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Late Effects of Treatment for Childhood Cancer (PDQ®): Treatment - Patient Information [NCI] - Central Nervous System

Brain and spinal cord late effects are more likely to occur after treatment for certain childhood cancers.

Treatment for these and other childhood cancers may cause brain and spinal cord late effects:

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Radiation to the brain increases the risk of brain and spinal cord late effects.

The risk of health problems that affect the brain or spinal cord increases after treatment with the following:

  • Radiation to the brain, especially high doses of radiation.
  • Intrathecal /intraventricular chemotherapy or high doses of chemotherapy that cross the blood-brain barrier (protective lining around the brain).
  • Chemotherapy with vinca alkaloids such as vincristine or vinblastine.
  • Stem cell transplant, including total-body irradiation (TBI) or intrathecal chemotherapy.
  • Surgery to remove a tumor on the brain or spinal cord.

When radiation to the brain and intrathecal chemotherapy are given at the same time, the risk of late effects is higher.

The following may also increase the risk of brain and spinal cord late effects:

  • Being female and having radiation therapy.
  • Being young at the time of treatment.
  • Having hydrocephalus and a shunt placed to removed the extra fluid from the ventricles.
  • Having seizures caused by the tumor.
  • Having hearing loss.

Late effects that affect the brain and spinal cord may cause certain health problems.

Childhood cancer survivors who received radiation, intrathecal chemotherapy, or surgery to the brain or spinal cord are at risk of late effects to the brain and spinal cord. These include the following:

  • Headaches.
  • Loss of coordination and balance.
  • Seizures.
  • Loss of the myelin sheath that covers nerve fibers in the brain.
  • Movement disorders that affect the legs and eyes or the ability to speak and swallow.
  • Nerve damage in the hands or feet.
  • Stroke.
  • Hydrocephalus.
  • Loss of bladder and/or bowel control.

Survivors may also have late effects that affect thinking, learning, and behavior. Newer ways of targeting therapy and using lower doses of radiation have fewer effects on thinking and functioning.

Possible signs of brain and spinal cord late effects include headaches, loss of coordination, and seizures.

These symptoms may be caused by brain and spinal cord late effects:

  • Headache that may go away after vomiting.
  • Seizures.
  • Loss of balance, lack of coordination, or trouble walking.
  • Trouble speaking, swallowing or coordinating eye movements.
  • Numbness, tingling, weakness in the hands or feet; being unable to bend your ankle to lift your foot up.
  • Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body).
  • Unusual sleepiness or change in activity level.
  • Unusual changes in personality or behavior.
  • A change in bowel habits or trouble urinating.
  • Increase in head size (in infants).
  • Sudden confusion, trouble speaking or understanding speech.
  • Sudden trouble seeing with one or both eyes.
  • Sudden severe headache with no known cause.
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