (Neosar)

Heart problems caused by cancer treatment may include:

*A weakening of the heart muscle, which is known as congestive heart failure. It can cause shortness of breath, dizziness, and swollen hands or feet.

*Coronary artery disease, which occurs when the small blood vessels that supply blood and oxygen to the heart become narrow. It can cause chest pain or shortness of breath. This problem is more common in those who had high doses of radiation therapy to the chest.

'''Ways to Manage'''

After cancer treatment, you should have regular check-ups. If you have heart problems, your doctor or nurse might suggest that you:

*'''Eat a heart-healthy diet''' 
:A heart-healthy diet includes a variety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish, beans, and fat-free or low-fat milk or milk products. Your doctor will probably recommend that you follow a diet low in salt, because salt can cause extra fluid to build up in your body, making heart problems worse. The American Heart AssociationExit Disclaimer has many tips for heart-healthy eating.

*'''Watch fluid intake'''
:Drinking too much fluid can worsen heart problems, so it's important for people who have heart failure to drink the correct amounts and types of fluid. Talk with your doctor about what amounts and types of fluid you should have each day.

:Let your doctor know right away if you have sudden weight gain. This could mean extra fluid is building up. Also, if you have heart failure, you shouldn't drink alcohol.

*'''Lose weight if you're overweight or obese'''
:Carrying extra weight can put added strain on your heart. Work with your health care team to lose weight safely.

*'''Exercise''' 
:The right type and amount of exercise can help keep you and your heart healthy.  Talk with your doctor about which activities you can safely do. Exercise can help you become more fit and stay as active as possible.

*'''Quit smoking and avoid using illegal drugs''' 
:Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke. Smoking and drugs can make heart failure worse and harm your health. For help to quit smoking, visit Smokefree.gov or call toll-free, 1-800-QUIT-NOW (1-800-784-8669).

*'''Get enough rest''' 
:To learn more about sleep problems and how they are managed, see our information on Sleep Problems.

*'''Take medicines prescribed by your doctor''' 
:Your doctor may prescribe medicines based on the type of heart problem you have, how severe it is, and your response to certain medicines. Taking these medicines is important.

=== Joint Changes ===

Radiation therapy, some chemotherapy drugs, and steroids can cause scar tissue, weakness, and bone loss. These problems can lead to loss of motion in joints, such as your jaw, shoulders, hips, or knees. If you receive radiation therapy, these problems will occur only in the part of the body that was treated.

'''Ways to Manage'''

It is important to be aware of early signs of joint problems so these can be addressed before they worsen. These signs include:

*Trouble opening your mouth wide

*Pain when you make certain movements, such as reaching over your head or putting your hand in a back pocket

'''Talk with your doctor or nurse'''. He or she may refer you to a physical therapist who will assess your joint problems and give you exercises to do. Physical therapy exercises can decrease pain, increase strength, and improve movement. In some cases, your doctor may recommend a knee or hip replacement.

=== Lung Problems ===

Chemotherapy and radiation therapy to the chest may damage the lungs. Cancer survivors who received both chemotherapy and radiation therapy to the chest may have a higher risk of lung damage.  Lung damage can cause shortness of breath, wheezing, fever, dry cough, congestion, and feeling tired. Tell your doctor if you have any of these symptoms.

'''Ways to Manage'''

*'''Oxygen therapy'''
:If you have serious trouble breathing, your doctor may prescribe oxygen therapy. Oxygen is most often given through nasal prongs or a mask that fits over your mouth and nose.  In some cases, you might receive oxygen through a ventilator.

*'''Lose weight if you're overweight or obese''' 
:Excess weight can make it hard to breathe. Work with your doctor and health care team to lose weight safely.

*'''Exercise''' 
:Talk with your doctor about which activities you can safely do. Exercise can help you become more fit and stay as active as possible.

*'''Quit smoking and avoid using illegal drugs''' 
:Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke. Smoking and drugs can worsen lung problems and harm your health. For help to quit smoking, visit Smokefree.gov or call toll-free, 1-800-QUIT-NOW (1-800-784-8669).

*'''Take medicines prescribed by your doctor'''
:Your doctor can prescribe medicines to help you relax when it is hard to breathe, relieve discomfort, and treat pain.

Some people with lung problems take steroid pills. Steroids can interfere with the way the body uses specific nutrients, including calcium, potassium, sodium, protein, and vitamins C and D.

If you take steroid pills for lung problems, it is very important to eat a balanced diet that meets the Choose My Plate Food Guidelines. A healthy diet that includes foods from each food group can make up for some of the effects of steroid therapy.

=== Lymphedema ===

Lymphedema is a problem in which the lymph fluid does not drain like it should, builds up in the tissues, and causes swelling. You may be at risk for lymphedema if part of your lymph system is damaged during surgery to remove lymph nodes or by radiation therapy to areas with large numbers of lymph nodes. Lymphedema can develop many years after treatment.

See our Lymphedema page for more information, tips for managing, and signs to look for.

=== Mouth Changes ===

Radiation therapy to your head or neck and some chemotherapy drugs can cause late side effects in your mouth. Problems may include dry mouth, cavities, or bone loss in the jaw.

'''Ways to Manage'''

*'''Visit your dentist'''
:You may be asked to have your teeth checked every 1 to 2 months for at least 6 months after radiation treatment ends. During this time, your dentist will look for changes in your mouth, teeth, and jaw.

*'''Exercise your jaw'''
:Your doctor or nurse may suggest that you open and close your mouth 20 times as far as you can without causing pain, three times a day, even if your jaw isn’t stiff.

*'''Stimulate saliva'''
:Your doctor or nurse may suggest that you drink 8 to 10 cups of liquid per day. Keep a water bottle handy so you can sip throughout the day. You may also find sucking on sugarless candy or chewing gum helpful.

*'''Take good care of your teeth and gums'''
:Floss and use a mouthwash with fluoride every day. Brush your teeth after meals and before you go to bed. Also, avoid mouthwashes that contain alcohol.

*'''Explore your treatment options'''
:Ask your dentist to contact your radiation oncologist before you have dental or gum surgery. There may be other treatment options besides surgery. Also, do not have teeth pulled from the part of your mouth that received radiation.

=== Second Primary Cancers ===

Cancer treatment can sometimes cause a new cancer many years after you have finished treatment. When a new primary cancer occurs in a person with a history of cancer, it is known as a second primary cancer. Second primary cancers do not occur very often, but they can happen.

'''Ways to Manage'''

*Talk with your doctor about the types of second cancers you may be at risk for.

*Have regular check-ups for the rest of your life to check for cancer—the one you were treated for and any new cancer that may occur. Your doctor can suggest tests you may need to look for a new cancer and how often you should have them.

*Tell your doctor if you have any new symptoms or problems.

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