Key Points for This Section

Teeth and jaw Childhood cancer survivors may have late effects that affect the teeth and jaw. Certain factors increase the risk that teeth and jaw late effects will occur. Teeth and jaw late effects may be caused by treatment for certain childhood cancers. Liver Childhood cancer survivors may have late effects that affect the liver. Certain factors increase the risk that liver late effects will occur. Liver late effects may be caused by treatment for certain childhood cancers. Digestive tract Childhood cancer survivors may have late effects that affect the digestive tract. Radiation therapy to the abdomen may damage blood vessels and increase the risk of digestive tract late effects. Digestive tract late effects may be caused by treatment for certain childhood cancers.

Teeth and jaw

Childhood cancer survivors may have late effects that affect the teeth and jaw.

Teeth and jaw late effects may include the following:

• Teeth are small or do not have a normal shape.
• The roots of the teeth are short.
• Missing teeth.
• New teeth come in at a later than normal age.
• The head and face do not reach full growth.
• Tooth enamel is not normal.
• Salivary glands do not make enough saliva.
• Tooth decay (including cavities) and gum disease.

Certain factors increase the risk that teeth and jaw late effects will occur.

The risk of teeth and jaw late effects may be increased in childhood cancer survivors who received any of the following:

• Radiation therapy to the head and neck.
• Chemotherapy to treat leukemia.
• High-dose chemotherapy with stem cell transplant and total-body irradiation (TBI) to treat neuroblastoma.

Risk may also be increased in survivors who were younger than 3 years at the time of treatment.

It is important that childhood cancer survivors have regular dental checkups to help prevent or detect infection or decay.

Teeth and jaw late effects may be caused by treatment for certain childhood cancers.

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

• Central nervous system (CNS) leukemia.
• Neuroblastoma.
• Hodgkin lymphoma.
• Head and neck cancers.
• Nasopharyngeal cancer.

Liver

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

Liver late effects may include the following:

• Hepatic fibrosis (an overgrowth of connective tissue in the liver).
• Liver failure.
• Portal hypertension.
• Hepatitis C infection.
• Permanent liver damage caused by veno-occlusive disease.

Hepatic fibrosis, hepatitis C infection, and veno-occlusive disease can cause long-term problems.

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

The risk of liver late effects may be increased in childhood cancer survivors who received any of the following:

• A blood transfusion before 1992.
• Radiation therapy together with chemotherapy.
• Chemotherapy with thioguanine to treat acute lymphoblastic leukemia (ALL).

Risk may also be increased in survivors who had liver disease before treatment or developed veno-occlusive disease during treatment.

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

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

• Acute lymphoblastic leukemia (ALL).
• Neuroblastoma.
• Wilms tumor.

Digestive tract

Childhood cancer survivors may have late effects that affect the digestive tract.

Digestive tract late effects may include the following:

• Ulcers.
• Bowel perforation (a hole in the intestine).
• Pain in the abdomen.
• Inability of the intestine to absorb nutrients from food.
• A narrowing of the intestine.
• Blocked bowel (chronic).
• Infection.
• Diarrhea (chronic).

These effects may be caused by damage to the blood vessels, which may lead to long-term problems.

Radiation therapy to the abdomen may damage blood vessels and increase the risk of digestive tract late effects.

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

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

• Paratesticular rhabdomyosarcoma.
• Wilms tumor.

Glossary Terms

The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

An aggressive (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 acute lymphocytic leukemia and ALL.

The administration of blood or blood products into a blood vessel.

A tube through which the blood circulates in the body. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins.

The long, tube-shaped organ in the abdomen that completes the process of digestion. The bowel has two parts, the small bowel and the large bowel. Also called intestine.

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also 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.

The brain and spinal cord. Also called CNS.

Treatment with drugs that kill cancer cells.

A disease or condition that persists or progresses over a long period of time.

Supporting tissue that surrounds other tissues and organs. Specialized connective tissue includes bone, cartilage, blood, and fat.

Frequent and watery bowel movements.

The organs through which food and liquids pass when they are swallowed, digested, and eliminated. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum and anus.

The growth of fibrous tissue.

Refers to the liver.

A condition in which some of the veins in the liver are blocked. It is sometimes a complication of high-dose chemotherapy given before a bone marrow transplant and is marked by increases in weight, liver size, and blood levels of bilirubin.

A virus that causes hepatitis (inflammation of the liver). It is carried and passed to others through blood or sexual contact. Also, infants born to infected mothers may become infected with the virus.

An intensive drug treatment to kill cancer cells, but that also destroys the bone marrow and can cause other severe side effects. High-dose chemotherapy is usually followed by bone marrow or stem cell transplantation to rebuild the bone marrow.

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.

A blood pressure of 140/90 or higher. Hypertension usually has no symptoms. It can harm the arteries and cause an increase in the risk of stroke, heart attack, kidney failure, and blindness. Also called high blood pressure.

Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.

The long, tube-shaped organ in the abdomen that completes the process of digestion. The intestine has two parts, the small intestine and the large intestine. Also called bowel.

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

Cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of blood cells to be produced and enter the bloodstream.

A large organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile.

The upper part of the throat behind the nose. An opening on each side of the nasopharynx leads into the ear.

Cancer that arises in immature nerve cells and affects mostly infants and children.

A chemical compound (such as protein, fat, carbohydrate, vitamin, or mineral) contained in foods. These compounds are used by the body to function and grow.

A blood vessel that carries blood to the liver from the stomach, small and large intestines, spleen, pancreas, and gallbladder. Also called hepatic portal vein.

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 irradiation and radiotherapy.

Cancer that forms in the soft tissues in a type of muscle called striated muscle. Rhabdomyosarcoma can occur anywhere in the body.

The watery fluid in the mouth made by the salivary glands. Saliva moistens food to help digestion and it helps protect the mouth against infections.

A gland in the mouth that produces saliva.

A method of replacing immature blood-forming cells that were destroyed by cancer treatment. The stem cells are given to the person after treatment to help the bone marrow recover and continue producing healthy blood cells.

An anticancer drug that belongs to the family of drugs called antimetabolites.

Radiation therapy to the entire body. It is usually followed by bone marrow or peripheral stem cell transplantation.

The formation of a break on the skin or on the surface of an organ. An ulcer forms when the surface cells die and are cast off. Ulcers may be associated with cancer and other diseases.

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.