Key Points for This Section

Bone Childhood cancer survivors may have late effects that affect the bones. Certain factors increase the risk that bone late effects will occur. Bone late effects may be caused by treatment for certain childhood cancers. Body weight Childhood cancer survivors may have late effects that affect body weight and cause obesity. Obesity may be caused by treatment for certain childhood cancers.

Bone

Childhood cancer survivors may have late effects that affect the bones.

Bone late effects may include the following:

• Bone pain.
• Joint stiffness.
• Weak or thin bones that can break easily.
• Decreased amounts of calcium in bones.
• Decreased bone and tissue growth in treated areas.

Certain factors increase the risk that bone late effects will occur.

The following may increase the risk of bone late effects:

• Being female.
• Being older at the time of treatment.
• Having low levels of estrogen or growth hormone.

Risk may also be increased in childhood cancer survivors who received either of the following:

• Radiation therapy, especially to the head and spine.
• Steroids, such as dexamethasone, with cancer treatment.

Bone late effects may be caused by treatment for certain childhood cancers.

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

• Acute lymphoblastic leukemia (ALL).
• Central nervous system (CNS) tumors.
• Bone cancer.
• Wilms tumor.

Body weight

Childhood cancer survivors may have late effects that affect body weight and cause obesity.

The following may increase the risk of obesity:

• Being female and having received treatment at age 4 years or younger, with high- dose radiation therapy to the head.
• Being young at the time of treatment (the younger the child, the greater the risk).
• Being slender at the time of diagnosis.
• Having an increase in body fat at an earlier than normal age.

Obesity may be caused by treatment for certain childhood cancers.

Treatment for these and other childhood cancers may cause obesity:

• Acute lymphoblastic leukemia (ALL).
• Brain tumors.
• Hodgkin lymphoma.
• Non-Hodgkin lymphoma.

Glossary Terms

ALL. A fast-growing type of leukemia (blood cancer) in which too many lymphoblasts (immature white blood cells) are found in the blood and bone marrow. Also called ALL and acute lymphocytic leukemia.

The growth of abnormal cells in the tissues of the brain. Brain tumors can be benign (non-cancerous) or malignant (cancerous).

A mineral found in teeth, bones, and other body tissues.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

Central nervous system tumor. A tumor of the central nervous system (CNS), including brain stem glioma, craniopharyngioma, medulloblastoma, and meningioma. Also called central nervous system tumor.

A synthetic steroid (similar to steroid hormones produced naturally in the adrenal gland). Dexamethasone is used to treat leukemia and lymphoma and may be used to treat some of the problems caused by other cancers and their treatment.

The process of identifying a disease by the signs and symptoms.

The amount of medicine taken, or radiation given, at one time.

A type of hormone made by the body that helps develop and maintain female sex characteristics and the growth of long bones. Estrogens can also be made in the laboratory. They may be used as a type of birth control and to treat symptoms of menopause, menstrual disorders, osteoporosis, and other conditions.

A cancer of the immune system that is marked by the presence of a type of cell called the Reed-Sternberg cell. The two major types of Hodgkin lymphoma are classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma. Symptoms include the painless enlargement of lymph nodes, spleen, or other immune tissue. Other symptoms include fever, weight loss, fatigue, or night sweats. Also called Hodgkin disease.

One of many chemicals made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs. Some hormones can also be made in the laboratory.

Side effects of cancer treatment that appear months or years after treatment has ended. Late effects include physical and mental problems and second cancers.

Any of a large group of cancers of the immune system. Non-Hodgkin lymphomas can occur at any age and are often marked by enlarged lymph nodes, fever, and weight loss. There are many different types of non-Hodgkin lymphoma, which can be divided into aggressive (fast-growing) and indolent (slow-growing) types and can be classified as either B-cell or T-cell non-Hodgkin lymphoma. B-cell non-Hodgkin lymphomas include Burkitt lymphoma, diffuse large B-cell lymphoma, follicular lymphoma, immunoblastic large cell lymphoma, precursor B-lymphoblastic lymphoma, and mantle cell lymphoma. T-cell non-Hodgkin lymphomas include mycosis fungoides, anaplastic large cell lymphoma, and precursor T-lymphoblastic lymphoma. Lymphomas related to lymphoproliferative disorders following bone marrow or stem cell transplantation are usually B-cell non-Hodgkin lymphomas. Prognosis and treatment depend on the stage and type of disease. Also called NHL.

Having an abnormally high, unhealthy amount of body fat.

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called radiotherapy and irradiation.

The bones, muscles, tendons, and other tissues that reach from the base of the skull to the tailbone. The spine encloses the spinal cord and the fluid surrounding the spinal cord. Also called backbone, spinal column, and vertebral column.

A type of drug used to relieve swelling and inflammation. Some steroid drugs may also have antitumor effects.

A group or layer of cells that work together to perform a specific function.

A disease in which malignant (cancer) cells are found in the kidney, and may spread to the lungs, liver, or nearby lymph nodes. Wilms tumor usually occurs in children younger than 5 years old.