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Musculoskeletal System

    Bone and joint

    Bone and joint late effects are more likely to occur after treatment for certain childhood cancers.

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

    Surgery, chemotherapy, radiation therapy, and other treatments increase the risk of bone and joint late effects.

    Radiation therapy

    Radiation therapy can stop or slow the growth of bone. The type of bone and joint late effect depends on the part of the body that received radiation therapy. Radiation therapy may cause any of the following:

    • Changes in the way the face or skull form, especially when treatment is given to children before age 5 or when high-dose radiation is given.
    • Tooth or sinus problems.
    • Short stature (being shorter than normal).
    • Scoliosis (curving of the spine) or kyphosis (rounding of the spine).
    • One arm or leg is shorter than the other arm or leg.
    • Osteoporosis (weak or thin bones that can break easily).


    Amputation or limb-sparing surgery to remove the cancer and prevent it from coming back may cause late effects depending on where the tumor was, age of the patient, and type of surgery. Health problems after amputation or limb-sparing surgery may include:

    • Having problems with activities of daily living.
    • Not being able to be as active as normal.
    • Chronic pain or infection.
    • Problems with the way prosthetics fit or work.
    • Broken bone.
    • One arm or leg is shorter than the other.

    Studies show no difference in quality of life in childhood cancer survivors who had amputation compared to those who had limb-sparing surgery.

    Chemotherapy and other drug therapy

    Risk may be increased in childhood cancer survivors who receive anticancer therapy that includes methotrexate or corticosteroids or glucocorticoids such as dexamethasone. Drug therapy may cause any of the following:

    • Osteoporosis (weak or thin bones that can break easily).
    • Osteonecrosis (one or more parts of a bone dies from a lack of blood flow), especially in the hip or knee.

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